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Exp Clin Endocrinol Diabetes 2005; 113(9): 529-533
DOI: 10.1055/s-2005-865802
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Patterns of Hormone Replacement Therapy in a Population-Based Cohort of Postmenopausal German Women. Changes after HERS II and WHI

C. Clanget1 , V. Hinke1 , S. Lange2 , R. Fricke2 , R. Botko3 , J. Pfeilschifter3
  • 1Department of Medicine I, BG-Kliniken Bergmannsheil, Ruhr-University Bochum, Germany
  • 2Department of Medical Informatics, Biometry and Epidemiology; Ruhr-University Bochum, Germany
  • 3Department of Medicine I, Ev. Krankenhaus Lutherhaus Essen, Germany
Further Information

Publication History

Received: January 7, 2005 First decision: April 2, 2005

Accepted: June 10, 2005

Publication Date:
19 October 2005 (online)

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Abstract

In July 2002, data from the Women's Health Initiative (WHI) trial provided strong evidence for an increased risk of cardiovascular disease with use of combined estrogen plus progestogen in postmenopausal women. These unexpected results triggered a large and ongoing discussion about the role of hormone replacement therapy (HRT). We investigated the frequency of HRT before and after the publications of the WHI trial and the Heart and Estrogen/Progestin Replacement Study II (HERS II) in a population-based random sample of German women aged 45 - 65 years. A total of 8380 women completed a questionnaire on menopausal status, hysterectomy and HRT. 75 % were postmenopausal. Mean age was 56.1 years; mean age of natural menopause 49.9 years; mean duration of postmenopause was 11 years; 27 % of the women had undergone hysterectomy. The percentage of current HRT users dropped by 16 % (35.4 % to 29.8 %, p = 0.004), past users increased from 19.8 % to 23.5 % (p = 0.03). Among current HRT users, the share of combined conjugated estrogen/progestogen decreased by 41 % (p = 0.008). We observed a decreased prevalence of HRT among German women 7 months after publication of the HERS II and WHI results. The decline was, however less pronounced than reported from other countries. The use of conjugated estrogen/gestagen combinations declined disproportionately compared to other formulations.

