Patterns of medication use for the treatment of menopausal symptoms before and after the women’s health initiative; implications for decision-making practices of women and women’s health professionals

Chioma Uzoigwe Smith, Srini Rajagopalan, Shiva Sajjan, Shuvayu Sankar Sen, Wenchen Kenneth Wu, Henry Hu

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DOI: 10.4236/health.2011.37069                

Abstract

Background: The Women’s Health Initiative (WHI) published findings in 2002 that changed the perception of the use of hormone replacement therapy (HRT) for the reduction of cardiovascular risks. Menopausal women using HRT for the relief of vasomotor symptoms were advised to use the lowest possible dose of HRT over the shortest possible duration. Objective: This study sought to examine patterns of HRT use for the treatment of menopausal symptoms before and after the WHI among women at least 40 years of age. Methods: A retrospective analysis was performed on a total of 1367 women in the pre-WHI group and 6467 women in the post-WHI group using the U.S. General Electric (GE) Centricity electronic medical record database. Menopause diagnosis was assessed using ICD-9 codes. Clinical characteristics and medication use were assessed for women with at least 3 years of enrollment (1 year baseline, 2 years follow-up). Results: The proportion of women in the post-WHI group that initiated HRT was significantly less than that of women in the pre-WHI group (31.3% vs. 56.9%, respectively; p < 0.001). Combination HRT use declined significantly (21.9% pre-WHI cohort vs. 7.2% post- WHI cohort, p < 0.001) among increases in non-HRT use, namely SSRIs (15.2% pre-WHI cohort v. 22.3% post-WHI cohort, p < 0.001) and tranquilizers (9.5% pre-WHI cohort v. 15.8% post-WHI cohort, p < 0.001). Conclusion: The results of the WHI 2002 publication made an impression on the perception of HRT’s role in the relief of menopausal symptoms. Decision-making on the part of women seeking treatment for vasomotor symptoms and women’s health professionals demonstrates that despite HRT precautions, women continue to exhibit a need for HRT use. This study’s findings suggest that women seeking treatment for menopausal symptom relief and women’s health professionals continue to work together to find the appropriate balance between therapy use and adherence to therapy use guidelines.

Keywords

Women’s Health Initiative (WHI); Hormone Replacement Therapy (HRT); Women’s Health; Menopause

