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A Sustained Decline in Postmenopausal Hormone Use: Results From the National Health and Nutrition Examination Survey, 1999–2010

Sprague, Brian L. PhD; Trentham-Dietz, Amy PhD; Cronin, Kathleen A. PhD

doi: 10.1097/AOG.0b013e318265df42
Original Research

OBJECTIVE: Short-term declines in postmenopausal hormone use were observed after the Women's Health Initiative trial results in 2002. Although concerns about the trial's generalizability have been expressed, long-term trends in hormone use in a nationally representative sample have not been reported. We sought to evaluate national trends in the prevalence of hormone use and to assess variation by type of formulation and patient characteristics.

METHODS: We examined postmenopausal hormone use during 1999–2010 using cross-sectional data from 10,107 women aged 40 years and older in the National Health and Nutrition Examination Survey.

RESULTS: In 1999–2000, the prevalence of oral postmenopausal hormone use was 22.4% (95% confidence interval [CI] 19.0–25.8) overall, 13.3% (95% CI 11.0–15.5) for estrogen only, and 8.3% (95% CI 6.2–10.4) for estrogen plus progestin. A sharp decline in use of all formulations occurred in 2003–2004, when the overall prevalence decreased to 11.9% (95% CI 9.6–14.2). This decline was initially limited to non-Hispanic whites; use among non-Hispanic blacks and Hispanics did not decline substantially until 2005–2006. Hormone use continued to decline through 2009–2010 across all patient demographic groups, with the current prevalence now at 4.7% (95% CI 3.3–6.1) overall, 2.7% (95% CI 1.9–3.4) for estrogen only, and 1.7% (95% CI 0.7–2.7) for estrogen plus progestin. Patient characteristics currently associated with hormone use include history of hysterectomy, non-Hispanic white race or ethnicity, and income.

CONCLUSION: Postmenopausal hormone use in the United States has declined in a sustained fashion to low levels across a wide variety of patient subgroups.


The prevalence of current oral postmenopausal hormone use among women older than age 40 years in the United States has declined to less than 5%.

From the Department of Surgery and the Office of Health Promotion Research, University of Vermont, Burlington, Vermont; the Department of Population Health Sciences, University of Wisconsin, and the University of Wisconsin Carbone Cancer Center, Madison, Wisconsin; and the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.

Supported by the National Cancer Institute (U01 CA152958).

Corresponding author: Brian L. Sprague, PhD, 1 South Prospect Street, UHC Rm 4425, Burlington, VT 05401; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.