Trends in Menopausal Hormone Therapy Dispensing in Sweden Over 15 Years

What's new

A comprehensive study conducted in Sweden analyzed the dispensing patterns of menopausal hormone therapy (MHT) among nearly one million women over a 15-year period, from 2006 to 2020 [1]. The findings indicate a notable shift in how MHT is utilized, with a significant decrease in the dispensing of systemic MHT and a corresponding increase in local MHT [1]. The research also sheds light on how age, specific cohorts, and various sociodemographic characteristics influence these dispensing patterns, underscoring the dynamic nature of MHT use in response to evolving clinical guidelines and public understanding [1].

The science behind it

This population-based, closed cohort study utilized data from several Swedish national health registers, tracking 951,455 women aged 45–60 years at the start of the study period in 2006 [1]. The researchers examined MHT dispensing through three main lenses: distinguishing between local and systemic MHT, comparing oral versus transdermal estrogen, and analyzing different types and administration routes of progestogens [1]. The cohort was also stratified by age at baseline (45–49, 50–54, 55–60 years) to observe age-specific trajectories [1].

The study observed that systemic MHT dispensing decreased from 9.6% in 2006 to 3.8% in 2020, while local MHT use rose from 6.7% to 16.7% during the same period [1]. Interestingly, the oldest age group consistently showed higher rates of systemic MHT dispensing throughout the years [1]. While oral estrogen remained the predominant form, there was a modest increase in the relative use of transdermal estrogen towards the end of the study [1]. The study also identified disparities based on sociodemographic factors: women born outside Europe were less likely to be dispensed systemic MHT, whereas those with higher education and income showed a greater tendency towards transdermal estrogen compared to oral forms [1]. Synthetic progestogens were the most commonly dispensed type, with bioidentical progesterone/dydrogesterone and hormonal intrauterine devices being less frequently used [1]. These patterns illustrate the complex interplay of clinical recommendations, patient preferences, and societal factors in MHT utilization.

What it means in practice

The observed trends suggest a growing preference for local MHT, likely reflecting a focus on managing localized menopausal symptoms with potentially fewer systemic risks, aligning with updated clinical guidance [1]. The sustained higher use of systemic MHT among older women may indicate a cohort effect, where women who initiated MHT earlier in life continued its use, or it could reflect persistent, severe symptoms requiring systemic treatment [1]. The identified sociodemographic disparities in MHT dispensing, particularly concerning origin, education, and income, highlight potential inequities in access to or information about MHT [1]. Healthcare providers might consider these factors when discussing MHT options with patients, ensuring that recommendations are tailored and accessible to diverse populations. The findings also emphasize the importance of ongoing education for both clinicians and patients regarding the various MHT formulations and their appropriate uses, moving towards more personalized and equitable care [1].

Caveats

This study is based on register data from Sweden, which provides robust population-level insights but may not fully capture individual patient decisions or reasons behind MHT choices [1]. Dispensing data reflects prescriptions filled, not necessarily actual consumption [1]. The study's focus on a specific time frame (2006-2020) means that newer trends or changes in MHT guidelines post-2020 are not included [1]. While the study controlled for several sociodemographic factors, other unmeasured variables could also influence MHT dispensing patterns [1]. The generalizability of these findings to other countries with different healthcare systems, cultural contexts, and MHT guidelines may also be limited [1].

Source: [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC13356479/