Background: Menopause is a common general practice presentation. Menopausal hormone therapy (MHT) use in Australia declined rapidly following publication of the WHI study (2002), and then plateaued. Many non-hormonal (non-MHT symptomatic) medications are potential alternatives to MHT. We aimed to assess trends in MHT prescribing following the documented plateau in prescribing. We also aimed to assess trends in MHT versus non-MHT symptomatic medications prescribing.
Method: A longitudinal analysis from the ReCEnT study. In ReCEnT, registrars document 60 consecutive consultations, six-monthly, on three occasions. The outcome factor was MHT (estrogen and/or progestogen) prescribed. All menopause-related problems were included in the primary analysis. The secondary analysis included only menopause-related problems for which MHT or non-MHT symptomatic medicines were prescribed. Associations of MHT-prescribing, including year (2010-2017), were assessed by univariate and multivariable logistic regression.
Results: 1,736 registrars documented 1,569 menopause-related problems for female patients aged 25 years or-over. There were 756 menopause-related problems for which patients were prescribed MHT or a non-MHT symptomatic drug; 626 (39.3% [95% CI 37.4- 42.5] of the total) were prescribed MHT at the index consultation. There was no linear trend in MHT prescription over time. 130 (17.2% [95% CI 14.6-20.1] of the total) had a non-MHT symptomatic drug prescribed. For the ratio of MHT prescription to non-MHT symptomatic menopause medications, there was no significant time-trend.
Discussion: MHT and non-MHT symptomatic drug prescribing remained constant in the period eight to 15 years following WHI publication. This is despite the publication of follow-up studies that might be thought to encourage less restrictive MHT use. It may still be too early to see a rise in MHT prescribing, given the generally slow uptake of research evidence into practice.
Implications for practice: In this complex situation, there is a role for more targeted education of GPs (including registrars) in evidence-based menopausal prescribing.