Study reveals sharp decline in menopausal hormone therapy use among US women, with significant differences between racial and ethnic groups over the past two decades.
Study: Hormone therapy use in menopause among postmenopausal women. Image credit: adriaticfoto/Shutterstock.com
In a recent study published in JAMA Health Forumresearchers investigated the use of menopausal hormone therapy (MHT) by postmenopausal American women over the past few decades.
Their findings highlight a decline in MHT use in the United States over the past 20 years across ethnic, racial, and age groups.
Background
Studies show that each year, approximately 1.3 million women experience menopause, with 80% of these people affected by cognitive changes, sleep difficulties, genitourinary problems and vasomotor changes such as night sweats and hot flashes. For 30%, the symptoms are severe, with vasomotor problems being particularly bothersome.
Research has shown that MHT is an effective treatment for menopausal symptoms, particularly urogenital and vasomotor problems.
However, while MHT prescriptions increased in the 1990s after studies showed benefits for heart health, there is evidence 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 treatment could outweigh the benefits.
Further studies have shown that the effects of MHT are related to the type of hormone used as well as dosage, time and age.
Clinical recommendations from medical associations now say that MHT should not be used to prevent chronic conditions after menopause and that treatment, if prescribed, should be tailored to individual needs.
However, further research is needed to identify the harms and benefits of different MHT formulations. Furthermore, understanding trends, prevalence, and factors influencing MHT use can inform national policies and debates.
About the study
The researchers used data collected from the National Health and Nutrition Examination Survey, which provides estimates of diet, health and risk factors for US citizens, collecting data every two years. Using surveys conducted between 1999 and 2020, the research team focused on menopausal status, prescription drugs, and demographic characteristics.
They identified postmenopausal women based on questions about oophorectomy, hysterectomy, and menstrual history, including women who had reported menopause or having both ovaries removed.
Researchers used participant-reported prescriptions to understand MHT use, and 86% of prescriptions were verified.
Female sex hormone drugs were classified into different categories, including contraceptives and MHT, and further categorized based on the type of hormone, e.g. combined estrogen and testosterone, only estrogen, etc.
Statistical models accounted for sociodemographic factors such as 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. The researchers used sample weights to ensure their results were representative of 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 participants were non-Hispanic white and 74% had a family income-to-poverty ratio of 1.3.
Almost 60% had more than a high school education and 61% had private insurance. About 27% and 41% were classified as overweight and obese, respectively, and 60% had never smoked.
The researchers found a statistically significant decrease in MHT use, with nearly 27% of respondents reporting using it in 1999-2000, but less than 5% doing so in 2017-2020. The largest decline in use (over 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 observed across racial and ethnic groups. For non-Hispanic white women, MHT use dropped sharply from 31% to 6%, among Hispanics from 14% to 3%, and among non-Hispanic black participants from 12% to less than 1%. Across survey cycles, non-Hispanic White participants reported the highest MHT use.
Between 2017 and 2020, estrogen-based MHT accounted for nearly 53% of treatment use, with combined estrogen and progestogen for 36%, progestogen alone 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 observed with higher family income-to-poverty ratios and health insurance coverage. Overall, Hispanic and non-Hispanic black women were less likely to use MHT, but educational attainment was associated with 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 showing similar results in the United Kingdom, Korea, Germany, and Australia.
They also suggest that non-Hispanic black women, who often experience more severe menopausal symptoms that start earlier and last longer, may be less likely to receive treatment.
Further research is needed to identify safe, effective MHTs for the relief of menopausal symptoms during transition for women across income and education levels, race, and age.
