OBJECTIVE: Vasomotor symptoms (VMS) are the most frequently reported menopausal symptoms leading women to seek medical care. Current treatment options include hormonal as well as nonhormonal therapies (eg, selective serotonin reuptake inhibitors [SSRIs] or serotonin-norepinephrine reuptake inhibitors [SNRIs], herbal remedies, dietary supplements, lifestyle modifications). Our objective was to describe current treatment patterns for menopausal symptoms and associated healthcare resource use in the United States.
DESIGN: This noninterventional, observational study was performed with a convenience sample of 283 healthcare providers (HCPs) equally distributed by US region. Participating HCPs were gynecologists (38%), primary care physicians (43%), and advanced practice providers in gynecology (9%) and primary care (11%) who provided patient data; 87% of HCPs were in office-based private practice. Data on prescription and nonprescription therapy and menopause-specific healthcare resource use were abstracted from medical records of US women who initially presented with menopausal complaints (including VMS) between 1 Jan 2016 and 31 Dec 2019 and were aged 40‒60 years. Data were collected from 16 Oct 2020 to 28 Jan 2021.
RESULTS: Data from 1,016 women (mean age [SD]: 53 [4.4] years) were analyzed; 342 were current (9%) or former (25%) smokers. Menopausal symptoms were the primary reason for making an appointment for 50% of the sample and were discussed at a routine visit by 49%. The most common symptoms at initial presentation were hot flashes (91%), sleep problems (50%), and vaginal dryness (47%). Half (513 [51%]) had menopausal symptoms for ≥6 months before reporting them to the HCP. At least one comorbidity was present in 646 (64%) women, most commonly hypertension (407 [40%]), headaches/migraines (184 [18%]), and diabetes (144 [14%]). Therapy for menopausal symptoms was recorded for 883 (87%) women, of whom 249 (28%) initiated prescription medication only, 272 (31%) initiated nonprescription therapy only, and 362 (41%) initiated both; 133 (13%) had no recorded therapy. Demographic characteristics were generally similar regardless of the use of therapy. Among the 611 women with a documented prescription medication for treatment of menopausal symptoms, the most prescribed therapies were estrogen (systemic or local) alone (244 [40%], includes compounded in 15 [2.5%]), combination estrogen/progestogen (228 [37%], includes compounded in 26 [4.3%]), SSRIs/SNRIs (126 [21%]), and other nonhormonal treatments (<5% each). Most (88%) women who were prescribed treatment did not receive prescriptions for more than one medication for menopausal symptoms. Estrogen-based treatments were initiated primarily because of established efficacy, HCP recommendation, and patient perception. Among the 634 women reporting a nonprescription treatment, the most common, excluding lifestyle interventions, was black cohosh (190 [30%]), chosen based on patient perception (94 [49%]), advice from family/friends (51 [27%]), and efficacy (41 [22%]). Therapy modification was documented for 52 (27%) patients taking black cohosh, primarily owing to lack of efficacy (38 [73%]). Women had a mean (SD) of 2 (2.0) office visits related to menopause. Referrals to menopause specialists (5%) and endocrinologists (3%) and for procedures (hysteroscopy [5%], pelvic ultrasound [20%], and hysterectomy [0.3%]) were uncommon during the documented visits. Blood tests were performed for 46% of women. Visits to complementary healthcare providers were also uncommon (11%).
CONCLUSION: Our findings point to several potential unmet needs of women with VMS associated with menopause: 51% delayed seeking care for ≥6 months, about 40% had no prescription medication documented, and 13% had no prescription or nonprescription therapy documented in their medical record.
