Objectives: To review the history, current clinical practice, choice of methods and number of prescriptions and sales of hormone replacement therapy (HRT) in the US.
Methods: Literature review, survey data collection, sales and prescription data.
Results: The number of women currently utilizing HRT is greater in women aged 40-60 (35%) but falls with advancing age greater than 65 (15%) and declines further in women greater than 80 (7%). News media and physicians represent the largest source of information used by US women for information regarding HRT. Obstetricians and gynecologists currently are the predominant physicians prescribing HRT, but in the future, family practitioners and paramedical workers will prescribe HRT. Women who spontaneously develop menopause early and younger women undergoing castration are more likely to take transdermal estrogen. However, the majority of prescriptions in the US are oral estrogens (86% of the market). The market leader of oral estrogens in the US are conjugated equine estrogens (70%). Fifty percent of prescriptions in women with a uterus consist of combined continuous estrogen and progestogen whereas as 42% consist of cyclic estrogen and progestogen.
Conclusions: It appears that although there is an increase in HRT use by postmenopausal women in the US, the actual percentage of current users remains lower than anticipated. This occurred in spite of widespread media and educational efforts of benefits of HRT. Many women still fear the risk of breast and uterine cancer as well as the side effects of estrogen (primarily bleeding) which reduces the number of women currently taking estrogen. A number of surveys suggested that most women receive their information from the media and an equal amount from their physicians. With respect to estrogen use alone the majority of prescriptions are written for women without a uterus. Transdermal estrogens are used more commonly in women in the early postmenopausal period. In women with a uterus, most US physicians prescribe a combination of estrogen plus a progestogen, but when they do they utilize oral estrogen rather than transdermal estrogen.