Key words

Hormone replacement therapy - menopause - hysterectomy - epidemiology

References

  • 1 Arzneimittelkommission der deutschen Ärzteschaft . Hormontherapie im Klimakterium.  Arzneiverordnung in der Praxis. 2003;  30 1-40
    PubMedGoogle Scholar
  • 2 Austin P C, Mamdani M M, Tu K, Jaakkimainen L. Prescriptions for estrogen replacement therapy in Ontario before and after publication of the Women's Health Initiative Study.  JAMA. 2003;  289 3241-3242
    CrossrefPubMedGoogle Scholar
  • 3 Banks E, Barnes I, Baker K, Key T J. Use of hormonal therapy for menopause in nine European countries.  IARC Sci Publ. 2002;  156 301-303
    PubMedGoogle Scholar
  • 4 Barrett-Connor E. Hormones and the health of women: past, present, and future. Keynote address.  Menopause. 2002;  9 23-31
    PubMedGoogle Scholar
  • 5 Barrett-Connor E, Grady D. Hormone replacement therapy, heart disease, and other considerations.  Annu Rev Public Health. 1998;  19 55-72
    CrossrefPubMedGoogle Scholar
  • 6 Beral V. Million Women Study Collaborators . Breast cancer and hormone-replacement therapy in the Million Women Study.  Lancet. 2003;  362 419-427
    CrossrefPubMedGoogle Scholar
  • 7 Chlebowski R T, Hendrix S L, Langer R D, Stefanick M L, Gass M, Lane D, Rodabough R J, Gilligan M A, Cyr M G, Thomson C A, Khandekar J, Petrovitch H, McTiernan A. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial.  JAMA. 2003;  289 3243-3253
    CrossrefPubMedGoogle Scholar
  • 8 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe . Konsensusempfehlungen zur Hormontherapie (HT) im Klimakterium und in der Postmenopause.  Frauenarzt. 2004;  45 620ff
    PubMedGoogle Scholar
  • 9 Goodman M T, Nomura A M, Wilkens L R, Kolonel L N. Agreement between interview information and physician records on history of menopausal estrogen use.  Am J Epidemiol. 1990;  131 815-825
    PubMedGoogle Scholar
  • 10 Grady D, Rubin S M, Petitti D B, Fox C S, Black D, Ettinger B, Ernster V L, Cummings S R. Hormone therapy to prevent disease and prolong life in postmenopausal women.  Ann Intern Med. 1992;  117 1016-1037
    PubMedGoogle Scholar
  • 11 Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M, Hsia J, Hulley S, Herd A, Khan S, Newby L K, Waters D, Vittinghoff E, Wenger N. for the HERS Research Group . Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/Progestin Replacement Study follow-up (HERS II).  JAMA. 2002;  288 49-57
    CrossrefPubMedGoogle Scholar
  • 12 Greendale G A, James M K, Espeland M A, Barrett-Connor E. Can we measure prior postmenopausal estrogen/progestin use? The Postmenopausal Estrogen/Progestin Interventions Trial. The PEPI Investigators.  Am J Epidemiol. 1997;  146 763-770
    PubMedGoogle Scholar
  • 13 Grodstein F, Manson J E, Colditz G A, Willett W C, Speizer F E, Stampfer M J. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease.  Ann Intern Med. 2000;  133 933-941
    CrossrefPubMedGoogle Scholar
  • 14 Haas J S, Kaplan C P, Gerstenberger E P, Kerlikowske K. Changes in the use of postmenopausal hormone therapy after the publication of clinical trial results.  Ann Intern Med. 2004;  140 184-188
    CrossrefPubMedGoogle Scholar
  • 15 Hays J, Ockene J K, Brunner R L, Kotchen J M, Manson J E, Patterson R E, Aragaki A K, Shumaker S A, Brzyski R G, LaCroix A Z, Granek I A, Valanis B G. Effects of estrogen plus progestin on health-related quality of life.  N Engl J Med. 2003;  348 1839-1854
    PubMedGoogle Scholar
  • 16 Hersh A L, Stefanick M L, Stafford R S. National use of postmenopausal hormone therapy: annual trends and response to recent evidence.  JAMA. 2004;  291 47-53
    CrossrefPubMedGoogle Scholar
  • 17 Hinke V, Clanget C, Botko R, Kallenbach S, Löscher S, Richter A, Schumacher J, Schatz H, Pfeilschifter J. The Bochum Postmenopause Study.  Exp Clin Endocrinol Diabetes. 2003;  111 A2
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E. for the Heart and Estrogen/progestin Replacement Study Research Group . Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women.  JAMA. 1998;  280 605-613
    CrossrefPubMedGoogle Scholar
  • 19 Jannausch M L, Sowers M R. Consistency of perimenopausal estrogen use reporting by women in a population-based prospective study.  Maturitas. 1992;  14 161-169
    CrossrefPubMedGoogle Scholar
  • 20 Keating N L, Cleary P D, Rossi A S, Zaslavsky A M, Ayanian J Z. Use of hormone replacement therapy by postmenopausal women in the United States.  Ann Intern Med. 1999;  130 545-553
    PubMedGoogle Scholar
  • 21 Kopera H. [History of the hormonal treatment of climacteric disease symptoms].  Wien Med Wochenschr. 1991;  141 346-348
    PubMedGoogle Scholar
  • 22 Lawton B, Rose S, McLeod D, Dowell A. Changes in use of hormone replacement therapy after the report from the Women's Health Initiative: cross sectional survey of users.  BMJ. 2003;  327 845-846
