Trends in estrogen replacement therapy use among younger gynecologic cancer survivors, 2013-2021

To evaluate temporal trends in estrogen replacement therapy (ERT) utilization among younger gynecologic cancer survivors.

We conducted a cross-sectional study using the Merative MarketScan Research Database from January 1, 2013, through December 31, 2021. We included female patients aged 18-51 years with a diagnosis or history of gynecologic cancer. Annual prevalence of ERT use was calculated, and trends over time were assessed using annual percent change (APC) and 95% confidence intervals (CIs). Results were assessed across cancer types and age groups.

ERT utilization increased from 10.9% in 2013 to 14.1% in 2021 among all gynecologic cancer survivors (APC 3.41%, 95% CI 2.13-4.71%). Increasing ERT use was observed across all gynecologic cancer subgroups and age categories during the study period. Ovarian cancer survivors consistently had the greatest prevalence of ERT use, whereas uterine cancer survivors had the lowest prevalence across the study period. Among the age sub-groups, the 18-34 years old age group had the largest increase in ERT utilization, from 6.8% to 10.5% (APC 5.68%, 95% CI 3.1-8.33) over the study period.

ERT utilization among younger gynecologic cancer survivors increased between 2013 and 2021. As ERT use continues to rise in this population, further research is needed to identify patient-, provider-, and system-level factors associated with prescribing and uptake and to evaluate gaps in menopausal survivorship care.