Use of Menopausal Hormone Therapy and Bioidentical Hormone Therapy in Australian Women 50 to 69 Years of Age: Results from a National, Cross-Sectional Study.

Louiza S Velentzis,Eng Hooi Tan,Karen Canfell,Emily Banks,Freddy Sitas,Usha Salagame,William B Coleman

doi:10.1371/journal.pone.0146494

Abstract

Menopausal Hormone Therapy (MHT) use in Australia fell by 55% from 2001 to 2005, following the release of large-scale findings on its risks and benefits. Comprehensive national data, including information on overall prevalence of MHT use as well as information on duration of use in Australia have not been reported since the 2004–5 National Health Survey, when 11% of women aged 45+ years were estimated to be current MHT users. No national data are available on prevalence of use of “bioidentical” hormone therapy (BHT). The objective of this study was to determine recent prevalence of MHT and BHT use. A cross-sectional, national, age-stratified, population survey was conducted in 2013. Eligible women, aged 50–69 years, resident in Australia were randomly sampled in 5-year age groups from the Medicare enrolment database (Australia’s universal health scheme). The response rate was 22% based on return of completed questionnaires, and analyses were restricted to 4,389 women within the specified age range. The estimated population-weighted prevalence of current use of MHT was 13% (95%CI 12–14), which was broadly similar to the previously reported national figures in 2004–5, suggesting that the use of MHT in Australia has largely stabilised over the past decade. A total of 39% and 20% of current-users with an intact uterus reported use of oestrogen-progestagen MHT and oestrogen-only MHT, respectively, whereas 77% of hysterectomised current-users used oestrogen-only MHT. Almost three-quarters of current-users [population-weighted prevalence 9% (95%CI 8–10)] had used MHT for ≥5 years. In regard to BHT, estimated population-weighted prevalence of ever use was 6% (95%CI 6–7) and 2% (95%CI 2–3) for current use. The population-weighted prevalence of MHT and BHT combined, in current users in their fifties and sixties was 15% (95%CI 14–16). These data provide a recent national “snapshot” of Australian women’s use of both conventional MHT and of BHT.

Highlights

Menopausal hormone therapy (MHT) is an effective treatment for vasomotor symptoms associated with the menopause [1].MHT use for relief of these symptoms is recommended for the shortest duration possible and should not be used for the prevention of chronic disease [2,3,4]
Consistent with these findings, a National Health Survey conducted in 2004–5 found that the prevalence of self-reported current use of MHT in women over 45 years was 11% [8], a fall from 21% which was reported in 2001 for women 50 years of age [9]. Since these initial falls in MHT use were documented, there has been limited information [10,11] on more recent trends in national prevalence of MHT use in Australia with no data on duration or type of MHT. This is important because independent quantitative synthesis of the evidence has found an increased risk for breast cancer in MHT users, with these risks being higher in women using combined oestrogen-progestagen MHT; relative risks increase with increasing duration of use but return to baseline soon after women cease use [4]
The number of MHT attributable cancers in Australia was estimated using overall and long term MHT exposure based on the 2004–5 National Health Survey, and it was estimated that 453 breast cancers were attributable to combined MHT in 2010 [13]

Summary

Introduction

Menopausal hormone therapy (MHT) is an effective treatment for vasomotor symptoms associated with the menopause [1].MHT use for relief of these symptoms is recommended for the shortest duration possible and should not be used for the prevention of chronic disease [2,3,4]. Analysis of trends in annual MHT prescribing in Australia demonstrated a 40% drop in MHT use from 2001 to 2003 among women aged 50 years and older [6]; and a 55% drop from 2001–2005 [7] Consistent with these findings, a National Health Survey conducted in 2004–5 found that the prevalence of self-reported current use of MHT in women over 45 years was 11% [8], a fall from 21% which was reported in 2001 for women 50 years of age [9]. The number of MHT attributable cancers in Australia was estimated using overall and long term MHT exposure based on the 2004–5 National Health Survey, and it was estimated that 453 breast cancers were attributable to combined MHT in 2010 [13]

Objectives

Methods

Results