A Sustained Decline in Postmenopausal Hormone Use Results From the National Health and Nutrition Examination Survey, 1999-2010

OBJECTIVE: Short-term declines in postmenopausal hormone use were observed after the Women's Health Initiative trial results in 2002. Although concerns about the trial's generalizability have been expressed, long-term trends in hormone use in a nationally representative sample have not been reported. We sought to evaluate national trends in the prevalence of hormone use and to assess variation by type of formulation and patient characteristics. METHODS: We examined postmenopausal hormone use during 1999-2010 using cross-sectional data from 10,107 women aged 40 years and older in the National Health and Nutrition Examination Survey. RESULTS: In 1999-2000, the prevalence of oral postmenopausal hormone use was 22.4% (95% confidence interval [CI] 19.0 -25.8) overall, 13.3% (95% CI 11.0-15.5) for estrogen only, and 8.3% (95% CI 6.2-10.4) for estrogen plus progestin. A sharp decline in use of all formulations occurred in 2003-2004, when the overall prevalence decreased to 11.9% (95% CI 9.6-14.2). This decline was initially limited to non-Hispanic whites; use among non-Hispanic blacks and Hispanics did not decline substantially until 2005-2006. Hormone use continued to decline through 2009-2010 across all patient demographic groups, with the current prevalence now at 4.7% (95% CI 3.3-6.1) overall, 2.7% (95% CI 1.9-3.4) for estrogen only, and 1.7% (95% CI 0.7-2.7) for estrogen plus progestin. Patient characteristics currently associated with hormone use include history of hysterectomy, non-Hispanic white race or ethnicity, and income. CONCLUSION: Postmenopausal hormone use in the United States has declined in a sustained fashion to low levels across a wide variety of patient subgroups. (Obstet Gynecol 2012; 120: 595-603) DOI: http://10.1097/AOG.0b013e318265df42 LEVEL OF EVIDENCE: II