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mayo Clinic (2010) Menopause symptoms. http://www.mayoclinic.com/health/menopause/DS00119/DSECTION=symptoms
[2]	Nihira, M.A. (2010) Menopause guide. http://www.webmd.com/menopause/guide/understanding-menopause-basics
[3]	Birkhauser, M.H. (2009) Quality of life and sexuality issues in aging women. Climacteric, 12, 52-57. doi:10.1080/13697130903013163
[4]	Van Dole, K.B., Williams, R.E., Brown, R.S., Gaynes, B., Devellis, R. and Funk, M.J. (2010) Longitudinal association of vasomotor symptoms and psychosocial outcomes among postmenopausal women in the United States: A population-based study. Menopause, 17, 917-923. doi:10.1097/gme.0b013e3181d824c8
[5]	Welton, A.J., et al. (2008) Health related quality of life after combined hormone replacement therapy: Randomised controlled trial. British Medical Journal, 337, a1190. doi:10.1136/bmj.a1190
[6]	Guay, M.P., et al. (2007) Changes in pattern of use, clinical characteristics and persistence rate of hormone replacement therapy among postmenopausal women after the WHI publication. Pharmacoepidemiology and Drug Safety, 16, 17-27. doi:10.1002/pds.1273
[7]	Rossouw, J.E., et al. (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women’s health initiative randomized controlled trial. Journal of the American Medical Association, 288, 321-333.
[8]	Usher, C., et al. (2006) Effect of clinical trial publicity on HRT prescribing in Ireland. European Journal of Clinical Pharmacology, 62, 307-310. doi:10.1007/s00228-005-0083-x
[9]	Hing, E. and Brett, K.M. (2006) Changes in U.S. prescribing patterns of menopausal hormone therapy, 2001-2003. Obstetrics & Gynecology, 108, 33-40. doi:10.1097/01.AOG.0000220502.77153.5a
[10]	Wei, F., et al. (2005) Changes in women’s use of hormones after the women’s health initiative estrogen and progestin trial by race, education, and income. Journal of the National Cancer Institute Monographs, 35, 106-112. doi:10.1093/jncimonographs/lgi047
[11]	Faber, A., et al. (2005) Dramatic change in prescribing of hormone replacement therapy in The Netherlands after publication of the million women study: A follow-up study. British Journal of Clinical Pharmacology, 60, 641-647. doi:10.1111/j.1365-2125.2005.02502.x
[12]	Main, P. and Robinson, M. (2008) Changes in utilisation of hormone replacement therapy in Australia following publication of the findings of the women’s health initiative. Pharmacoepidemiology and Drug Safety, 17, 861- 868. doi:10.1002/pds.1605
[13]	Menon, U., et al. (2007) Decline in use of hormone therapy among postmenopausal women in the United Kingdom. Menopause, 14, 462-467. doi:10.1097/01.gme.0000243569.70946.9d
[14]	Newton, K.M., et al. (2005) The impact of comorbidities on hormone use. After the 2000 release of the Women’s Health Initiative. Journal of General Internal Medicine, 20, 350-356. doi:10.1111/j.1525-1497.2005.04059.x
[15]	Bestul, M.B., et al. (2004) Impact of the women’s health initiative trial results on hormone replacement therapy. Pharmacotherapy, 24, 495-499. doi:10.1592/phco.24.5.495.33349
[16]	Gerend, M.A., et al. (2006) Women’s use of hormone therapy before and after the women’s health initiative: A psychosocial model of stability and change. Preventive Medicine, 43, 158-164. doi:10.1016/j.ypmed.2006.04.008
[17]	Rossouw, J.E., et al. (2007). Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. Journal of the American Medical Association, 297, 1465-1477. doi:10.1001/jama.297.13.1465
[18]	Stevenson, J.C. (2009) Hormone replacement therapy and cardioscular disease revisited. Menopause International, 15, 55-57. doi:10.1258/mi.2009.009018
[19]	Anderson, G.L., et al. (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The women’s health initiative randomized controlled trial. Journal of the American Medical Association, 291, 1701-1712. doi:10.1001/jama.291.14.1701
[20]	Manson, J.E., et al. (2003) Estrogen plus progestin and the risk of coronary heart disease. The New England Journal of Medicine, 349, 523-534. doi:10.1056/NEJMoa030808
[21]	Du, Y., et al. (2007) Differences in menopausal hormone therapy use among women in Germany between 1998 and 2003. BMC Womens Health, 7, 19. doi:10.1186/1472-6874-7-19
[22]	Manson, J.E., et al. (2007) Estrogen therapy and coronary-artery calcification. The New England Journal of Medicine, 356, 2591-2602. doi:10.1056/NEJMoa071513
[23]	Hsia, J., et al. (2006) Conjugated equine estrogens and coronary heart disease: The women’s health initiative. Archives of Internal Medicine, 166, 357-365. doi:10.1001/archinte.166.3.357
[24]	Parazzini, F. (2008) Trends of determinants of hormone therapy use in Italian women attending menopause clinics, 1997-2003. Menopause, 15, 164-170.
[25]	Wegienka, G., et al. (2006) Menopausal hormone therapy in a health maintenance organization before and after women’s health initiative hormone trials termination. Journal of Women’s Health, 15, 369-378. doi:10.1089/jwh.2006.15.369
[26]	Barton, D.L., et al. (2003) Pilot evaluation of citalopram for the relief of hot flashes. The Journal of Supportive Oncology, 1, 47-51.
[27]	Mills, D. (2010) Antidepressants for menopause symptoms: Pros and cons. http://www.womentowomen.com/menopause/antidepressantsinmenopause.aspx#offlabel