Use of hormone replacement therapy by postmenopausal women after publication of the women's health initiative trial

Background. After publication of the Women's Health Initiative (WHI) trial in July 2002, many physicians discontinued hormone replacement therapy (HRT) in most of their postmenopausal patients. However, little is known about the women who remain on HRT. Methods. We performed a retrospective chart analysis of 1000 postmenopausal women seen at an internal medicine practice to establish the prevalence of continued HRT use after publication of the WHI trial, determine the reasons for its use, and establish the prevalence of conditions adversely affected by HRT. Results. Of 1000 postmenopausal women, mean age 66 +/- 9 years, 445 (45%) had used or still were on HRT (HRT users) at the time of the review. Of 445 HRT users, 159 (36%) were still on HRT, whereas 286 women (64%) had discontinued therapy. Of the latter, 181 women (63%) had stopped using HRT after the WHI publication, and 136 women (48%) reported the study as the direct cause of HRT cessation. Of the 159 women still on HRT, the main reasons for continued use were severe menopausal symptoms in 39 women (25%), osteoporosis or osteopenia in 31 women (20%), and patient preference in 20 women (13%). Of the 159 women still on HRT, 41 had atherosclerotic disease (26%), 7 had previous venous thromboembolic disease (4%), 8 had a history of breast cancer (5%), and 12 had a family history of breast cancer (8%). Conclusions. Despite the widespread impact of the WHI trial results, many women still remained on HRT in an internal medicine practice for a variety of reasons and despite relative contraindications to its use.