Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996-2023: An Observational Study of the Welsh Population.

Abstract

OBJECTIVE To analyse prescribing trends for oral and transdermal hormone replacement therapy (HRT) in Wales from 1996 to 2023, including predictors of discontinuation within one year of initiation. DESIGN Observational study using the Secure Anonymised Information Linkage (SAIL) databank. SETTING Primary and secondary care data from Wales, encompassing 86% of the population. POPULATION Annual HRT prescription rates from 1996 to 2023 were assessed for all women in Wales. Predictors of HRT discontinuation within one year were assessed in women aged 40-65 (n = 103 114), excluding those with oophorectomy, hysterectomy, or premature menopause. METHODS HRT prescription rates were calculated per 1000 women per year and stratified by HRT type, age groups and deprivation quintiles. Predictors of discontinuation were assessed using a zero-inflated negative binomial regression. MAIN OUTCOME MEASURES Annual HRT prescription rates and predictors of discontinuation, including age, deprivation, time period and HRT type. RESULTS From 1996 to 2023, 292 707 women were prescribed oral or transdermal HRT in Wales. Transdermal prescriptions rose exponentially post-2021, whereas oral prescriptions declined post-2002. Discontinuation rates followed a curvilinear trend: increasing at ages 40-43 and mid-50s onwards and decreasing in mid-40s to early 50s. Oral formats were linked to decreased discontinuation, whereas transdermals showed increased discontinuation. Deprivation reduced HRT prescriptions overall. Prescriptions post-2000 predicted increased discontinuation, with highest rates seen post-2021. CONCLUSIONS Disparities in HRT prescribing patterns reflect GP and patient perceptions of safety. Women in their mid-40s to early 50s, often at a natural menopause stage, adhered better, particularly to oral tablets, suggesting that administration route and symptom relief influence adherence. Socio-economic deprivation remains a barrier to HRT access. Time trends highlight the influence of widely publicised studies and media on uptake, albeit adherence has continually declined since 2001. Additional research is needed to tackle socio-economic inequalities and assess strategies for achieving cost-effective and efficient HRT prescribing practices.