Patterns of medication use for the treatment of menopausal symptoms before and after the women’s health initiative; implications for decision-making practices of women and women’s health professionals

Background: The Women’s Health Initiative (WHI) published findings in 2002 that changed the perception of the use of hormone replacement therapy (HRT) for the reduction of cardiovascular risks. Menopausal women using HRT for the relief of vasomotor symptoms were advised to use the lowest possible dose of HRT over the shortest possible duration. Objective: This study sought to examine patterns of HRT use for the treatment of menopausal symptoms before and after the WHI among women at least 40 years of age. Methods: A retrospective analysis was performed on a total of 1367 women in the pre-WHI group and 6467 women in the post-WHI group using the U.S. General Electric (GE) Centricity electronic medical record database. Menopause diagnosis was assessed using ICD-9 codes. Clinical characteristics and medication use were assessed for women with at least 3 years of enrollment (1 year baseline, 2 years follow-up). Results: The proportion of women in the post-WHI group that initiated HRT was significantly less than that of women in the pre-WHI group (31.3% vs. 56.9%, respectively; p < 0.001). Combination HRT use declined significantly (21.9% pre-WHI cohort vs. 7.2% postWHI cohort, p < 0.001) among increases in nonHRT use, namely SSRIs (15.2% pre-WHI cohort v. 22.3% post-WHI cohort, p < 0.001) and tranquilizers (9.5% pre-WHI cohort v. 15.8% post-WHI cohort, p < 0.001). Conclusion: The results of the WHI 2002 publication made an impression on the perception of HRT’s role in the relief of menopausal symptoms. Decision-making on the part of women seeking treatment for vasomotor symptoms and women’s health professionals demonstrates that despite HRT precautions, women continue to exhibit a need for HRT use. This study’s findings suggest that women seeking treatment for menopausal symptom relief and women’s health professionals continue to work together to find the appropriate balance between therapy use and adherence to therapy use guidelines.