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Insufficient use of menopausal hormone therapy in Swedish women with early or premature menopause caused by bilateral oophorectomy: a register-based study
Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Kalmar Cty Hosp, Sweden.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Orebro Univ, Sweden.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0003-3067-8587
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. NEPI Fdn, Sweden.ORCID iD: 0000-0001-9420-3316
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2023 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Article in journal (Refereed) Epub ahead of print
Abstract [en]

ObjectiveTo investigate the use of menopausal hormone therapy (MHT) in premenopausal women after bilateral oophorectomy.DesignRetrospective register-based cohort study.SettingSweden.PopulationSwedish women aged 35-44 years without malignancy who underwent bilateral oophorectomy in 2005-2020 were identified using The Swedish National Quality Register of Gynaecological Surgery (GynOp).MethodsData from GynOp were cross-linked with data on dispensed drugs extracted from the Swedish Prescribed Drug Register.Main outcome measuresProportion of women dispensed MHT at least once within 1 year after surgery. Repeated treatment episodes were defined, and the proportion of person time covered by dispensations was analysed.ResultsIn total, 1231 of all women (n = 1706) were dispensed MHT at some point after surgery, with 1177 women dispensed MHT within 1 year. This proportion increased from 64% in 2005 to 84% in 2019 (p < 0.001). In the total population, 4537 treatment years transpired, corresponding to 43% of the mean time covered. In women dispensed MHT within 1 year, the proportion of time covered was 63%.ConclusionsOnly 69% of all women without malignancy of any kind who underwent bilateral oophorectomy were dispensed MHT within 1 year after surgery, and the duration of treatment was limited. It is important to study further the reasons behind the low dispensation rate in this group to increase adherence to current treatment guidelines, improve quality of life, and avoid increased morbidity and mortality.

Place, publisher, year, edition, pages
WILEY , 2023.
Keywords [en]
early menopause; menopausal hormone therapy; oophorectomy; premature menopause
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-198078DOI: 10.1111/1471-0528.17647ISI: 001061861400001PubMedID: 37667667OAI: oai:DiVA.org:liu-198078DiVA, id: diva2:1799963
Note

Funding Agencies|Forskningsradet i Sydostra Sverige; NEPI foundation

Available from: 2023-09-25 Created: 2023-09-25 Last updated: 2023-10-11
In thesis
1. Epidemiological and Clinical Aspects of Hormonal Contraception and Menopausal Hormone Therapy in Women
Open this publication in new window or tab >>Epidemiological and Clinical Aspects of Hormonal Contraception and Menopausal Hormone Therapy in Women
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The main indications for therapy with female sex hormones are contraception and menopausal hormone therapy (MHT). The aim of this thesis was to investigate the use of hormonal contraception and MHT in different populations of women in Sweden, 2000–2021. The use of contraception in women with obesity was studied. The use of MHT in Sweden over time was studied and different run-in periods were validated to define an incident MHT user. We also investigated the risk of pulmonary embolism (PE) in women using MHT, including considerations regarding administration form, treatment duration and type of progestin used. Women with premature or early menopause after bilateral oophorectomy were studied with regard to dispensed MHT.

Material and Methods: The studies were based on different data sources including electronical medical records, national mandatory health registers, and a national quality register (GynOp). The use of MHT over time was studied using defined daily doses (DDD) per 1,000 women per day, one-year prevalence and incidence proportion. The definition of an incident drug user was validated by calculating the predictive value of different run-in periods.

Results: The most prescribed contraceptive method in women with obesity was progestin-only pills (44%), but 21% were prescribed combined hormonal contraceptives contrary to Swedish and European guidelines. Incident users with obesity were significantly more likely to discontinue their contraceptive method within one year, compared with normal weight women. The use of MHT decreased significantly after the turn of the century. In the 50–54 years age interval, the dispensed amount decreased from 282 DDD/1,000 women per day in 2000, to 77 in 2006. It then stabilised around 50 DDD/1,000 women per day during 2010 to 2017. The one-year prevalence followed the same pattern, with a plateau 2010–2016. From 2017, an increase in MHT dispensations was observed. A run-in period of 18 months had a PV of 88% in the 50 to 54 years age group and was found to be suitable and reliable for defining incident users of MHT at the ages close to menopause. The risk of PE was significantly increased in users of oral MHT, but not transdermal. The risk was highest in first-ever users (OR 2.32; 95% CI, 1.34–4.00) and was considerably lower in women who may have used MHT previously (OR 1.38; 95% CI, 1.01–1.89). 69% of all women with a bilateral oophorectomy had at least one dispensation of MHT within one year after surgery. Within this treated group the estimated treatment time constituted 63% of the remaining time to natural menopause.

Conclusions: Progestin-only pills was the most prescribed contraceptive method in women with obesity, but many women with obesity were prescribed combined hormonal contraceptives contrary to clinical guidelines. The use of MHT decreased significantly after the turn of the century, but has increased since 2017 in the age groups close to menopause. The classifications used for prevalent and incident drug use are of importance to the results. The risk of pulmonary embolism is increased in users of oral but not transdermal MHT. There seems to be a significant undertreatment with hormone therapy in women with premature, surgical menopause.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. p. 106
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1849
Keywords
Hormonal contraceptives, Obesity, Menopausal hormone therapy, Hormone replacement therapy, Pulmonary embolism, Premature menopause, Pharmacoepidemiology
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-193217 (URN)10.3384/9789180751216 (DOI)9789180751209 (ISBN)9789180751216 (ISBN)
Public defence
2023-05-25, Hjärnan, Länssjukhuset Kalmar, Kalmar, 13:00 (Swedish)
Opponent
Supervisors
Note

Funding agencies: The Medical Research Council of Southeast Sweden (FORSS), Region Kalmar County, and the NEPI foundation – the Swedish Network for Pharmacoepidemiology

Updates:

2023-04-21 The thesis was first published online. The online published version reflects the printed version.

2023-08-29 The thesis was updated with an errata list which is also downloadable from the DOI landing page. Before this date the PDF has been downloaded 148 times.

Available from: 2023-04-21 Created: 2023-04-21 Last updated: 2023-10-11Bibliographically approved

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Sundell, MicaelaBrynhildsen, JanFredrikson, MatsHoffmann, MikaelSpetz Holm, Anna-Clara
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Division of Children's and Women's HealthFaculty of Medicine and Health SciencesDepartment of Gynaecology and Obstetrics in LinköpingDivision of Inflammation and InfectionDivision of Society and Health
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