Impact of Global Consensus Statement on compliance with hormonal therapy for surgical menopause

Abstract

Objective

Initiation of and compliance with menopausal hormonal therapy (MHT) have been dropping due to the 2002 Women’s Health Initiative (WHI) publication. We evaluated the change in practice of MHT for surgical menopause after implementing the 2013 ‘Global Consensus Statement on MHT’ to our institutional guideline.

Methods

A retrospective study was conducted in surgically menopausal women newly registering at the Siriraj Menopause Clinic in a university hospital, Thailand, from 1995 to 2013. The patients were categorized into four groups according to periods of MHT initiation: 1995–1998 (control), 2000–2003 (WHI affected), 2005–2008 (post WHI) and 2010–2013 (Global Consensus Statement affected). Their 3-year compliance with MHT was compared using forward stepwise regression analysis.

Results

There were 288, 156, 107 and 104 cases in the 1995–1998, 2000–2003, 2005–2008 and 2010–2013 groups. Their mean age at surgery was 42.8 ± 4.7 years. After the first, second and third years, overall compliance was 82.4%, 70.9% and 61.2%, respectively. The 3-year compliance drastically dropped in the 2000–2003 group, and then improved to control level in the 2010–2013 group (51.9% vs. 77.9%, p = 0.035).

Conclusion

The initiation of MHT continuously dropped during 2000–2013; however, compliance with MHT initiated during 2010–2013 improved after implementing the 2013 ‘Global Consensus Statement on MHT’ to our institutional guideline. Each institute should have a strategy to encourage the initiation of and compliance with MHT for surgical menopause to achieve long-term health benefits.

摘要

目的：由于2002年妇女健康倡议（WHI）的发表, 绝经期激素治疗（MHT）的开始和依从性有所下降。在我们的机构指南中实施2013年的“MHT全球共识声明”后, 我们评估了在手术绝经后MHT实践变化。

方法：对1995年至2013年在泰国Siriraj一所大学医院的更年期诊所新登记的手术绝经妇女进行回顾性研究。根据MHT开始的时间段, 将患者分为四组：1995-1998年（对照组）、2000-2003年（WHI受影响）、2005-2008年（WHI后）和2010-2013年（受全球共识声明影响）。采用前向逐步回归分析比较他们3年的MHT依从性。

结果：1995年至1998年、2000年至2003年、2005年至2008年和2010年至2013年组中分别有288例、156例、107例和104例。他们接受手术的平均年龄是42.8 ± 4.7年。在第一年、第二年和第三年之后, 总体依从性为82.4%, 70.9%和61.2%。2000-2003年组的三年依从性大幅下降, 然后在2010-2013年组提高到稳定水平（51.9%VS77.9%, p=0.035）。

结论：2000年至2013年, MHT的启动率持续下降；然而, 在我们的机构指南中实施了2013年的“MHT全球共识声明”后, 2010-2013年启动的MHT有所提升。每个研究所都应该有一个策略来鼓励在手术绝经期间开始并持续MHT, 以实现长期的健康效益。

Keywords:

• Menopausal hormonal therapy
• compliance
• guideline
• surgical menopause

Acknowledgements

The authors gratefully acknowledge Mr Suthipol Udompunturak for statistical analyses, Ms Nitchamon Pingkul for data collection and Ms Chongdee Dangrat for data cleaning.

Potential conflict of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

Research and Development Fund, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.