Replacing hormone therapy--is the decline in prescribing sustained, and are nonhormonal drugs substituted?

After two cautioning landmark studies in 2002 and 2003, a dramatic decrease in hormonal therapy (HT) prescribing for menopausal symptoms was seen. Our objectives were to (1) determine whether this decline in HT prescribing sustained until 2007 and (2) investigate nonhormonal drug prescribing for women who stopped HT.

We analyzed drug dispensing data from community pharmacies in The Netherlands. For the first objective, we analyzed exposure prevalence of HT. For our second objective, we selected all women who were dispensed HT prescriptions between August 2002 and August 2003. From this study cohort, we defined our index group as all women who stopped HT shortly after the studies (n = 1,254) and a reference group as all women who continued HT (n = 839). We calculated the incidence of nonhormonal therapies for both groups, reporting risk ratio (RR) and 95% CI. Kaplan-Meier curves were also constructed.

Mean exposure prevalence of HT (per 1,000 women) pre 2002 versus post 2004 was 30.6 versus 15.3 (50.0% decline) for 40 to 49 years, 79.2 versus 25.5 (67.7% decline) for 50 to 59 years, and 28.4 versus 11.6 (59.1% decline) for 60 to 69 years. HT exposure remained low until 2007. HT stoppers receive more clonidine, RR 3.48 (2.36-5.13); anxiolytics or sedatives, RR 1.46 (1.15-1.87); and osteoporosis prophylaxis and treatment, RR 2.04 (1.14-3.66). Young stoppers (40-49 y) received more antidepressants, RR 2.70 (1.41-5.11), whereas older stoppers (60-69 y) received less antidepressants, RR 0.43 (0.18-1.05). Kaplan-Meier curves showed that nonhormonal drug prescribing occurred soon after HT was stopped.

This study shows the dramatic and sustained impact of the cautioning landmark studies on HT prescribing. HT stoppers received more nonhormonal therapies for menopausal symptoms compared with those who continued HT.