From the Journals

Postmenopausal estrogen use down since 2006



Use of oral estrogens declined by half during 2007-2015 in women aged 50 years and older, but trends have varied for other forms of estrogen, according to a commercial database with prescription claims for more than 12 million women.

The prevalence of prescriptions for noncontraceptive oral estrogen dropped from 83 per 1,000 women in 2007 to 42 per 1,000 in 2015 for women aged 50 years and older, Joel L. Weissfeld, MD, MPH, of the Office of Surveillance and Epidemiology at the Center for Drug Evaluation and Research at the Food and Drug Administration, and his associates reported based on data from IQVIA Real World Data Adjudicated Claims – U.S. Database.

Prescription claims for estrogen among 50- to 54-year-olds
“In the wake of a marked [Women’s Health Initiative]–related decline in the use of oral estrogens, we observed an age-specific rise in the use of vaginal ring and insert products between 2006 and 2011,” they wrote.

Prescriptions for vaginal forms (creams, rings, and inserts) rose from 27 per 1,000 women in 2006 to 42 per 1,000 in 2011 but declined to 35 per 1,000 by 2017, the investigators reported in Menopause.

For women aged 50-54 years, use of vaginal rings and inserts was steady for 2 years and then dropped every year after 2009, with prevalence lower in 2017 than in 2006. Vaginal ring/insert use increased for the first 2 years among those aged 55-59 years and for the first 5 years for those aged 60-64 years, but then each group started a fairly rapid and ongoing decline that had 2017 levels below those in 2006. Among women aged 65 years and older, however, prevalence of ring/insert use rose for most of the study period, and the declines left prevalences for 2015 above those for 2006, Dr. Weissfeld and his associates wrote.

The data source couldn’t provide reasons for use of vaginal rings or inserts, but the researchers noted that it’s possible that use for vasomotor symptoms “predominated in younger (aged 50-59 years) women closer in age to the onset of menopause. We presume that use for [vulvar and vaginal atrophy] predominated in women 60-65 years of age and older, women who are more distant in age from onset of menopause.”

Trends for use of transdermal patches also varied by age group but with smaller levels of difference. Use among women aged 50-54 years and 55-59 years fluctuated but showed no overall change. Those aged 60-64 years had a gradual decline over the study period, those aged 70-74 years had an initial increase in 2007 and then a decline, and those aged 75 years or older had an increase that lasted until 2011 before use started to fall, they wrote.

SOURCE: Weissfeld JL et al. Menopause. 2018;25(6):611-14.

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