Differences in Menopausal Hormone Therapy Use Among Women in Germany
Differences in Menopausal Hormone Therapy Use Among Women in Germany
Background: To examine the differences in menopausal hormone therapy (MHT) use and user profiles among women in Germany before and after the communication of the Women's Health Initiative (WHI) trial and other study results concerning the risks and benefits of MHT.
Methods: Current MHT use was ascertained in two periodic German national health surveys conducted in 1997–1999 and 2003–2004. MHT prevalence and user profiles were assessed within each survey. The association of the survey period (2003–2004 vs. 1997–1999) with current MHT use was analyzed in weighted multivariable logistic regression (MLR) models, pooling data from both surveys.
Results: The overall prevalence of current MHT use decreased by 40.2% from 16.9% of the sample in 1997–1999 to 10.1% in 2003–2004. The difference in prevalence between surveys varied with age decade with the smallest decreases among women 60–69 years of age (20.3% vs. 18.5%), compared to women of younger and older age groups (40–49: 10.7% vs. 3.9%; 50–59: 36.3% vs. 21.3%; 70–79: 5.7% vs. 3.2%). Variables independently associated with higher current MHT use in both health surveys included age category (curvilinear relationship with highest use among women 50–59 years) and residence in West vs. East Germany. A higher social status, lower body mass index, and more health-conscious behaviour were significantly associated with higher current MHT use in the 1997–1999 survey, but these associations were not found in the later survey. MLR analyses confirmed a significant decline in MHT use between the 1997–1999 and 2003–2004 surveys, however, the effect was modified by social status and was not significant among lowest social-status women.
Conclusion: Current MHT use considerably declined among women in Germany between the pre- and post-WHI era. A convergence of current MHT use among women of higher social status with pre-existing patterns of use among lower social-status women suggests that MHT in Germany is now less likely to be used for health promotion.
During the past two decades menopausal hormone therapy (MHT, the term used for both estrogen therapy and estrogen plus progestin therapy) has been widely proposed and prescribed for postmenopausal women, not only for the relief of menopausal symptoms, but also for the prevention of cardiovascular diseases and osteoporosis in later life. Such advice to women was based on a wealth of supporting results from preclinical as well as observational clinical and epidemiological studies, although confirmatory data from randomized clinical trials (RCTs) were still lacking or not based on hard clinical endpoints. Some experts kept advising caution in view of limited evidence. However, it was not before the publication of results from two RCTs, the Heart and Estrogen/Progestin Replacement Study (HERS) in 1998 and the combined estrogen plus progestin therapy arm of the Women's Health Initiative randomized controlled trial (EPT-WHI) in 2002 as well as the large observational Million Women Study (MWS) in 2003 that this position gained widespread attention among medical experts and health care officials. Ever since, studies from the United States[9-16] and various other European countries, including Germany, have consistently reported a substantial decline in MHT use.
Up to now, few studies have examined changes in user profiles with respect to socio-demographic and co-morbidity patterns at a nationally representative level. In the present study, we have analyzed differences in the prevalence and correlates of current MHT use among women in Germany, based on data from two periodic national health surveys conducted in 1997–1999 and 2003–2004.
Abstract and Background
Abstract
Background: To examine the differences in menopausal hormone therapy (MHT) use and user profiles among women in Germany before and after the communication of the Women's Health Initiative (WHI) trial and other study results concerning the risks and benefits of MHT.
Methods: Current MHT use was ascertained in two periodic German national health surveys conducted in 1997–1999 and 2003–2004. MHT prevalence and user profiles were assessed within each survey. The association of the survey period (2003–2004 vs. 1997–1999) with current MHT use was analyzed in weighted multivariable logistic regression (MLR) models, pooling data from both surveys.
Results: The overall prevalence of current MHT use decreased by 40.2% from 16.9% of the sample in 1997–1999 to 10.1% in 2003–2004. The difference in prevalence between surveys varied with age decade with the smallest decreases among women 60–69 years of age (20.3% vs. 18.5%), compared to women of younger and older age groups (40–49: 10.7% vs. 3.9%; 50–59: 36.3% vs. 21.3%; 70–79: 5.7% vs. 3.2%). Variables independently associated with higher current MHT use in both health surveys included age category (curvilinear relationship with highest use among women 50–59 years) and residence in West vs. East Germany. A higher social status, lower body mass index, and more health-conscious behaviour were significantly associated with higher current MHT use in the 1997–1999 survey, but these associations were not found in the later survey. MLR analyses confirmed a significant decline in MHT use between the 1997–1999 and 2003–2004 surveys, however, the effect was modified by social status and was not significant among lowest social-status women.
Conclusion: Current MHT use considerably declined among women in Germany between the pre- and post-WHI era. A convergence of current MHT use among women of higher social status with pre-existing patterns of use among lower social-status women suggests that MHT in Germany is now less likely to be used for health promotion.
Background
During the past two decades menopausal hormone therapy (MHT, the term used for both estrogen therapy and estrogen plus progestin therapy) has been widely proposed and prescribed for postmenopausal women, not only for the relief of menopausal symptoms, but also for the prevention of cardiovascular diseases and osteoporosis in later life. Such advice to women was based on a wealth of supporting results from preclinical as well as observational clinical and epidemiological studies, although confirmatory data from randomized clinical trials (RCTs) were still lacking or not based on hard clinical endpoints. Some experts kept advising caution in view of limited evidence. However, it was not before the publication of results from two RCTs, the Heart and Estrogen/Progestin Replacement Study (HERS) in 1998 and the combined estrogen plus progestin therapy arm of the Women's Health Initiative randomized controlled trial (EPT-WHI) in 2002 as well as the large observational Million Women Study (MWS) in 2003 that this position gained widespread attention among medical experts and health care officials. Ever since, studies from the United States[9-16] and various other European countries, including Germany, have consistently reported a substantial decline in MHT use.
Up to now, few studies have examined changes in user profiles with respect to socio-demographic and co-morbidity patterns at a nationally representative level. In the present study, we have analyzed differences in the prevalence and correlates of current MHT use among women in Germany, based on data from two periodic national health surveys conducted in 1997–1999 and 2003–2004.
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