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Continuation of postmenopausal hormone replacement therapy

comparison of cyclic versus continuous combined schedules

Ettinger, Bruce1; Li, De-Kun1; Klein, Raymond2

doi: 10.1097/GME.0000000000001215
Commemorative Papers

Discontinuation of hormone replacement therapy (HRT) is much more common than what is reported in randomized, double-blind clinical trials. Our purpose in this retrospective study, using a prescription database, was to compare the continuation rate among women who took cyclic combination therapy adding progesterone to estrogen (CYC-PERT) or continuous combined estrogen progestin therapy (CC-PERT). The study subjects were 1,532 women, ≥45 years old, who initially filled index prescriptions for 0.625 mg conjugated estrogens. They were divided into two groups (CYC-PERT = 644, CC-PERT = 888) on the basis of coprescribed medroxyprogesterone. We found that for all women initiating therapy, 35-40% did not return for a refill and 76-81% stopped therapy within 3 years. Those prescribed CC-PERT initially were more likely to stop than those prescribed CYC-PERT (rate ratio [RR] = 1.20; 95% confidence interval [CI] = 1.06-1.35). Adjustments for age, year of starting medication, cost of medication, and prescriber specialty did not affect the difference in discontinuation between the two regimens (RR 1.18, 95% CI = 1.04-1.34). We conclude that the likelihood of women continuing HRT beyond 3 years of initiation is low. Furthermore, compared with CYC-PERT users, those receiving CC-PERT have a slightly higher probability of discontinuation. Efforts should be made to understand why three quarters of women beginning HRT will stop it long before it can provide major long-term benefit.

1Division of Research, Kaiser Permanente Medical Care Program, Oakland, California

2Wyeth Ayerst Laboratories, Philadelphia, Pennsylvania, U.S.A.

Address correspondence to: Dr. Bruce Ettinger, Division of Research, Kaiser Permanente Medical Care Program. 3505 Broadway, Oakland, CA 94611-5714, U.S.A.

Received 22 April, 1996

Accepted 28 May, 1996

Menopause 1996;4:185-189. Reprinted with permission.

© 2018 by The North American Menopause Society.