Side effects and sociobehavioral factors associated with the discontinuation of hormone therapy in a Massachusetts health maintenance organization

Objective: To identify sociobehavioral factors and side effects associated with the discontinuation of postmenopausal hormone therapy in a clinical pr actice setting Design: A total of 816 women aged 45-59 who began hormone therapy between J uly 1993 and June 1995 in a Massachusetts health maintenance organization w ere followed for 2 years from the day they received a prescription for estr ogen. This cohort has been previously studied for health, treatment, and de mographic determinants of hormone therapy discontinuation. In March 1999, t hese women were mailed a questionnaire containing closed and open-ended que stions. A total of 449 women (55%) completed the survey. Discrete-time haza rds models were used to identify determinants of discontinuation, controlli ng for medical predictors of survey nonresponse. Results: Women separated from their partners when they initiated hormone th erapy (relative risk [RR] of discontinuation = 3.42; 95% confidence interva l [CI] = 1.09, 10.73) and women with a body mass index greater than 29.0 (R R = 1.62; 95% CI = 1.18, 2.23) were more likely to discontinue. Women who h ad ever used oral contraceptives were less likely to discontinue hormone th erapy (RR = 0.70; 95% CI = 0.51, 0.98). After women began using hormone the rapy, those who experienced irregular bleeding (RR = 1.58; 95% CI = 1.08, 2 .31), edema (RR = 2.18; 95% CI = 1.42, 3.34), or abdominal cramps and pelvi c pain (RR = 2.42; 95% CI = 1.46, 4.02) while using hormones were more like ly to discontinue. The effect of edema and abdominal cramps on the rate of discontinuation was greatest during the first 6 months of use. Women who ad justed their progestin schedule on their own were four times more likely th an other women to discontinue hormones (RR = 4.18; 95% CI = 2.20, 7.94). Th e use of alternative therapies was not statistically associated with discon tinuation. Conclusions: Women who report therapeutic benefits from hormone therapy are more likely to continue using hormones long-term. The experience of certai n side effects, especially during the first few months of hormone use, stro ngly affects whether women continue using hormone therapy.