Postmenopausal hormone therapy use declines amidst risk-benefit concerns
Study reveals sharp decline in menopausal hormone therapy use among U.S. women, with significant disparities across racial and ethnic groups over the past two decades.
Study: Menopausal Hormone Therapy Use Among Postmenopausal Women. Image Credit: adriaticfoto/Shutterstock.com
In a recent study published in JAMA Health Forum, researchers investigated the use of menopausal hormone therapy (MHT) by postmenopausal American women in recent decades.
Their findings highlight the decline in MHT use in the United States during the past 20 years across ethnic, racial, and age groups.
Background
Studies suggest that each year, about 1.3 million women experience menopause, with an estimated 80% of these people being affected by cognitive changes, sleep difficulties, genitourinary issues, and vasomotor changes such as night sweats and hot flashes. For 30%, the symptoms are severe, with vasomotor issues being particularly disruptive.
Research has shown that MHT is an effective treatment for menopausal symptoms, particularly for genitourinary and vasomotor issues.
However, while MHT prescriptions increased in the 1990s after studies showed benefits for heart health, there are indications that its use has declined since 2002, when a well-known clinical trial found that it did not improve heart health and that the risks of the therapy could outweigh the benefits.
Further studies showed that the effects of MHT are linked to the type of hormone used as well as dosage, timing, and age.
Clinical recommendations from medical associations now say that MHT should not be used to prevent chronic conditions after menopause and that the treatment, if prescribed, should be tailored to individual needs.
However, further research is needed to identify the harms and benefits of different formulations of MHT. Additionally, understanding trends, prevalence, and factors influencing MHT use can guide national policies and discussions.
About the study
Researchers used data collected by the National Health and Nutrition Examination Survey, which provides estimates of nutrition, health, and risk factors for American civilians, collecting data every two years. Using surveys conducted between 1999 and 2020, the research team focused on menopausal status, prescription medications, and demographic characteristics.
They identified menopausal women based on questions about ovary removal, hysterectomy, and menstrual history, including women who had reported menopause or the removal of both ovaries.
Researchers used prescription medications reported by the participants to understand MHT use, and 86% of prescription containers were verified.
Female sex hormone medications were classified into different categories, including contraceptives and MHT, and further categorized based on the type of hormone, i.e., combined estrogen and testosterone, estrogen only, etc.
The statistical models accounted for sociodemographic factors like race, ethnicity, insurance, family income, education level, marital status, and age.
Health factors, such as smoking status and body mass index (BMI), were also included. Researchers utilized sample weights to ensure that their results would represent women across the country.
Findings
The study included 13,048 women from 10 survey cycles between 1999 and 2020.
In the most recent survey, nearly 72% of the participants were non-Hispanic white, and 74% had a family income-to-poverty ratio of 1.3.
Nearly 60% had more than a high school education, and 61% had private insurance. About 27% and 41% were classified as having overweight and obesity, respectively, and 60% had never smoked.
Researchers found a statistically significant decline in the use of MHT, with nearly 27% of respondents reporting using it in 1999-2000 but less than 5% doing so in 2017-2020. The greatest decrease in use (more than 31%) was seen among women between the ages of 52 and 65, who, until 2005, reported the highest rates of use.
These declines were also seen across all racial and ethnic groups. For non-Hispanic White women, MHT use decreased sharply from 31% to 6%, among Hispanic women from 14% to 3%, and among non-Hispanic Black participants from 12% to less than 1%. Across all survey cycles, non-Hispanic White participants reported the highest use of MHT.
Between 2017 and 2020, estrogen-based MHT accounted for nearly 53% of treatment use, while combined estrogen and progestogen for 36%, progestogen-only for about 11%, and estrogen and testosterone for less than 1%.
Age and higher BMI showed a negative association with MHT use, while positive relationships were seen with higher family income-to-poverty ratios and coverage under health insurance. Overall, Hispanic and non-Hispanic Black women were less likely to use MHT, but educational attainment was linked to MHT use for these two groups.
Non-Hispanic White women who smoked were less likely to use MHT but Hispanic women who smoked were more likely to do so.
Conclusions
These findings highlight the significant decline in MHT use in the United States, adding to studies that show similar results in the United Kingdom, Korea, Germany, and Australia.
They also indicate that non-Hispanic Black women, who often experience more severe menopausal symptoms that appear earlier and last longer, may be less likely to receive treatment.
Further research is needed to identify safe, effective MHTs to ease symptoms of menopause during transition for women across levels of income and education, race, and age.
