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The average age of menopause in women in the Western world is 51 years. Women who experience menopause between the ages of 40 and 45 years have what has been called ‘early menopause’, which is reported to occur in approximately 5% of women [1, 2]. These women, with a premature decrease of estrogen production, seem to have an increased risk of overall mortality and morbidity [2–5]. However, to our knowledge, only a few studies have been published on the benefits from long-term hormone therapy (HT) in this population [4,6].

 

According to the standard recommendations, HT should be given to women at premature or early menopause and should be continued at least to age 51–52 years, the average age of menopause in Shuster’s study population (Mayo Clinic Olmsted County, Minnesota) [2].

 

In Sweden, the use of HT in 47–56-year-old women was approximately 6% (data from the Swedish Prescribed Drug Registry 2010–2012), which we consider to be an underutilization of HT when considering the prevalence of symptoms in this age group. We also suspected that the underutilization would be even more pronounced in women aged 40–44 years. 

 

The aim was to determine the number of current and new HT users and the duration of HT use in Swedish women aged 40–44 years with probable early menopause during a 5-year period (July 2005–December 2011). 

 

The study population consisted of all women, nationally registered in Sweden, who were 40–44 years old on 31 December 2005 ([i]n[/i] = 310,404). These women and their HT use were followed from 1 July 2005 until 31 December 2011. Of these women, 5.9% ([i]n[/i] = 18,184) had HT dispensed at least on one occasion between 1 July 2005 and 31 December 2011, 4.3% ([i]n[/i] = 13,229) had been dispensed twice and 3.5% ([i]n[/i] = 10,984) three times. Only 1% of the women were current users when the study started. About 0.9% of women 40–44 years old started HT during the study period and the majority discontinued HT within 1 year; median duration of HT use was 308 days (25th–75th percentile 1059–120 days; mean 598 days) At the end of the study period, only about one-fifth ([i]n[/i] = 487) of women under 45 years at start of HT still used HT.

Author(s)

  • Mats Hammar, Anna-Clara Spetz Holm and Lotta Lindh-Astrand
    Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping University, County Council of  Östergötland, Linköping, Sweden
  • Mikael Hoffmann
    The NEPI foundation, Division of Health Care Analysis, Department of Medicine and Health, Link-ping University, Link-ping, Sweden
  • Mats Fredriksson
    The NEPI foundation, Division of Health Care Analysis, Department of Medicine and Health, Link-ping University, Link-ping, Sweden

Citations

  1. Coulam C, Adamson S, Annegers J. Incidence of premature ovarian failure. Obstet Gynecol 1986;67:604-6
    http://www.ncbi.nlm.nih.gov/pubmed/3960433
  2. Shuster LT, Rhodes DJ, Gostout BS, Grossardt BR, Rocca WA. Premature menopause or early menopause: long-term health consequences. Maturitas 2010;65:161-6
    http://www.ncbi.nlm.nih.gov/pubmed/19733988
  3. Lokkegaard E, Jovanovic Z, Heitmann BL, Keiding N, Ottesen B, Pedersen AT. The association between early menopause and risk of ischaemic heart disease: influence of hormone therapy. Maturitas 2006;53:226-33
    http://www.ncbi.nlm.nih.gov/pubmed/15955642
  4. Rivera CM, Grossardt BR, Rhodes DJ, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 2009;16:15-23
    http://www.ncbi.nlm.nih.gov/pubmed/19034050
  5. Rivera CM, Grossardt BR, Rhodes DJ, Rocca WA. Increased mortality for neurological and mental diseases following early bilateral oophorectomy. Neuroepidemiology 2009;33:32-40
    http://www.ncbi.nlm.nih.gov/pubmed/19365140
  6. Popat VB, Calis KA, Kalantaridou SN, et al. Bone mineral density in young women with primary ovarian insufficiency: results of a three-year randomized controlled trial of physiological transdermal estradiol and testosterone replacement. J Clin Endocrinol Metab 2014;99:3418-26
    http://www.ncbi.nlm.nih.gov/pubmed/24905063
  7. Beral V, Million Women Study C. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003;362:419-27
    http://www.ncbi.nlm.nih.gov/pubmed/12927427
  8. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA 1998;280:605-13
    http://www.ncbi.nlm.nih.gov/pubmed/9718051
  9. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Womens Health Initiative randomized controlled trial. JAMA 2002;288:321-33
    http://www.ncbi.nlm.nih.gov/pubmed/12117397
  10. Hoffmann M, Hammar M, Kjellgren KI, Lindh-Åstrand L, Brynhildsen J. Changes in womens attitudes towards and use of hormone therapy after HERS and WHI. Maturitas 2005;52:11-17
    http://www.ncbi.nlm.nih.gov/pubmed/16023804
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