Health of Women Beginning Postmenopausal Hormone Therapy
Health of Women Beginning Postmenopausal Hormone Therapy
Objective. After we demonstrated a substantial drop in postmenopausal hormone therapy (HT) in France after 2002, we sought to compare health characteristics assessed before menopause and reasons for beginning treatment among women who started postmenopausal HT before and after this year.
Methods. Among participants of the GAZEL (GAZ and ELectricité) cohort of employees of the French national power company, we studied 1,229 women who reached menopause before 2002 and 562 women who reached menopause after 2002. We analyzed HT use among these newly postmenopausal women before and after 2002 and its relations to self-rated health, simple and troublesome hot flushes, and various other symptoms before menopause.
Results. After 2002, compared with before 2002, women starting HT were more likely to have reported troublesome hot flushes before menopause (odds ratio, 2.3; 95% CI, 1.0-5.4). The groups of new HT users did not differ significantly except for health characteristics. Significantly higher proportions of women starting HT reported using it for hot flushes (68.1% vs 52.9%, P = 0.02) and sleep disorders (11.1% vs 2.8%, P = 0.001) and a significantly lower proportion of women starting HT reported using it for osteoporosis prevention (12.5% vs 43.9%, P < 0.001) after 2002 than before 2002.
Conclusions. After 2002, HT tended to be prescribed for more severe hot flushes, but almost one third of prescriptions were still written for reasons not linked to hot flushes. Doctors seem to be following recommendations to not use HT as a first-line treatment of osteoporosis.
In the year after the publication of the results of the Women's Health Initiative (WHI) trial in July 2002, the European Medicines Agency restricted the indications for postmenopausal hormone therapy (HT) to the treatment of climacteric symptoms. It also advised against its use as a firstline treatment of osteoporosis after concluding that risks outweighed benefits for that indication. The guidelines issued in the same year by the French Health Products Safety Agency also limited indications for HT and recommended that its use for treating climacteric symptoms be as brief as possible. These recommendations were reiterated in 2004, 2006, and 2008. From 2002 onward, HT use declined rapidly and substantially in numerous countries, including France. We have shown in two French cohorts that the proportion of women starting HT also fell substantially among newly postmenopausal women, a drop accompanied by changes in the types of HT used. However, little is known about whether women starting HT after 2002 have different health characteristics and motivations for using HT from those treated before the publication of the WHI results and the subsequent changes in recommendations by health agencies.
Our main hypothesis was that newly postmenopausal women beginning HT after 2002 were in better general health before beginning treatment than newly postmenopausal women who began HT before that year (ie, because both physicians and postmenopausal women are now aware of the health risks associated with HT, this treatment is administered only to selected healthy women). Our other hypotheses were that, after 2002 compared with the years before, newly postmenopausal women were more often treated for climacteric symptoms (vasomotor symptoms) than for preventive purposes (osteoporosis or cardiovascular health) and that climacteric symptoms now must be more severe than previously for doctors to prescribe HT and for women to agree to take HT.
To explore these hypotheses, we used data from a longitudinal cohort study of French women who were recruited from a general population of working people and followed since 1989, which allowed us to (1) compare, among newly postmenopausal women, the characteristics of women who began treatment before and after 2002, in particular their general health and psychological, osteoarticular, and climacteric symptoms, and (2) analyze the reasons for HT use during these two periods.
Abstract and Introduction
Abstract
Objective. After we demonstrated a substantial drop in postmenopausal hormone therapy (HT) in France after 2002, we sought to compare health characteristics assessed before menopause and reasons for beginning treatment among women who started postmenopausal HT before and after this year.
Methods. Among participants of the GAZEL (GAZ and ELectricité) cohort of employees of the French national power company, we studied 1,229 women who reached menopause before 2002 and 562 women who reached menopause after 2002. We analyzed HT use among these newly postmenopausal women before and after 2002 and its relations to self-rated health, simple and troublesome hot flushes, and various other symptoms before menopause.
Results. After 2002, compared with before 2002, women starting HT were more likely to have reported troublesome hot flushes before menopause (odds ratio, 2.3; 95% CI, 1.0-5.4). The groups of new HT users did not differ significantly except for health characteristics. Significantly higher proportions of women starting HT reported using it for hot flushes (68.1% vs 52.9%, P = 0.02) and sleep disorders (11.1% vs 2.8%, P = 0.001) and a significantly lower proportion of women starting HT reported using it for osteoporosis prevention (12.5% vs 43.9%, P < 0.001) after 2002 than before 2002.
Conclusions. After 2002, HT tended to be prescribed for more severe hot flushes, but almost one third of prescriptions were still written for reasons not linked to hot flushes. Doctors seem to be following recommendations to not use HT as a first-line treatment of osteoporosis.
Introduction
In the year after the publication of the results of the Women's Health Initiative (WHI) trial in July 2002, the European Medicines Agency restricted the indications for postmenopausal hormone therapy (HT) to the treatment of climacteric symptoms. It also advised against its use as a firstline treatment of osteoporosis after concluding that risks outweighed benefits for that indication. The guidelines issued in the same year by the French Health Products Safety Agency also limited indications for HT and recommended that its use for treating climacteric symptoms be as brief as possible. These recommendations were reiterated in 2004, 2006, and 2008. From 2002 onward, HT use declined rapidly and substantially in numerous countries, including France. We have shown in two French cohorts that the proportion of women starting HT also fell substantially among newly postmenopausal women, a drop accompanied by changes in the types of HT used. However, little is known about whether women starting HT after 2002 have different health characteristics and motivations for using HT from those treated before the publication of the WHI results and the subsequent changes in recommendations by health agencies.
Our main hypothesis was that newly postmenopausal women beginning HT after 2002 were in better general health before beginning treatment than newly postmenopausal women who began HT before that year (ie, because both physicians and postmenopausal women are now aware of the health risks associated with HT, this treatment is administered only to selected healthy women). Our other hypotheses were that, after 2002 compared with the years before, newly postmenopausal women were more often treated for climacteric symptoms (vasomotor symptoms) than for preventive purposes (osteoporosis or cardiovascular health) and that climacteric symptoms now must be more severe than previously for doctors to prescribe HT and for women to agree to take HT.
To explore these hypotheses, we used data from a longitudinal cohort study of French women who were recruited from a general population of working people and followed since 1989, which allowed us to (1) compare, among newly postmenopausal women, the characteristics of women who began treatment before and after 2002, in particular their general health and psychological, osteoarticular, and climacteric symptoms, and (2) analyze the reasons for HT use during these two periods.