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A recently published paper by Sprague and colleagues [1] is the second publication after the report from Steinkellner and colleagues [2] within 6 months showing a sharp and still continuing decline of hormone use in the US following the publication of the preliminary data of the Women’s Health Initiative (WHI) in 2002. The new prospective data collection [1] is based on a complex cluster sampling method to create a sample population from which nationally representative estimates for hormone use can be produced. It describes a decrease of the overall prevalence of oral postmenopausal hormone use from 22.4% (95% confidence interval (CI) 19.0–25.8) in 1999–2000 to an overall prevalence of 11.9% (95% CI 9.6–14.2) in 2003–2004. Since then, hormone use has continued to decline through 2009–2010 across all patient demographic groups, with the current overall prevalence at 4.7% (95% CI 3.3–6.1) in 2010. The decline in hormone use after 2002 was observed among all age groups. Before 2002, current use of postmenopausal hormones was highest among non-Hispanic whites, women who attended college, and women with a higher income-to-poverty ratio. After 2002, the decrease of hormone use was more marked in non-Hispanic whites, and the decline in use was delayed for non-Hispanic blacks and Hispanic women. Non-Hispanic whites continued to have a higher prevalence of hormone use, although the absolute magnitude of the difference in use has declined sharply compared to women from other ethnicities. In conclusion, today, the percentage of American women aged 40 years and older reporting that they are currently using postmenopausal hormones has declined to less than 5%. In 1999–2002, one in five women older than age 40 years was a current user of oral postmenopausal hormones, whereas, by 2009–2010, the prevalence was fewer than 1 in 20.


  • Martin Birkhäuser
    University of Berne, Basel, Switzerland


  1. Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use. Results from the National Health and Nutrition Examination Survey, 19992010. Obstet Gynecol 2012;120:595603.
  2. Steinkellner AR, Denison SE, Eldridge SL, Lenzi LL, Chen W, Bowlin SJ. A decade of postmenopausal hormone therapy prescribing in the United States: long-term effects of the Womens Health Initiative. Menopause 2012;19:616-21.
  3. LaCroix AZ, Chlebowski RT, Manson JA, et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy. A randomized controlled trial. JAMA 2011;305:1305-14.
  4. Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409.
  5. Canonico M, Oger E, Plu-Bureau G, et al. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: The ESTHER Study. Circulation 2007;115:820-2.
  6. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2008;107:103-11.
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