מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – If findings from a Massachusetts health plan are any indication, long-term postmenopausal hormone replacement therapy (HRT) has become uncommon in clinical practice in the US, especially when it is used as an alternative to antidepressant therapy.
Dr. Robert F. Reynolds, of Pfizer Inc., New York, and colleagues examined the rate and predictors of HRT discontinuation among 992 women who began treatment between 1993 and 1995 in a Massachusetts health plan. The women (ages 45 to 59 years) were followed for 2 years after they filled a prescription for estrogen.
By the end of the first year of followup, 53% of the women had discontinued therapy, the team reports in the October issue of the Journal of Clinical Epidemiology. Twenty percent discontinued after the first month, and 33% discontinued by the fourth month. By the end of the study, 65% had stopped using HRT.
The investigators report that a prescription from a gynecologist was associated with a lower rate of discontinuation (RR = 0.82). They speculate that this may be because gynecologists are more likely to prescribe regimens that reduce side effects and may explain the risks and benefits of therapy better than other physicians.
Having a mammogram 1 year prior to therapy initiation was also associated with a lower rate of discontinuation (RR = 0.75). The authors note that this "likely reflects a woman's general orientation to preventive health measures and her willingness to use medical technologies to manage health risks."
Use of monoamine oxidase inhibitors or selective serotonin reuptake inhibitors 3 months prior to initiation (RR = 2.07) and enrollment in the health plan for less than 3 years (RR = 1.31) significantly increased the likelihood of discontinuation.
Estrogen is believed to inhibit monoamine oxidase activity, the researchers note. They point out that some physicians may prescribe HRT in place of or in addition to antidepressants to relieve mood swings related to menopause.
The team reports that the year a woman entered the cohort was associated with a rapidly increasing rate of HRT discontinuation. Compared with women enrolling in 1993, those enrolling in 1994 were 40% more likely to discontinue therapy, and those enrolling in 1995 were 95% more likely to discontinue.
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