    CrossrefPubMedGoogle Scholar
  • 23 Lundberg V, Tolonen H, Stegmayr B, Kuulasmaa K, Asplund K. Use of oral contraceptives and hormone replacement therapy in the WHO MONICA project.  Maturitas. 2004;  48 39-49
    CrossrefPubMedGoogle Scholar
  • 24 Manson J E, Martin K A. Postmenopausal hormone-replacement therapy.  N Engl J Med. 2001;  345 34-40
    CrossrefPubMedGoogle Scholar
  • 25 Oddens B J, Boulet M J, Lehert P, Visser A P. Has the climacteric been medicalized? A study on the use of medication for climacteric complaints in four countries.  Maturitas. 1992;  15 171-181
    CrossrefPubMedGoogle Scholar
  • 26 Petitti D B. Hormone replacement therapy and heart disease prevention: experimentation trumps observation.  JAMA. 1998;  280 650-652
    CrossrefPubMedGoogle Scholar
  • 27 Rapp S R, Espeland M A, Shumaker S A, Henderson V W, Brunner R L, Manson J E, Gass M L, Stefanick M L, Lane D S, Hays J, Johnson K C, Coker L H, Dailey M, Bowen D. Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial.  JAMA. 2003;  289 2663-2672
    CrossrefPubMedGoogle Scholar
  • 28 Schneider H P. Cross-national study of women's use of hormone replacement therapy (HRT) in Europe.  Int J Fertil Womens Med. 1997;  42 (Suppl 2) 365-375
    PubMedGoogle Scholar
  • 29 Shumaker S A, Legault C, Kuller L, Rapp S R, Thal L, Lane D S, Fillit H, Stefanick M L, Hendrix S L, Lewis C E, Masaki K, Coker L H. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study.  JAMA. 2004;  291 2947-2958
    CrossrefPubMedGoogle Scholar
  • 30 Shumaker S A, Legault C, Rapp S R, Thal L, Wallace R B, Ockene J K, Hendrix S L, Jones B N, Assaf A R, Jackson R D, Kotchen J M, Wassertheil-Smoller S, Wactawski-Wende J. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial.  JAMA. 2003;  289 2651-2662
    CrossrefPubMedGoogle Scholar
  • 31 Stampfer M J, Colditz G A. Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence.  Prev Med. 1991;  20 47-63
    CrossrefPubMedGoogle Scholar
  • 32 Stove J, Sturmer T, Kessler S, Brenner H, Puhl W, Gunther K P. Hysterectomy and patterns of osteoarthritis. The Ulm Osteoarthritis Study.  Scand J Rheumatol. 2001;  30 340-345
    CrossrefPubMedGoogle Scholar
  • 33 Strothmann A, Schneider H P. Hormone therapy: the European women's perspective.  Climacteric. 2003;  6 337-346
    PubMedGoogle Scholar
  • 34 The North American Menopause Society . Amended report from the NAMS Advisory Panel on Postmenopausal Hormone Therapy.  Menopause. 2003;  10 6-12
    CrossrefPubMedGoogle Scholar
  • 35 The North American Menopause Society .Recommendations for estrogen and progestogen use in peri- and postmenopausal women: Oktober 2004 Position Statement of The North American Menopause Society. http://www.menopause.org/edumaterials/2004HTreport.pdf. access date: 6 - 11 - 2004. 2004
    Google Scholar
  • 36 The Women's Health Initiative Study Group . Design of the Women's Health Initiative clinical trial and observational study.  Control Clin Trials. 1998;  19 61-109
    Google Scholar
  • 37 The Writing Group for the PEPI Trial . Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial.  JAMA. 1995;  273 199-208
    CrossrefPubMedGoogle Scholar
  • 38 Thiel C, Heinemann L A, Assmann A. [Reasons for the change in HRT therapy from the perspective of women. Results of the German Cohort Study on Women's Health].  Zentralbl Gynakol. 2001;  123 390-398
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Turgeon J L, McDonnell D P, Martin K A, Wise P M. Hormone therapy: physiological complexity belies therapeutic simplicity.  Science. 2004;  304 1269-1273
    CrossrefPubMedGoogle Scholar
  • 40 US Preventive Services Task Force . Postmenopausal hormone replacement therapy for primary prevention of chronic conditions: recommendations and rationale.  Ann Intern Med. 2002;  137 834-839
    PubMedGoogle Scholar
  • 41 van Keep P A. The history and rationale of hormone replacement therapy.  Maturitas. 1990;  12 163-170
    CrossrefPubMedGoogle Scholar
  • 42 Wassertheil-Smoller S, Hendrix S L, Limacher M, Heiss G, Kooperberg C, Baird A, Kotchen T, Curb J D, Black H, Rossouw J E, Aragaki A, Safford M, Stein E, Laowattana S, Mysiw W J. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women's Health Initiative: a randomized trial.  JAMA. 2003;  289 2673-2684
    CrossrefPubMedGoogle Scholar
  • 43 Writing Group for the Women's Health Initiative Investigators . Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative Randomized Controlled Trial.  JAMA. 2002;  288 321-333
    CrossrefPubMedGoogle Scholar

Dr. Christof Clanget

Berufsgenossenschaftliche Kliniken Bergmannsheil
Department of Medicine I, University of Bochum

Bürkle-de-la-Camp-Platz 1

44789 Bochum

Germany

Phone: + 492343026400

Fax: + 49 23 43 02 64 03

Email: Christof.Clanget@ruhr-uni-bochum.de

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