Correlates of postmenopausal estrogen use and trends through the 1980s in two southeastern New England communities

Correlates and prevalence of current postmenopausal estrogen use were examined in two southeastern New England communities for the period 1981 through 1990. Data were obtained from five biennial cross-sectional household health surveys, with current use of postmenopausal estrogen determined by inspection of medication bottles. Analysis included 3,279 women aged 40-64 years, of whom 2,215 (67.6%) were postmenopausal. The prevalence of estrogen use among all postmenopausal women increased from 5.3% (95% confidence interval (CI) 3.2-7.4) in 1981-1982 to 10.9% (95% CI 7.5-14.4) in 1989-1990. Among women with surgical menopause, prevalence increased from 11.4% (95% CI 6.6-16.2) to 20.3% (95% CI 13.6-27.0), while use among women with natural menopause increased from 1.5% (95% CI 0.04-2.9) to 3.5% (95% CI 0.74-6.2). Logistic regression was used to compute age-adjusted prevalence of estrogen use according to demographic characteristics and cardiovascular risk factors. Postmenopausal estrogen use was positively associated with income, and a positive trend with education was suggested. Estrogen use was positively associated with high density lipoprotein cholesterol and was inversely associated with body mass index. Nonsmokers, women who exercised at least once per week, and women who reported having their cholesterol checked in the past year were more likely to use estrogen. These findings suggest that estrogen users have a more healthy profile than do nonusers. In addition, the prevalence of postmenopausal estrogen use appears to be substantially lower in women with natural versus surgical menopause throughout the period studied.