Effect of age on reasons for initiation and discontinuation of hormone replacement therapy

Objective: The purpose of this study was to examine age-related differences in reasons that post menopausal women began and stopped hormone replacemen t therapy (HRT). Design: Two identical telephone surveys were conducted of women members of Kaiser Foundation Health Plan who had begun HRT within the previous 3 years . The first, in 1997, was of 604 older women aged 65 years or older; the se cond, in 1998, was of 866 younger women aged 50-55 years. Prescription reco rds for both groups provided the means for determining continuation of ther apy. Results: Among older women, 35% reported prevention or treatment of osteopo rosis as the primary reason for starting HRT. Younger women were less likel y (14%) to report this (p < 0.001). Relief of vasomotor menopausal symptoms was the most frequently reported reason that younger women gave for starti ng HRT; it was the primary reason in 34%. In contrast, only 7% of older wom en reported relief of vasomotor symptoms as the primary reason for starting HRT (p < 0.001). Older women were more likely than younger women to discon tinue HRT; after 12 months, the probabilities of discontinuation were 62% a nd 48% (relative risk = 1.4; 95% confidence interval = 1.2-1.6). Treatment- related side effects were most often the reason given for stopping HRT; 87% of older women and 64% of younger women who stopped reported that a treatm ent side effect was their primary reason (p < 0.001). Among treatment side effects, vaginal bleeding was the most frequently reported reason for stopp ing HRT; it was the primary reason for stopping in 52% of older women and 2 9% of younger women (p < 0.001). Conclusions: Older women differ from younger women in their reasons for sta rting and stopping HRT. Whereas osteoporosis is the predominant reason that older women begin HRT, relief of vasomotor symptoms is the major reason th at younger women begin. Early discontinuation of HRT is common and is great er among older women. Intolerance of treatment, particularly vaginal bleedi ng, is the predominant reason for stopping HRT. (Menopause 1999;6:282-289. (C) 1999, The North American Menopause Society.).