title: Side effects and sociobehavioral factors associated with the discontinuation of hormone therapy in a Massachusetts health maintenance organization.
abstract: OBJECTIVE
  To identify sociobehavioral factors and side effects associated with the discontinuation of postmenopausal hormone therapy in a clinical practice setting
  
  
  METHODS
  A total of 816 women aged 45-59 who began hormone therapy between July 1993 and June 1995 in a Massachusetts health maintenance organization were followed for 2 years from the day they received a prescription for estrogen. This cohort has been previously studied for health, treatment, and demographic determinants of hormone therapy discontinuation. In March 1999, these women were mailed a questionnaire containing closed and open-ended questions. A total of 449 women (55%) completed the survey. Discrete-time hazards models were used to identify determinants of discontinuation, controlling for medical predictors of survey nonresponse.
  
  
  RESULTS
  Women separated from their partners when they initiated hormone therapy (relative risk [RR] of discontinuation = 3.42; 95% confidence interval [CI] = 1.09, 10.73) and women with a body mass index greater than 29.0 (RR = 1.62; 95% CI = 1.18, 2.23) were more likely to discontinue. Women who had ever used oral contraceptives were less likely to discontinue hormone therapy (RR = 0.70; 95% CI = 0.51, 0.98). After women began using hormone therapy, those who experienced irregular bleeding (RR = 1.58; 95% CI = 1.08, 2.31), edema (RR = 2.18; 95% CI = 1.42, 3.34), or abdominal cramps and pelvic pain (RR = 2.42; 95% CI = 1.46, 4.02) while using hormones were more likely to discontinue. The effect of edema and abdominal cramps on the rate of discontinuation was greatest during the first 6 months of use. Women who adjusted their progestin schedule on their own were four times more likely than other women to discontinue hormones (RR = 4.18; 95% CI = 2.20, 7.94). The use of alternative therapies was not statistically associated with discontinuation.
  
  
  CONCLUSIONS
  Women who report therapeutic benefits from hormone therapy are more likely to continue using hormones long-term. The experience of certain side effects, especially during the first few months of hormone use, strongly affects whether women continue using hormone therapy.
authors.affiliation: Safety Evaluation and Epidemiology, Pfizer Inc., New York, New York, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Reynolds
authors.forename: C M
authors.initials: CM
authors.lastname: Obermeyer
authors.forename: A M
authors.initials: AM
authors.lastname: Walker
authors.forename: D
authors.initials: D
authors.lastname: Guilbert
mesh_terms: D001519:Behavior; D015331:Cohort Studies; D005260:Female; D006279:Health Maintenance Organizations; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D008404:Massachusetts; D008593:Menopause; D008875:Middle Aged; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016312:Treatment Refusal