Use of hormone replacement therapy by menopausal women in six family-practice teaching clinics in Israel

Use of hormone replacement therapy, 1998-2007: sustained impact of the Women's Health Initiative findings

BACKGROUND

Trials of hormone replacement therapy (HRT) for prevention of chronic disease in postmenopausal women have suggested that the risks of treatment outweigh the benefits. The publication in 2002 of the Women's Health Initiative (WHI) study sparked a rapid decline in HRT purchases among American women.

OBJECTIVE

To examine the impact of the WHI findings on patterns of HRT use in Israeli women.

METHODS

We linked purchases of estrogen preparations from 1998 to 2007 by female Israeli health maintenance organization members aged 45 years and older to membership data. For each year, we calculated total annual purchases and rate of HRT utilization, characterized new users by age and mode of therapy, and examined rates of switching between modes of therapy.

RESULTS

Twenty percent of women aged 45 years and older purchased estrogen products in 2001, versus 10% in 2007 (p < 0.001; chi(2)). Vaginally administered products accounted for a rising percentage of purchases, from 5% in 1999 to 18% in 2007. An increasing percentage of new users aged 55 years and older started with a vaginal product (62% in 1999, 82% in 2007). After 2002, new users of oral therapy discontinued use more quickly than those who started oral therapy before 2002. Tibolone accounted for an increasing percentage of oral drugs purchased (12% in 2003, 29% in 2007).

CONCLUSIONS

The WHI findings had a rapid and sustained impact on HRT utilization in a large population of Israeli women, including a sharp decrease in the rate of use, particularly of oral preparations, as well as reduced duration of therapy and increased use of vaginal preparations and tibolone as first choices for treatment.

Prevalence and correlates of hormonal therapy among Israeli women in the post-WHI era

OBJECTIVES

Following the results of recent randomized controlled trials on the risks and benefits of the long-term use of hormonal therapy (HT), practice guidelines regarding HT use have been revised. The aim of the study is to assess the prevalence and the correlates of HT use in Israel in 2003.

METHODS

This is a cross-sectional study, conducted on a representative sample of the general population in Israel aged 21 years and over. The study questionnaire is based on the European Health Interview Survey (EUROHIS) project, aimed to develop uniform study tools, to enable international comparisons. The current module of the survey focused on women's health, and telephone interviews were conducted with 1396 women by trained interviewers in the year 2003.

RESULTS

Out of a total of 1396 participants, 535 were defined as peri- or postmenopausal (38%). Of them, 9.9% were currently using HT (11.7% and 2.9% among the Jewish and Arab participants, respectively), and their mean age (S.D.) was 57.7 (6.5) years. Mean duration of HT use was 8.0 (5.5) years. Treatment of menopausal symptoms was the most common reason for HT use (69.2%). Significant correlates of HT use were age, being secular and having seen a gynecologist in the previous 12 months.

CONCLUSIONS

Current HT use rates reported are lower than those reported 3 years ago for Israeli women. Awareness of both physicians and patients to the WHI results (2002), may have accounted for this trend, at least partially.

Relevance of the results of the Women's Health Initiative on the prescription of hormone therapy in Spain

OBJECTIVE

To identify the possible repercussions of suspending the estrogen-gestagen arm of the WHI trial among Spanish health-care professionals habitually using hormonal therapy in their practice of medicine and to attempt to identify the possible changes in their attitudes and prescription habits regarding this issue.

DESIGN

We designed a survey in the form of an anonymous self-administered interview with 18 questions, distributed to 3592 specialists in Obstetrics and Gynecology belonging to the Spanish Association for the Study of the Menopause (AEEM in its Spanish acronym) and the Spanish Gynecology and Obstetrics Society (SEGO in its Spanish acronym). The study was national in scope and the questionnaires were distributed between November 2002 and January 2003, with reception of questionnaires concluding in February 2003.

RESULTS

Of the participants, 96% stated that they knew the results of the Women's Health Initiative (WHI) study as published in the Journal of the American Medical Association; 63% felt that the cardiovascular results of the trial were important for their clinical practice (55% of males and 80% of females surveyed), and 42% of the men and 18% of women stated the opposite. The results of the WHI should not be extrapolated to other types of hormone therapy (84%) and only 10% considered this possibility acceptable.

CONCLUSIONS

From our study, it can be inferred that Spanish gynecologists believe they know the WHI study and state that its results cannot be extrapolated to our setting. However, following its publication, they have suspended more than 10% of therapies, have limited their indications, and have reduced their recommended duration.