Initiation and Duration of Systemic Hormone Therapy for Menopausal Symptoms.

IF 5.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology Pub Date : 2026-11-01 Epub Date: 2026-07-27 DOI:10.1097/AOG.0000000000006386

Intira Sriprasert, Yongmei Huang, Donna Shoupe, Megan L Evans, Xiao Xu, Jason D Wright

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引用次数: 0

Abstract

Objective: To examine real-world patterns of systemic hormone therapy (HT) initiation and continuation among women with a diagnosis of menopause.

Methods: Using the Merative™ MarketScan® Research Databases (2009-2022), we identified women aged 45-60 years with menopause-related claims and at least 12 months of continuous enrollment. Patients with bilateral oophorectomy, breast or gynecologic cancers, or HT contraindications were excluded. Multivariable regression analyzed factors associated with HT initiation, formulation, and duration.

Results: Of 318,621 eligible women, 21.7% initiated systemic HT within 1 year. Predictors of HT initiation included younger age (adjusted odds ratio [aOR] 2.17; 95% CI, 2.12-2.23), prior hysterectomy (aOR 1.98; 95% CI, 1.77-2.21), and local hormone use (aOR 3.25; 95% CI, 3.05-3.47). Initiation was significantly lower among women with obesity (aOR 0.78; 95% CI, 0.75-0.81), diabetes (aOR 0.69; 95% CI, 0.66-0.72), and Black racial identification (aOR 0.78; 95% CI, 0.68-0.89). Initial formulations were estrogen plus progestogen (52.5%), estrogen-alone (32.4%), and progestogen-alone (15.1%). The median first-episode duration was 6.6 months; 38.8% of patients continued at 12 months. Black racial (adjusted hazard ratio [aHR] 1.52; 95% CI, 1.34-1.73) and Hispanic ethnic (aHR 1.43; 95% CI, 1.14-1.80) identities predicted faster discontinuation. Conversely, prior hysterectomy (aHR 0.75; 95% CI, 0.68-0.83) and concurrent local hormone use (aHR 0.84; 95% CI, 0.80-0.89) reduced discontinuation risk.

Conclusion: Although one-fifth of women initiated systemic HT shortly after their diagnosis, low persistence and racial disparities among those who initiated reveal critical gaps in long-term menopause management. Furthermore, true real-world utilization is likely even lower due to underdocumentation in clinical coding. These findings underscore an urgent need for targeted, equitable interventions to improve treatment adherence and ensure consistent, comprehensive care for menopausal women.

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绝经期症状的全身激素治疗的开始和持续时间。

目的：研究诊断为更年期的妇女开始和继续接受全身激素治疗的现实模式。方法：使用Merative™MarketScan®研究数据库（2009-2022），我们确定了年龄在45-60岁之间、有绝经相关声明且至少连续入组12个月的女性。排除双侧卵巢切除术、乳腺癌或妇科癌症或HT禁忌症患者。多变量回归分析了与HT开始、配方和持续时间相关的因素。结果：在318621名符合条件的女性中，21.7%在1年内接受了全身HT治疗。HT发生的预测因素包括年龄较小（校正优势比[aOR] 2.17; 95% CI, 2.12-2.23）、既往子宫切除术（aOR 1.98; 95% CI, 1.77-2.21）和局部激素使用（aOR 3.25; 95% CI, 3.05-3.47）。在肥胖（aOR 0.78; 95% CI, 0.75-0.81）、糖尿病（aOR 0.69; 95% CI, 0.66-0.72）和黑人种族认同（aOR 0.78; 95% CI, 0.68-0.89）的女性中，起始率明显较低。最初的配方是雌激素加孕激素（52.5%）、单独雌激素（32.4%）和单独孕激素（15.1%）。首发持续时间中位数为6.6个月；38.8%的患者在12个月时继续治疗。黑人（校正风险比[aHR] 1.52; 95% CI, 1.34-1.73）和西班牙裔（aHR: 1.43; 95% CI, 1.14-1.80）身份预测更快的停药。相反，既往子宫切除术（aHR 0.75; 95% CI, 0.68-0.83）和同时局部使用激素（aHR 0.84; 95% CI, 0.80-0.89）可降低停药风险。结论：尽管五分之一的女性在诊断后不久就开始全身激素治疗，但持续时间短和种族差异显示了长期绝经管理的关键差距。此外，由于临床编码中的文档不足，真实世界的利用率可能更低。这些发现强调了迫切需要有针对性的、公平的干预措施，以提高治疗依从性，并确保对更年期妇女的持续、全面的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obstetrics and gynecology 医学-妇产科学

CiteScore

11.10

自引率

4.20%

发文量

867

审稿时长

1 months

期刊介绍： "Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics. "Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.