Hormone therapy might be underutilized in women with early menopause

STUDY QUESTION: Are Swedish women age 40-44 years with assumed early menopause 'undertreated' by hormone therapy (HT)? SUMMARY ANSWER: Many women with probable early menopause discontinue their HT after a short period of time. Thus, they fail to complete the recommended replacement up to age 51-52 years, the average age of menopause. WHAT IS KNOWN ALREADY: Spontaneous early menopause occurs in similar to 5% ofwomen age 40-45 years. Regardless of the cause, women who experience hormonal menopause due to bilateral oophorectomy before the median age of spontaneous menopause are at increased risk of cardiovascular disease, neurological disease, osteoporosis, psychiatric illness and even death. STUDY DESIGN, SIZE, DURATION: The study is descriptive, and epidemiological and was based on the use of national registers of dispensed drug prescriptions (HT) linking registers from the National Board of Health and Welfare and Statistics Sweden from 1 July 2005 until 31 December 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study population consisted of 310 404 women, 40-44 years old on 31 December 2005 who were followed from 1 July 2005 until 31 December 2011. MAIN RESULTS AND THE ROLE OF CHANCE: Only 0.9% of women 40-44 years old started HT during the study period. A majority of these women used HT < 1 year. LIMITATIONS, REASONS FOR CAUTION: We do not know the indications that led to the prescription of HT but assume that early onset of menopause was the main reason. Because of the study design-making a retrospective study of registers-we can only speculate on the reasons for most of the women in this group discontinuing HT. Another limitation of this study is that we have a rather short observation time. However, we have up to now only been able to collect and combine the data since July 2005. WIDER IMPLICATIONS OF THE FINDINGS: As the occurrence of spontaneous early menopause in women age 40-45 is reported to be similar to 5%, the fact that < 1% of Swedish women age 40-44 are prescribed HT, and can be shown also to have had the medication dispensed at a pharmacy suggests an unexpectedly low treatment rate. Some women with early menopause may have used combined contraceptives as supplementation therapy, but in Sweden HT is the recommended treatment for early menopause so any such women are not following this recommendation. Women who experience early menopause are at increased risk for overall morbidity and mortality, and can expect to benefit from HT until they have reached at least the median age of spontaneous menopause. It is therefore important to individualize the information given these women and to convey new knowledge in this area to gynaecologists and physicians in general as well as the recommendation that women in this group continue HT at least until the average age for spontaneous menopause is reached.