Current Use of Horse Urine Estrogen

Byron's Comments:

This is a sad story.

Study Title:

Trends in menopausal hormone therapy use of US office-based physicians, 2000-2009

Study Abstract:

OBJECTIVE: The aim of this study was to evaluate recent trends and the adoption of practice recommendations for menopausal hormone therapy (MHT) use from 2001 to 2009 by formulation, dose, woman’s age, and characteristics of physicians reporting MHT visits.

METHODS: The IMS Health (Plymouth Meeting PA) National Disease and Therapeutic Index physician survey data from 2001 to 2009 were analyzed for visits in which MHT use was reported by US office-based physicians. Estimated national volume of visits for which MHT use was reported.

RESULTS: MHT use declined each year since 2002. Systemic MHT use fell from 16.3 million (M) visits in 2001 to 6.1 M visits in 2009. Declines were greatest for women 60 years or older (64%) but were also substantial for women younger than 50 years (59%) and women 50 to 59 years old (60%). Women 60 years or older accounted for 37% of MHT use. Lower dose product use increased modestly, from 0.7 M (2001) to 1.3 M (2009), as did vaginal MHT use, from 1.8 M (2001) to 2.4 M (2009). Declines in continuing systemic MHT use (65%) were greater than for newly initiated MHT use (51%). Compared with other physicians, obstetrician/gynecologists changed their practices less, thereby increasing their overall share of total MHT visits from 72% (2001) to 82% (2009).

CONCLUSIONS: Total MHT use has steadily declined. Increased use of lower dose and vaginal products reflects clinical recommendations. Uptake of these products, however, has been modest, and substantial use of MHT continues in older women.

From press release:

Eight years after the Women’s Health Initiative trial found that traditional hormone replacement therapy carried serious health risks for postmenopausal women, doctors continue to write prescriptions for it by the millions, researchers said.

According to data from a large, continuous survey of physicians, about 3.1 million visits in the U.S. in 2009 resulted in prescriptions for standard-dose estrogen therapy, alone or in combination with other hormones, according to a study published online in Menopause.

About one million of those prescriptions were for women 60 and older, the population most at risk for the cardiovascular and cancer risks identified in the Women’s Health Initiative study, noted Sandra A. Tsai, MD, MPH, of Stanford University in California, and colleagues.

“Despite reduced use, standard-dose oral menopausal hormone therapy remains the dominant formulation,” they wrote.

Overall, systemic hormone therapy for menopause symptoms has fallen by nearly two-thirds since 2001, Tsai and colleagues found, from about 16.3 million prescriptions to 6.1 million in 2009.

But low-dose oral preparations and vaginal and transdermal formulations—believed to carry less risk of adverse effects—still accounted for a minority of prescriptions.

“Greater recognition of distinctions based on menopausal hormone therapy dose, route of administration, need for concomitant progestogens, and woman’s age may move clinical practice into better alignment with available evidence,” the researchers concluded.

The study used data from 2001 to 2009 in the National Disease and Therapeutic Index, an ongoing survey of about 1,800 physicians who provide quarterly reports on their management of patients evaluated on two recent, randomly assigned workdays.

The reports list diagnoses and prescriptions written (as well as OTC products recommended) for each patient seen on those days. Consequently, the data is detailed enough to identify hormonal preparations prescribed for menopause symptoms.

In 2009, according to Tsai and colleagues, the database included about 341,000 patient encounters. The researchers extrapolated the results to the entire U.S. physician population to yield estimates of national hormone therapy prescription numbers.

Between the release of the Women’s Health Initiative results and 2009, the number of oral estrogen-only hormone prescriptions at standard doses declined 71%. Estrogen combined with other hormones at standard doses fell 83%.

Use of vaginal hormone formulations rose steadily from an estimated 2 million to 2.5 million prescriptions, whereas transdermal hormone prescriptions declined slightly, from 1.7 million to 1.5 million.

Tsai and colleagues identified differences in prescribing patterns according to physician specialty. Ob/gyns showed smaller declines over time in the percentage of visits that included menopausal hormone therapy prescriptions (46% from 2001 to 2009) compared with all other specialties (69%).

Of all visits resulting in a menopausal hormone therapy prescription, 72% were written by ob/gyns.

One of the most remarkable study findings, Tsai and colleagues suggested, was that low-dose oral therapy prescriptions did not make greater inroads into overall use of oral formulations during the study period.

Low-dose formulations, which have been found to be effective for controlling unwanted menopause symptoms, did increase from 700,000 to 1.3 million in 2009.

But this was still only 29% of all oral menopausal hormone therapy prescriptions, the researchers noted.

Moreover, use of low-dose products has been declining since hitting a peak of 1.5 million prescriptions.

“Current recommendations to use the lowest dose ... effective for symptom relief should receive greater consideration,” they wrote.

They also expressed surprise that transdermal formulations have not gained in popularity during the study period.

Tsai and colleagues identified several limitations to the study. The survey excludes physicians in publicly funded practices, where lower income patients are more likely to be seen. Patients seen by respondent physicians may also not be representative of the general female population and their hormone therapy use.

In addition, information on symptoms and responses to previous therapies is sparse in the database.

As a result, the researchers noted, “there are inherent limitations in commenting on the appropriateness of current practice patterns.”

Study Information:

Tsai SA, Stefanick ML, Stafford RS. Trends in menopausal hormone therapy use of US office-based physicians, 2000-2009 Menopause  2010 November  
Stanford Prevention Research Center, Stanford School of Medicine, Stanford, CA.

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