Programme no. 344-OP
Patient Empowerment
Symptoms, use and discontinued use of hormone therapy among Norwegian women. Too much or too little?
Bjørn Gjelsvik*1, Steinar Hunskaar2, Ingvild Dalen3, Jørund Straand4, Elin O. Rosvold5
1Department of General Practice,Institute for Health and Society, University of Oslo,0317 Oslo,Norway, 2Department of Global Public Health ,University of Bergen,Bergen,Norway, 3Forskningsavdelingen,Helse Stavanger HF,Stavanger,Norway, 4Department of General Practice,Institute for Health and Society, University of Oslo,0317 Oslo,Norway, 5Department of General Practice,Institute for Health and Society, University of Oslo,0317 Oslo,Norway
* = Presenting author
Objectives: This work aims to study the use of hormone therapy (HT) in a representative cohort of Norwegian women during the menopausal transition, to identify predictors of HT use, the relation to vasomotor symptoms, and to describe the reappearance of symptoms in former HT users.
Background: The use of hormone therapy (HT) during and after menopause decreased dramatically after the publishing of the Women’s Health Initiative (WHI) study and other studies around 2002. Later reassessment of the WHI data indicate that the risk of HT use within the first 5-10 years after menopause (the 50-59 year group) are small, and for estrogen only may be beneficial with respect to breast cancer.
Results: The 2-year incidence of new HT users dropped from 8.2% (95% CI, 7.0-9.5) in 2002 to 4.3% (95% CI, 3.4-5.2) in 2004 and remained stable for the next 6 years despite an increasing prevalence of symptoms in the cohort. Self-rated health was stable during the period. The mean duration of HT use was 4.5 years (95% CI, 4.0-5.0). The odds of HT use were higher among women with daily hot flushes than among those who never or rarely experienced them (odds ratio, 3.2; 95% CI, 2.3-4.4). After HT cessation, hot flushes returned and corresponded to those in untreated controls.
Material/Methods: In 1997, 2,229 women in Hordaland County, aged 40 to 44 years, were selected randomly from a national health survey and followed up with seven postal questionnaires in 1999-2010. Data from 2,002 women (90%) were eligible for analysis. Summary statistics and multiple logistic regression analysis were used. Symptoms and use of HT during the observation period were analyzed. We also studied the reappearance of symptoms after HT discontinuation using a subcohort based on their propensity scores for HT use.
Conclusion: The 2-year incidence of HT users decreased almost 50% after 2002, despite increasing symptoms in the cohort. Increasing symptoms and decreasing incidence of HT use did not influence self-rated health. Hot flushes were the strongest predictor of HT use. Symptoms reappeared in most women after HT cessation.
Points for discussion: Do these findings imply that women are under-treated during the menopausal transition? Do GP’s (and/or their symptomatic menopausal patients) assess the benefits and risks of HT properly? Do we need instruments to discuss these topics with the patients?