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Menopausal hormone therapy trends before versus after 2002

impact of the Women's Health Initiative Study Results

Crawford, Sybil L. PhD1; Crandall, Carolyn J. MD, MS2; Derby, Carol A. PhD3; Khoudary, Samar R. El PhD4; Waetjen, L. Elaine MD5; Fischer, Mary PhD1; Joffe, Hadine MD, MSc6,7

doi: 10.1097/GME.0000000000001282
Original Articles

Objective: To better understand how to educate patients and providers about study findings relevant to treatment guidelines, we assessed pre- versus post-Women's Health Initiative (WHI) differences in menopausal hormone therapy (MHT) initiation and continuation and their correlates, and in women's reasons for initiation and discontinuation.

Methods: We analyzed survey data from up to 14 approximately annual visits over 17 years (1996-2013) from 3,018 participants in the Study of Women's Health Across the Nation, a prospective cohort study. We used logistic regression to compare pre- versus post-WHI associations of covariates with MHT initiation and continuation, and to compare pre- versus post-WHI reasons for initiation and continuation.

Results: MHT initiation dropped from 8.6% pre-WHI to 2.8% post-WHI (P < 0.0001), and the corresponding decrease in MHT continuation was 84.0% to 62.0% (P < 0.0001). Decreases in MHT initiation and continuation occurred across a range of participant subgroups, consistent with wide dissemination of post-WHI recommendations. However, contrary to current guidelines, we found large declines in MHT use in subgroups for whom MHT is often recommended, that is, younger women and those with more vasomotor symptoms. Post-WHI, women's reasons for MHT initiation and discontinuation reflected concerns highlighted by WHI results. The largest declines in initiation reasons were for reducing risks of osteoporosis and heart disease, whereas the largest increases in discontinuation reasons were for media reports and provider advice.

Conclusions: Immediate post-WHI recommendations for MHT use were widely adopted. MHT risks documented in older women, however, may have led younger symptomatic women to forgo MHT for symptom relief.

1University of Massachusetts Medical School, Graduate School of Nursing, Worcester, MA

2Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA

3Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY

4University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

5University of California Davis School of Medicine, Sacramento, CA

6Connors Center for Women's Health and Gender Biology, Boston, MA

7Department of Psychiatry, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.

Address correspondence to: Sybil L. Crawford, PhD, University of Massachusetts Medical School, Graduate School of Nursing, 55 Lake Ave North, S1-853, Worcester, MA 01655. E-mail:

Received 19 July, 2018

Revised 30 October, 2018

Accepted 30 October, 2018

Funding/support: Funding for this work was received from the National Institutes of Health. The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.

Financial disclosure/conflicts of interest: H.J. receives research funding from Merck and Pfizer, and is a consultant/advisor to Merck, KaNDY, and Sojournix. The remaining authors report no conflicts of interest.

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Online date: December 21, 2018

© 2019 by The North American Menopause Society.