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

Robin Andrews Orcid Logo, Arron Lacey Orcid Logo, Kate Bache, Emma J. Kidd

BJOG: An International Journal of Obstetrics & Gynaecology

Swansea University Author: Arron Lacey Orcid Logo

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DOI (Published version): 10.1111/1471-0528.18220

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:...

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Published in: BJOG: An International Journal of Obstetrics & Gynaecology
ISSN: 1470-0328 1471-0528
Published: Wiley 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69544
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.
Keywords: HRT, HRT adherence, HRT discontinuation, HRT trends, menopausal symptoms, menopause, oestrogen
College: Faculty of Medicine, Health and Life Sciences
Funders: Peer-reviewed project funded by The Waterloo Foundation, grant reference 1890/5027; the funder is not involved in any aspect of the work. Additional funding for the same project is provided by Health & Her, with Kate Bache involved in the conception of the ideas and the writing of the manuscript.

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