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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
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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&#x2013;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&#x2010;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&#x2010;2021, whereas oral prescriptions declined post&#x2010;2002. Discontinuation rates followed a curvilinear trend: increasing at ages 40&#x2013;43 and mid&#x2010;50s onwards and decreasing in mid&#x2010;40s to early 50s. Oral formats were linked to decreased discontinuation, whereas transdermals showed increased discontinuation. Deprivation reduced HRT prescriptions overall. Prescriptions post&#x2010;2000 predicted increased discontinuation, with highest rates seen post&#x2010;2021. Conclusions: Disparities in HRT prescribing patterns reflect GP and patient perceptions of safety. Women in their mid&#x2010;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&#x2010;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. 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spelling 2025-11-10T14:40:09.2561271 v2 69544 2025-05-20 Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population b69d245574e754d2637cc9e76379fe11 0000-0001-7983-8073 Arron Lacey Arron Lacey true false 2025-05-20 MEDS 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. Journal Article BJOG: An International Journal of Obstetrics & Gynaecology Wiley 1470-0328 1471-0528 HRT, HRT adherence, HRT discontinuation, HRT trends, menopausal symptoms, menopause, oestrogen 19 5 2025 2025-05-19 10.1111/1471-0528.18220 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 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. 2025-11-10T14:40:09.2561271 2025-05-20T14:44:34.2815070 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science Robin Andrews 0000-0002-5149-7649 1 Arron Lacey 0000-0001-7983-8073 2 Kate Bache 3 Emma J. Kidd 4 69544__34321__55fda2da3af04cfe92eafd07b36ed5d4.pdf 1471-0528.18220.pdf 2025-05-20T14:44:34.2748580 Output 564301 application/pdf Version of Record true © 2025 The Author(s). This is an open access article under the terms of the Creative Commons Attribution License (CC BY). true eng http://creativecommons.org/licenses/by/4.0/
title Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population
spellingShingle Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population
Arron Lacey
title_short Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population
title_full Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population
title_fullStr Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population
title_full_unstemmed Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population
title_sort Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996‐2023: An Observational Study of the Welsh Population
author_id_str_mv b69d245574e754d2637cc9e76379fe11
author_id_fullname_str_mv b69d245574e754d2637cc9e76379fe11_***_Arron Lacey
author Arron Lacey
author2 Robin Andrews
Arron Lacey
Kate Bache
Emma J. Kidd
format Journal article
container_title BJOG: An International Journal of Obstetrics & Gynaecology
publishDate 2025
institution Swansea University
issn 1470-0328
1471-0528
doi_str_mv 10.1111/1471-0528.18220
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 1
active_str 0
description 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.
published_date 2025-05-19T05:28:54Z
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