Discontinuation of postmenopausal hormone therapy in a Massachusetts HMO

Long-term postmenopausal hormone therapy alleviates menopausal symptoms, de creases women's risk of osteoporosis and has been shown to reduce cardiovas cular morbidity and mortality in more than 30 observational studies. Howeve r, nearly half of all women initiating hormone therapy discontinue within t he first year. This study was conducted to determine the rate and predictor s of hormone therapy discontinuation in a clinical practice setting. We ide ntified 992 women aged 45-59 who began hormone therapy between 1993 and 199 5 in a Massachusetts health maintenance organization. Women were followed 2 years from the day they filled a prescription for estrogen. 53% discontinu ed hormone therapy by the end of the first year and one-fifth stopped after the first prescription. A prescription from a gynecologist (RR = 0.82, 95% Cl: 0.68, 0.99) and a mammogram a year prior to initiation (RR = 0.75, 95% CI: 0.63, 0.89) were associated with a lower rate of discontinuation. Wome n who were using monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRI) antidepressants 3 months prior to initiation (R R = 2.07, 95% CL 1.26, 3.39) or who had been enrolled in the health plan fo r less than 3 years (RR = 1.33, 95% Cl: 1.10, 1.62) had an increased risk o f discontinuing hormone therapy. The year a woman entered the cohort was al so associated with a higher rate of discontinuation (RR = 1.40, 95% Cl: 1.1 4, 1.74 for 1994 and RR = 1.95, 95% Cl: 1.52, 2.50 for 1995). The results i ndicate that long-term hormone therapy use is uncommon in clinical practice , particularly when a woman or her physician attempts to use hormone therap y as an alternative to antidepressant therapy, and that the rates of discon tinuation of hormone therapy were rising rapidly in the mid-1990s. (C) 2001 Elsevier Science Inc. All rights reserved.