Friday October 19 5:22 PM ET
NEW YORK (Reuters Health) - If findings from a Massachusetts health plan are any indication, fewer postmenopausal women are staying on hormone replacement therapy (HRT) long-term.
Estrogen replacement after menopause can help prevent the bone-thinning disease osteoporosis, and some--but not all--studies suggest that the regimen can also protect women from developing cardiovascular disease. On the other hand, recent research has also linked HRT with a slightly increased risk for breast cancer.
Whatever their reasons, almost half of all women who start HRT now stop within a year, according to past research.
To investigate, Dr. Robert F. Reynolds of Pfizer Inc. in New York and colleagues followed over 900 women belonging to a Massachusetts health plan who had started HRT between 1993 and 1995. The women, who ranged in age from 45 to 59, were followed for 2 years after they filled a prescription for estrogen.
By the end of the first year of followup, 53% of the women had stopped taking HRT, the researchers report. Twenty percent discontinued after the first month, and 33% discontinued by the fourth month. By the end of the study, 65% had stopped using HRT, Reynolds and colleagues report in the October issue of the Journal of Clinical Epidemiology.
Previous studies have found that ``side effects and a fear of cancer are the primary reasons women cite for discontinuing hormone therapy,'' 1057 col 1 according to Reynolds' team. They note that women who had received their estrogen prescription from a gynecologist were less likely to stop taking HRT. This may have been because gynecologists were more likely to prescribe regiments that reduce side effects and were better able to explain the risks and benefits of HRT than other doctors, the authors speculate.
The later the woman entered the study, the researchers found, the more likely they were to stop taking HRT. Compared with women enrolling in 1993, those enrolling in 1994 were 40% more likely to discontinue therapy, and those enrolling in 1995 were 95% more likely to discontinue.
The media may be at least partially responsible for this trend. In recent years, the authors note, women and their doctors were ``certainly affected by the increasing prominence and frequency of reports of an association between estrogen use and the risk of breast cancer, as well as books and media accounts questioning whether the menopause should be managed medically.'' 1062
SOURCE: Journal of Clinical Epidemiology 2001;54:1056-1064.