Postmenopausal hormone therapy use increased dramatically during the
past 2 decades because of a prevailing belief in its health benefits. Recent
evidence from randomized trials published in July 2002 demonstrated adverse
cardiovascular disease events and other risks with hormone therapy in the
form of oral estrogen combined with progestin.
To describe patterns of hormone therapy use from 1995 until July 2003,
including the impact of recent evidence.
Design, Setting, and Population
Two databases were used to describe national trends in hormone therapy
use from January 1995 to July 2003. The National Prescription Audit database
provided data on the number of hormone therapy prescriptions filled by retail
pharmacies and the National Disease and Therapeutic Index database provided
data on patient visits to office-based physicians during which hormone therapy
Main Outcome Measures
Annual number of hormone therapy prescriptions and characteristics of
visits to physicians during which hormone therapy was prescribed.
Annual hormone therapy prescriptions increased from 58 million in 1995
to 90 million in 1999, representing approximately 15 million women per year,
then remained stable through June 2002. Adoption of new oral estrogen/progestin
combinations, primarily Prempro, accounted for most of this growth. Obstetrician/gynecologists
provided more than 70% of hormone therapy prescriptions, and more than one
third of patients were older than 60 years. Following the publication of trial
results in July 2002, hormone therapy prescriptions declined in successive
months. Relative to January-June 2002, prescriptions from January-June 2003
declined by 66% for Prempro and 33% for Premarin. Small increases were observed
in vaginal formulations and in new prescriptions for low-dose Premarin. If
prescription rates observed through July 2003 remain stable, a decline to
57 million prescriptions for 2003, similar to the rate in 1995, is projected.
Clinical practice responded rapidly to recent evidence of harms associated
with hormone therapy. Since July 2002, many patients have discontinued hormone
therapy or are tapering to lower doses.