Patterns of menopausal hormone therapy dispensing over 15 years-A Swedish register-based cohort study

Menopausal hormone therapy (MHT) is used to manage menopausal symptoms. Dispensing patterns are influenced by evolving guidelines, clinical practice, and public perceptions, which have shifted considerably over the past two decades. This study aims to describe patterns and age-specific trajectories of MHT dispensing in Sweden in a closed cohort of women aged 45-60 years at baseline, followed from 2006 to 2020.

A population-based closed cohort study linking several Swedish national health registers was performed. A total of 951 455 women aged 45-60 years residing in Sweden were included on January 1, 2006, and followed up until December 31, 2020. MHT dispensing was examined through three approaches: 1) local or no MHT versus systemic MHT, 2) oral versus transdermal estrogen, and 3) based on progestogen type and administration route. Analyses were also stratified by age at baseline (45-49, 50-54, 55-60 years).

Systemic MHT dispensing was 9.6% in 2006 and 3.8% in 2020, while 6.7% and 16.7% used local MHT, respectively. The oldest age group consistently dispensed systemic MHT to a greater extent through the years. Oral estrogen dominated, although relative transdermal estrogen use increased modestly toward the end of follow-up. Dispensing of systemic MHT was less common among women born outside Europe, while dispensing of transdermal estrogen, compared to oral, was higher among those with higher education and income. Synthetic progestogens remained the most common type of progestogen, whereas dispensing of bioidentical progesterone/dydrogesterone and hormonal intrauterine devices was rare.

In this large, population-based, closed cohort of women in Sweden, dispensing of systemic MHT declined with increasing age, while local MHT increased. Dispensing patterns, including route of estrogen administration and type of progestogen, varied by age cohort and sociodemographic characteristics. These findings illustrate how MHT dispensing is shaped by aging, cohort effects, evolving clinical practices, and updated guidelines, as well as by social determinants of health. Overall, the results underscore the importance of continued monitoring of MHT dispensing and efforts to ensure that prescribing remains evidence-based and equitable.