Use of unopposed estrogen in women with uteri: Prevalence, clinical implications, and economic consequence

Objective: Hormone replacement therapy with estrogen/progestin is the treat ment of choice for relieving postmenopausal vasomotor symptoms and preventi ng urogenital atrophy and osteoporosis in women with intact uteri. However, despite the known increased incidence of endometrial hyperplasia when unop posed estrogen is used in such women, this progestin regimen has not been u niversally adopted. Design: This study was conducted in a managed care organization to determin e the extent of the use of unopposed estrogen in women with intact uteri. P harmacy claims data for all women 55 years or older with claims for estroge n only from September 1, 1996, to December 31, 1996, were reviewed. A total of 5,209 records were identified, from which 480 were randomly selected. A survey of the members' physicians was then carried out to determine hyster ectomy status and was confirmed by chart audit. Results: Thirty-three (11%) of the members identified had not undergone hys terectomy. Follow-up physician contact revealed that five women did not hav e a uterus, Use of estrogen without opposing progestin was documented in a substantial percentage of files reviewed. It is of concern that with the do cumentation of the risks of endometrial hyperplasia and carcinoma in the in tact uterus, unopposed therapy still occurs. In addition to the clinical co sts, there are economic consequences to this practice. An economic model of unopposed estrogen use was created. A management cost of $1,504 for 3 year s was estimated. Conclusions: Further educational efforts are needed to ensure the use of op posed estrogen in the woman with an intact uterus. (Menopause 2000,7:123-12 8, (C) 2000, The North American Menopause Society.).