Postmenopausal hormone therapy in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): who still uses it?

Abstract

PurposeWe aim to investigate the patterns of hormone therapy (HT) use and associated factors in women participating in the Brazilian Longitudinal Study of Adult Health. MethodsThis study included 3281 naturally menopausal women of 40 to 74years of age at enrollment to the Brazilian Longitudinal Study of Adult Health study, who answered questions regarding their use and discontinuation of HT. Prevalence rates of current and previous HT use were calculated, and a multinomial logistic regression model was constructed to simultaneously analyze the associated factors. ResultsThe prevalence of HT use increased from 1995 onwards, peaking at 55.7% in 1997. A sharp decline occurred in the decade beginning in 2000, reaching 11.1% at the study baseline interview (2008-2010). Current use was associated with being 60years of age (Relative Risk Ratio (RRR): 1.81; 95%CI: 1.10-2.96), divorced (RRR: 1.72; 95%CI: 1.14-2.60), or married (RRR: 2.09; 95%CI: 1.41-3.10); having a university education (RRR: 1.66; 95%CI: 1.14-2.40) or postgraduate degree (RRR: 2.45; 95%CI: 1.80-3.35); and having private health insurance (RRR: 2.86; 95%CI: 2.00-4.09). Body mass index 30kg/m(2) was inversely associated with HT use (RRR: 0.37; 95%CI: 0.26-0.53) as was the presence of at least one contraindication to HT use (RRR: 0.63; 95%CI: 0.44-0.89). Of the current users 60years of age, 79.1% had been using HT for at least 5years, and 73.6% had been menopausal for at least 10years. ConclusionAlthough the use of HT has declined in Brazil, the women who continue using it are largely exceeding evidence-based limits of age, time since menopause, and time of use.