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A decade of postmenopausal hormone therapy prescribing in the United States: long-term effects of the Women’s Health Initiative

Steinkellner, Amy R. PharmD1; Denison, Shannon E. MA2; Eldridge, Sandra L. PharmD1; Lenzi, Lisa L. PharmD1; Chen, William PhD, MPH1; Bowlin, Steven J. DO, PhD1

doi: 10.1097/gme.0b013e31824bb039
Original Articles

Objective Nearly a decade ago, landmark clinical trials revealed an increase in the risks associated with hormone therapy in postmenopausal women, leading to early changes in prescribing patterns. Long-term prescribing patterns in the United States after these trials are unknown. The objective of this study was to describe changes in hormone therapy prescribing including dose, formulation, patient age, and prescriber specialty from 2000 to 2009.

Methods A national pharmacy claims database was used to describe the annual prevalence and incidence rates of hormone therapy prescribing from 2000 to 2009 in women 50 years and older.

Results Throughout the decade, a number of prescribing trends were observed: a continuous decline in hormone therapy overall, an initial drop in new therapy that stabilized after 2003, a decline in oral formulations and increase in vaginal formulations, a decline in standard- and high-dose and an increase in low-dose oral formulations, and an increase in the proportion of women who received hormone therapy from gynecologists.

Conclusions Overall prescribing of hormone therapy continued to decline during the past decade, suggesting a long-term impact of the Women’s Health Initiative findings. During this same time, treatment regimens shifted to favor vaginal and lower-dose oral formulations.

Supplemental digital content is available in the text.This large population-based study describes changes in menopause hormone therapy prescribing in the United States, including dose, formulation, patient age, and prescriber specialty, over a 10-year period.

From 1Medco Health Services Inc., Tampa, FL; 2HDConcepts, LLC, Gilbert, AZ.

Received November 12, 2011; revised and accepted January 17, 2012.

Funding/support: This study was solely funded by Medco Health Solutions Inc.

Financial disclosure/conflicts of interest: Dr. Steinkellner, Ms. Dennison, Dr. Eldridge, Dr. Lenzi, Dr. Chen, and Dr. Bowlin own Medco stock and stock options.

Medco Health Services Inc. is a wholly owned subsidiary of Medco Health Solutions Inc.

This article is based on our original work and has not been previously submitted or presented elsewhere. The study was solely funded by Medco Health Solutions Inc. All authors contributed to the research design and writing of the manuscript and have seen and approved the submission of this manuscript. Each author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Address correspondence to: Amy R. Steinkellner, PharmD, Medco Health Services Inc., 8800 Hidden River Parkway, Tampa, FL 33637. E-mail:

©2012The North American Menopause Society