Hormone therapy use among menopausal women continues to decline, despite proven safety
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Key takeaways:
- Hormone therapy use among menopausal women declined from 4.6% in 2007 to 1.8% in 2023.
- Misinformation about hormone therapy and confusing drug labeling may deter some women from initiating therapy.
CHICAGO — Hormone therapy use among menopausal women has fallen to just 1.8% as of 2023, data show, despite evidence and clinical guidance suggesting HT is safe and effective for most women for bothersome menopausal symptoms.
In a large analysis of claims data presented at the Annual Meeting of The Menopause Society, researchers also observed that declines in HT use were greatest for women in age groups with a generally high prevalence of bothersome menopause symptoms.
“HT use declined a little bit from 2011 or 2012, but more importantly, it has not gone up,” Stephanie S. Faubion, MD, MBA, NCMP, IF, director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society, told Healio. “I expected [use of HT] to increase. There is increased interest in women’s health and in menopause in general; so many discussions around menopause; and there is a new drug out there for nonhormonal management. With all of that attention, what we were entirely expecting was that HT use would increase.”
Use over time
The researchers analyzed medical and pharmacy claims data from OptumLabs for more than 200 million commercially insured and Medicare Advantage enrollees aged 40 years or older from 2007 through 2023. The study population of women grew from 2 million in 2007 to 4.5 million in 2023.
Researchers defined the annual rate of HT utilization as the proportion of women in a year who had at least 180 days of a filled prescription for systemic estrogen-containing menopausal HT. They evaluated the prevalence of HT use across age groups (ages 40-44 years; 45-49 years; 50-54 years; 55-59 years; 60-64 years; 65-69 years; and 70 years and older). Systemic HT was further categorized into oral vs. transdermal estrogen.
Among women aged 40 years and older, 4.6% filled prescriptions for HT in 2007, with that number falling to 2.5% between 2007 and 2014. HT use then continued to decline to 1.8% in 2023.
HT use also declined overall among women who were within 10 years of the mean age of menopause. The greatest decline in HT use was among women aged 50 to 59 years, falling from 7.3% in 2007 to 3.8% in 2023.
Oral HT was the most common route of administration.
Combatting misinformation
Faubion said several factors directly influenced the observed decline in uptake of HT among menopausal women. Among them, findings from the landmark Women’s Health Initiative study, which suggested HT may increase cardiovascular disease and cancer risk, though later analyses demonstrated the risk depended on factors including age and time since menopause onset.
“We just can’t shake the Women’s Health Initiative,” Faubion told Healio. “We cannot seem to get it out of our heads that HT is somehow dangerous and should be avoided altogether. The Women’s Health Initiative basically stopped all menopause education. There was not anything to do for menopause, so why teach it? As a result, you have generations of providers not educated in menopause. This is still going on.”
Women also face barriers due to general misinformation about HT, Faubion said.
“Women are hearing all kinds of information and a lot of it is incorrect,” Faubion told Healio. “Some information suggests you need hormones to prevent aging and cancer, which is not true. Or hormones are dangerous, they are going to kill you and give you cancer — also not true. The truth is somewhere in the middle and social media has amplified all of it.”
Black box warnings from the FDA for HT can also be confusing and may scare women from initiating therapy, Faubion said.
“The labeling for HT says, ‘black box warning,’ this causes cancer and dementia, regardless of the type or dose of estrogen, even if it is low-dose, vaginal estrogen,” Faubion said. “The label says use the lowest dose for shortest amount of time, which is not grounded in any guideline or based on any study. That also makes it sound scary.”
Faubion called for more education and a push among menopause experts to dispel HT myths.
“What does it take to get us out of this?” Faubion told Healio. “It is going to take women getting angry.”
For more information:
Stephanie S. Faubion, MD, MBA, NCMP, IF, can be reached at faubion.stephanie@mayo.edu; X (Twitter): @StephFaubionMD.