Vaginal estrogen creams: Use patterns among a cohort of women

OBJECTIVE: To assess the prevalence, amount, and duration of use of vaginal estrogen cream among several birth cohorts of women from 1983 through 1992 . DESIGN: Analyses are based on automated membership, pharmacy, and hospital discharge databases from Group Health Cooperative (GHC) of Puget Sound, a l arge health maintenance organization in Seattle, Washington. PARTICIPANTS: A total of 33,822 women, aged 45 years and older as of Decemb er 31, 1983, who were enrolled in GHC from 1983 to 1992 or who were enrolle d at baseline and died in the following decade. RESULTS: About 24% of the cohort had filled at least one prescription for v aginal estrogen cream during 1983 through 1992, and about 60% of the users had more than one prescription filled. The annual birth cohort-specific pre valence of having filled one or more prescriptions for vaginal estrogen cre ams ranged between 1.6 and 8.2% across birth cohorts, whereas the average a nnual prevalence for the cohort was between 5.3 and 6.8%. The total amount, duration of use, and proportion of total estrogen exposure from creams inc reased with age of the birth cohort. Among the 733 women with intact uteri who were long-term cream users, 60.4% had no progestin prescriptions while averaging 22.1 tubes of estrogen cream. CONCLUSION: The prescription-filling patterns for estrogen in this cohort s how an increase in the amount, years of use, and proportion of estrogen exp osure from creams with the age of the birth cohort and extensive unopposed cream use among a small proportion of women with intact uteri. The systemic effects of vaginal estrogen cream among older postmenopausal women with ur ogenital atrophy deserve closer scrutiny.