From systemic hormone therapy to vaginal estrogen - a nationwide register study in Finland, 2003-2012

To assess the patterns of use of reimbursed systemic hormone therapy (HT) and vaginal estrogen preparations among women aged 45 and older in Finland.

Reimbursed purchases of prescribed systemic HT and vaginal estrogen preparations for the years 2003-2012 were obtained from a nationwide prescription registry. Systemic preparations included estrogen patches, gels and tablets, tibolone, continuous combination preparations and sequential combination preparations. Prescribed vaginal estrogens included a vaginal ring and vaginal tablets.

Annual period prevalence for systemic HT and vaginal estrogen use.

The total prevalence of prescribed HT use remained relatively constant (at 26-27%) throughout the studied period, but the share of women using systemic preparations decreased from 21% to 12%, while the share of women using vaginal estrogens increased from 9% to 19%. Decreases were observed for all classes of systemic preparations, although the decrease was largest for sequential combination preparations (from 4.9% to 1.6%) and estrogen tablets (from 5.2% to 2.9%). Continuous combination preparations remained the most commonly used types of systemic preparation (5.4-4.2%). Systemic HT use decreased most among 45-49 year old women (9.5-4.3%), while the use of vaginal estrogens increased most among those aged 65 and over.

Based on the register data, the trends in HT use indicate changed prescribing patterns in accordance with clinical guidelines. It is notable that since 2009, vaginal estrogen was more commonly prescribed than systemic HT.