Postmenopausal hormone use following a 3-year randomized clinical trial

Postmenopausal women often discontinue estrogen therapy within the first ye ar. No studies have examined reasons why women continue or discontinue horm one replacement therapy (HRT) after several years of use, when hormone side effects have subsided. We wanted to identify determinants of estrogen use after participation in a 3-year randomized placebo-controlled trial. The Po stmenopausal Estrogen/Progestin Intervention (PEPI) study compared the effe cts of estrogen alone or in combination with one of three progestogens with placebo. Post-PEPI use of hormone therapy was ascertained 1-4 years after the trial in 775 (90%) of the originally enrolled women. Potential correlat es of treatment decisions were identified from sociodemographic characteris tics, medical histories, and clinical measures ascertained at baseline and during and after the trial. Among women who had been assigned to placebo du ring PEPI, post-PEPI hormone use was significantly less common in women who were adherent to placebo during PEPI, older, or of non-Caucasian ethnicity . Hormone use was positively associated with hysterectomy. Among women assi gned to an active regimen during PEPI, post-PEPI hormone use was significan tly more common in women who used hormones before PEPI and in women who wer e adherent to hormones during PEPI. Older age, less education, and being no n-Caucasian predicted less hormone use. Post-PEPI hormone use was highest i n San Diego and lowest in Iowa City. Women on placebo who lost more bone mi neral density (BMD) were more likely to begin hormones than women with less bone loss. Lipids, blood pressure, and other cardiovascular risk factors h ad relatively little influence on hormone use. The main predictors of post- PEPI hormone use were those associated with use in the general population ( education, ethnicity, geographical region, hysterectomy, and prior use/adhe rence).