Elsevier

Maturitas

Volume 40, Issue 2, 30 November 2001, Pages 131-141
Maturitas

Hormone replacement therapy in Norwegian women, 1996–1997

https://doi.org/10.1016/S0378-5122(01)00238-9Get rights and content

Abstract

Objectives: To assess the prevalence of hormone replacement therapy (HRT) among Norwegian women and examine factors related to use. Materials and methods: A random sample of 18,199 Norwegian women aged 45–64 years responded to a postal questionnaire in 1996–1997. The questionnaire included questions about menstruation status and fertility, oral contraceptives (OC) and HRT use, lifestyle, health and socio-economic status. The response rate was 60%. Results: Overall prevalence of ever using systemic or local HRT was 43.9%. Current use was reported by 31.9% of the women. The highest prevalence was in the age group of 55–59 years where 57.4% reported ever use, and 43.1% current use. Mean duration of use among current users was 4.6 years. More than 60% of the women were classified as postmenopausal, two-thirds of them naturally postmenopausal. The prevalence of ever using HRT was 51.8%. Prevalence of use was higher among earlier OC users, smokers, lean women and in households with high income. Among older women, users had a higher educational level than non-users, while this difference disappeared among the youngest of the women. Fixed combinations of estradiol and noretisteroneacetate either cyclic or continuous, are used by six out of ten users. Conclusions: Our results confirm the increasing trend in sales of estrogens in Norway and suggest that user patterns are changing. More than four out of ten women aged 45–64 years reported ever use of HRT, and one out of three reported current use. Socio-economic differences between users and non-users seem to disappear among women under 55 years of age, but persist in the older age groups. Short time use still dominates.

Introduction

In the past, Norwegian women were restrictive in their use of estrogens for peri- and postmenopausal symptoms. Compared with women in other Scandinavian countries they appeared to be more sceptical towards hormone replacement therapy (HRT) than many of their neighbouring sisters [1]. Some of this scepticism was probably due to fear of adverse reactions extrapolated from the use of oral contraceptives (OCs), but there also seems to be a reluctance to interfere with the natural process of ageing [2].

During the last 10 years, however, these patterns have changed Fig. 1. According to sales figures, there has been a considerable increase in the sale of estrogens in this period. If sales figures defined daily doses per day (DDD per day) for 1999 provide an reasonable indication of use, more than 200,000 Norwegian women, or approximately 40% of all women between the ages of 45 and 66, are using some kind of estrogens today [3].

In contrast to USA, where conjugated equine estrogens have been and still are the most frequently prescribed estrogen preparation, the Norwegian market is totally dominated by the natural estrogen estradiol, most often used in combination with a progestagen derivative [3]. Norway and Iceland seem to be the only or among the very few of the countries in Europe where conjugated equine estrogens are not at all available. The only medium potency estrogen available in Norway is the natural estrogen estradiol in different combinations and brands.

A study presented in Maturitas last summer [4] showed no significant increase in use of HRT during the period 1994–1998 in spite of a clear increase in the sale.

The Norwegian women and cancer (NOWAC) study, which is the first population study in this field in Norway, gives us the opportunity to have a closer look at prevalence and user patterns and to see whether or not there is an increasing use of HRT among Norwegian women.

Section snippets

Materials and methods

The Norwegian women and cancer study (NOWAC) is a population based, prospective study based on questionnaires mailed to women aged 30–70 years.

This report is based on cross-sectional data for women aged 45–64 years whose names were drawn randomly from the Central Population Register.

Norway has a Central Population Register of all inhabitants including those with temporary residency status. All persons living in Norway have been given a unique identification number, which includes information on

Results

The mean age of the women was 53 years and their mean education 11.6 years. About 60% of the women had a normal BMI, while 30% tended to be overweight and about 9% were obese. A majority of 80% were married or living with a partner.

Table 1 shows that more than 60% of the women were classified as postmenopausal. Less than 25% were premenopausal, 8% perimenopausal, and 7% of the women were unable to decide upon their own menstruation status. These women were classified as ‘uncertain status’, 99%

Methodology

The final response rate was 60%. This could imply a problem with selection bias of which we have two different types. One is the non-coverage type caused by not capturing participants by the actual mechanism of contact. The other is the non-response type, either due to non-completion or unwillingness to participate. In our study the non-coverage problem is almost non-existent (less than 0.5%), as the personal identification number is mandatory in Norway, frequently used for instance by the tax

Concluding remarks

The study shows that prevalence numbers have increased from 1996 to 1997. Our findings confirm estimates based on the sales figures in the same period, which say that almost every third woman between 45 and 64 years was using estrogens per os or trans-cutaneously in Norway in 1996–1997.

High household income, BMI≤30, ever smoking and use of OCs was positively related to HRT use. However, our data seem to indicate that the impact of socio-economic differences on the prevalence of HRT is

References (35)

  • G.M. Egeland et al.

    Premenopausal determinants of menopausal estrogen use

    Prev. Med.

    (1991)
  • P. Topo et al.

    Declining socioeconomic differences in the use of menopausal and postmenopausal hormone therapy in Finland

    Maturitas

    (1999)
  • M. Hammar et al.

    Hormone replacement therapy and previous use of oral contraceptives among Swedish women

    Maturitas

    (1996)
  • G.M. Egeland et al.

    Characteristics of noncontraceptive hormone users

    Prev. Med.

    (1988)
  • A.J. Sogaard et al.

    Østrogenbehandling [Estrogen replacement]

    Tidsskr. Nor. Laegeforen.

    (1998)
  • Norsk medisinaldepot, Legemiddelforbruket i Norge 1994–1998 [Drug consumption in Norway 1994–1998], Norsk...
  • World Health Organization, Obesity: preventing & managing the global epidemic, WHO, Geneva, 1998, pp....
  • Cited by (49)

    • Changes in Hormone Therapy Prescriptions Among Middle-Aged Women in Taiwan: Implications for Health Needs at Menopause

      2011, Women's Health Issues
      Citation Excerpt :

      In European countries, such as the United Kingdom, France, Denmark, Norway, and Sweden, the prevalence rate of HT use among middle-aged women or older exceeded 30% in the late 1990s. After the WHI reports, the rate declined by 15% within 1 year, falling by 40% by 2004 (Bakken, Eggen, & Lund, 2001; Gayet-Ageron et al., 2005; Mishra et al., 2006; Oddens & Boulet, 1997; Thunell, Stadberg, Milson, & Mattsson, 2005). Most of the above-mentioned studies, however, were concerned with HT reduction.

    View all citing articles on Scopus

    The Norwegian women and cancer (NOWAC) study 1996–1997

    View full text