Prescribing of menopausal hormone therapy in Germany: Current status and changes between 2004 and 2016

Abstract

Background Prescribing of menopausal hormone therapy (MHT) declined drastically after publication of the Women's Health Initiative's (WHI) findings in 2002, but studies on longer‐term trends and details of use are scarce. Methods We used the German Pharmacoepidemiological Research Database (GePaRD) containing health insurance claims data from ~25 million persons. Using data from 2004–2016, we conducted cross‐sectional analyses to determine the prevalence of MHT use overall and by type and route of administration in women aged 45–75. In longitudinal analyses, we assessed MHT use over 5 years and compared the patterns between different time periods. Results From 2004 to 2016, prevalence of systemic MHT prescriptions decreased by >60% in women aged 55–65 and by >50% in women aged 50 and 70 years old. Prevalence declined for most types and routes of administration at all ages (−16% to −79%) with some exceptions, for example, local MHT (vaginal estrogen). Among 50‐year‐old women in 2012, 6% were already prescribed systemic MHT at age 49 and of the remaining women, 16% were newly prescribed systemic MHT before age 55. At all ages, the cumulative dose of systemic MHT prescribed over 5 years was lower in the period 2012–2016 compared to 2005–2009 (−6% to −46%). Conclusions For most types of MHT and all age groups, prevalence declined considerably between 2004 and 2016 in Germany. The cumulative dose per MHT user also decreased, suggesting a trend towards a shorter duration of use.

Postmenopausal hormone therapy and mortality before and after the Women’s Health Initiative study

“…The findings suggest an alteration in the HT user profile after 2002 with a different pattern of HT use, perhaps due to the healthiest users deciding to either drop systemic HT or switching to local HT, as recommendations changed following the WHI publication. It highlights the importance of adequate In line with previous studies, we observed a decline in systemic HT prevalence between 2000 and 2005 for systematic HT users within the menopausal or postmenopausal age [9][10][11][12] . The WHI publication in 2002, and subsequent media attention and alteration in HT prescription guidelines, is generally considered the main reason for the observed decline, as systemic HT was recommended kept in the lowest possible dosage for the shortest amount of time and was not to be used by asymptomatic women 15,23,24 .…”

“…The association between systemic HT and all-cause mortality neither decreased nor increased the risk of all-cause mortality in initial WHI reports at both 13-years' and 18-years' follow-up [6][7][8] . The WHI publication altered the perception of systemic HT causing a drastic decrease in the prevalence of systemic HT worldwide after 2002 [9][10][11][12] .Healthy user bias has previously been hypothesised to be one of the explanations for the discrepancy in findings between observational studies and clinical trials on various outcomes, as HT users provided a better health profile at baseline 13,14 . Analysing associations before and after 2002 is especially relevant since alterations…”

“…The association between systemic HT and all-cause mortality neither decreased nor increased the risk of all-cause mortality in initial WHI reports at both 13-years' and 18-years' follow-up [6][7][8] . The WHI publication altered the perception of systemic HT causing a drastic decrease in the prevalence of systemic HT worldwide after 2002 [9][10][11][12] .…”

Hormone replacement therapy prescribing in menopausal women in the UK: a descriptive study

“… 5 , 13 Similar trends have been observed internationally. 14 – 16 The present study found a rapid increase in incident prescribing of HRT from 2015 onwards, except for the year 2020. A decrease in prescribing in 2020 may be a result of the decline in healthcare utilisation owing to restrictions imposed during the COVID-19 pandemic.…”

The osteoporosis treatment gap in Switzerland between 1998 and 2018

“…Finally, we did not retain hormone replacement therapy (HRT) in our selection of bone active substances, albeit it was shown to significantly reduce hip fracture risk by approximately one-third in the Women’s Health Initiative (WHI) trials [ 34 , 35 ]. The WHI trials also showed a significant increase in breast cancers, cardiovascular diseases, and all-cause mortality which led to drastic reductions in systemic HRT use since 2002, now being mainly reserved to younger postmenopausal women with vasomotor symptoms [ 36 , 37 ]. As the effect of HRT on hip fracture risk was shown having vanished three years after discontinuation [ 38 ], we consider that omitting HRT from our analyses should not be expected to alter the present observations and conclusions.…”