The number of first HRT prescriptions has increased steadily between 2010-21, according to a new study.

In 2002, the Women’s Health Initiative (WHI) trial linked hormone replacement therapy (HRT) with cardiovascular disease and breast cancer. HRT prescribing in the UK decreased between 2000-2005 and then remained steady until 2015. Further studies from the WHI, together with other studies and guidelines, including from NICE, have since clarified the risks and benefits of HRT. 

In the new study, researchers used primary care data of 1,908,177 women with recorded menopause and/or 50 years and older. HRT prescribing rose from 5.01 per 1,000 person-years at risk (PYAR) in 2010 to 18.16 in 2021, an increase of 13.6 per cent a year.

New prescriptions for fixed combinations of oestrogen plus progesterone and oestrogen-only HRT showed average annual increases of 17.6 and 16.7 per cent a year respectively. New prescriptions for progestins and sequential preparations increased by 13.2 and 4.3 per cent. 

Non-oral formulations, which seem to be associated with a lower risk of venous thromboembolism than oral HRT, are increasingly popular. 

Transdermal and locally administered HRT increased by, on average, 31.5 and 34.1 per cent a year respectively. 

In contrast, oral formulations increased by an average of 1.7 per cent a year. The rate of first prescriptions for testosterone therapy (for hypoactive sexual desire disorder) was relatively constant. 

The increase in new HRT prescribing was higher in younger women: 11.7 and 7.7 per cent in women aged 50-59 and 60-69 years respectively. 

“Increased prescribing of medicines used for the management of symptoms of menopause may reflect improved awareness by women and healthcare professionals,” the authors conclude. “Our findings suggest that the initial decrease in HRT prescribing after the first WHI trial has recovered.” (JAMA 2002;288:321-333 BJGP Open 2022: 10.3399/BJGPO.2022.0126)