Epidemiological and Clinical Aspects of Hormonal Contraception and Menopausal Hormone Therapy in Women

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Fältnamn	Indikatorer	Metadata
000		06820nam a2200517 4500
001		oai:DiVA.org:liu-193217
003		SwePub
008		230421s2023 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
020		a 9789180751209q print
020		a 9789180751216q electronic
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-1932172 URI
024	7	a https://doi.org/10.3384/97891807512162 DOI
040		a (SwePub)liu
041		a engb eng
042		9 SwePub
072	7	a vet2 swepub-contenttype
072	7	a dok2 swepub-publicationtype
100	1	a Sundell, Micaela,d 1989-u Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten4 aut0 (Swepub:liu)micsu56
245	1 0	a Epidemiological and Clinical Aspects of Hormonal Contraception and Menopausal Hormone Therapy in Women
264	1	a Linköping :b Linköping University Electronic Press,c 2023
300		a 106 s.
338		a electronic2 rdacarrier
490	0	a Linköping University Medical Dissertations,x 0345-0082 ;v 1849
500		a Funding agencies: The Medical Research Council of Southeast Sweden (FORSS), Region Kalmar County, and the NEPI foundation – the Swedish Network for PharmacoepidemiologyUpdates:2023-04-21 The thesis was first published online. The online published version reflects the printed version.2023-08-29 The thesis was updated with an errata list which is also downloadable from the DOI landing page. Before this date the PDF has been downloaded 148 times.
520		a Background: The main indications for therapy with female sex hormones are contraception and menopausal hormone therapy (MHT). The aim of this thesis was to investigate the use of hormonal contraception and MHT in different populations of women in Sweden, 2000–2021. The use of contraception in women with obesity was studied. The use of MHT in Sweden over time was studied and different run-in periods were validated to define an incident MHT user. We also investigated the risk of pulmonary embolism (PE) in women using MHT, including considerations regarding administration form, treatment duration and type of progestin used. Women with premature or early menopause after bilateral oophorectomy were studied with regard to dispensed MHT.Material and Methods: The studies were based on different data sources including electronical medical records, national mandatory health registers, and a national quality register (GynOp). The use of MHT over time was studied using defined daily doses (DDD) per 1,000 women per day, one-year prevalence and incidence proportion. The definition of an incident drug user was validated by calculating the predictive value of different run-in periods.Results: The most prescribed contraceptive method in women with obesity was progestin-only pills (44%), but 21% were prescribed combined hormonal contraceptives contrary to Swedish and European guidelines. Incident users with obesity were significantly more likely to discontinue their contraceptive method within one year, compared with normal weight women. The use of MHT decreased significantly after the turn of the century. In the 50–54 years age interval, the dispensed amount decreased from 282 DDD/1,000 women per day in 2000, to 77 in 2006. It then stabilised around 50 DDD/1,000 women per day during 2010 to 2017. The one-year prevalence followed the same pattern, with a plateau 2010–2016. From 2017, an increase in MHT dispensations was observed. A run-in period of 18 months had a PV of 88% in the 50 to 54 years age group and was found to be suitable and reliable for defining incident users of MHT at the ages close to menopause. The risk of PE was significantly increased in users of oral MHT, but not transdermal. The risk was highest in first-ever users (OR 2.32; 95% CI, 1.34–4.00) and was considerably lower in women who may have used MHT previously (OR 1.38; 95% CI, 1.01–1.89). 69% of all women with a bilateral oophorectomy had at least one dispensation of MHT within one year after surgery. Within this treated group the estimated treatment time constituted 63% of the remaining time to natural menopause.Conclusions: Progestin-only pills was the most prescribed contraceptive method in women with obesity, but many women with obesity were prescribed combined hormonal contraceptives contrary to clinical guidelines. The use of MHT decreased significantly after the turn of the century, but has increased since 2017 in the age groups close to menopause. The classifications used for prevalent and incident drug use are of importance to the results. The risk of pulmonary embolism is increased in users of oral but not transdermal MHT. There seems to be a significant undertreatment with hormone therapy in women with premature, surgical menopause.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Reproduktionsmedicin och gynekologi0 (SwePub)302202 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Obstetrics, Gynaecology and Reproductive Medicine0 (SwePub)302202 hsv//eng
653		a Hormonal contraceptives
653		a Obesity
653		a Menopausal hormone therapy
653		a Hormone replacement therapy
653		a Pulmonary embolism
653		a Premature menopause
653		a Pharmacoepidemiology
700	1	a Brynhildsen, Jan,c Professor,d 1962-u Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, Kvinnokliniken US4 ths0 (Swepub:liu)janbr05
700	1	a Spetz Holm, Anna-Clara,c Associate Professor,d 1973-u Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, Kvinnokliniken US4 ths0 (Swepub:liu)annsp09
700	1	a Fredrikson, Mats,c Associate Professor,d 1957-u Linköpings universitet,Avdelningen för samhälle och hälsa,Medicinska fakulteten,Avdelningen för inflammation och infektion4 ths0 (Swepub:liu)matfr43
700	1	a Hoffmann, Mikael,c MD.d 1960-u Linköpings universitet,Avdelningen för samhälle och hälsa,Medicinska fakulteten4 ths0 (Swepub:liu)mikho37
700	1	a Milsom, Ian,c Professoru Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg4 opn
710	2	a Linköpings universitetb Avdelningen för barns och kvinnors hälsa4 org
856	4	u https://doi.org/10.3384/9789180751216y Fulltext
856	4	u https://liu.diva-portal.org/smash/get/diva2:1752365/PREVIEW01.pngx Previewy preview image
856	4	u https://liu.diva-portal.org/smash/get/diva2:1752365/ERRATA01.pdfy errata
856	4	u https://liu.diva-portal.org/smash/get/diva2:1752365/FULLTEXT02.pdfx primaryx Raw objecty fulltext
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-193217
856	4 8	u https://doi.org/10.3384/9789180751216

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