In spite of risks, women continue to receive high-dose hormone therapy

Fewer women take hormone replacement therapy (HRT) now than in 2001, but they’re still getting relatively high doses that are associated with stroke and cancer risk.

Between 2001 and 2009 the number of women taking systemic HRT dropped from more than 16 million to 6 million, according to a study published online November 24 in Menopause: The Journal of the North American Menopause Society. However, use of low-dose products increased only modestly, from 700,000 to 1.3 million, during the same period.

“Despite reduced use, standard-dose oral HRT remains the dominant formulation,” although “lower dose transdermal and vaginal preparations may yield less harm,” the authors wrote.

“We’re disappointed,” study leader Randall S Stafford, MD, PhD, of Stanford University Prevention Research Center, Palo Alto, California, said in a statement. “We didn’t see the level of refinement of clinical practice that we expected.” The study found that obstetrician/gynecologists changed their practice less than other physicians.

Researchers analyzed data on the number of women using menopausal HRT gathered from reports by office-based physicians to the IMS Health National Disease and Therapeutic Index physician survey from 2001 through 2009. Use declined by 64% in women 60 years and older, 60% in women 50 to 59 years, and 59% in women younger than 50 years. Women 60 years or older accounted for 37% of HRT.

Since 2001, the number of women taking lower dose HRT increased from 0.7 million to 1.3 million, and the number of vaginal HRT users also rose (1.8 to 2.4 million).

The US Food and Drug Administration and other groups recommend using the lowest possible dose of HRT for the shortest possible time. The Women’s Health Initiative reported in 2002 that women who took systemic estrogen plus progesterone for 5 years had increased rates of ovarian cancer, breast cancer, strokes, and other health problems.