Study identifies key predictors of women stopping HRT within a year
A large population health study has identified several key factors linked to women discontinuing hormone replacement therapy (HRT) within one year of starting treatment, including age, HRT type and socio-economic deprivation.
This study was conducted via project PROPHECY (Predicting the Risks of Oestrogen-related Pathologies on Health Erosion to Conserve Healthy Years). PROPHECY (https://research.healthandher.com/pages/prophecy-project) is a research partnership between the Health & Her Centre for Research, Cardiff University and Swansea University, with grant funding provided by the Waterloo Foundation (https://waterloofoundation.org.uk/).
The observational study, published in BJOG, analysed anonymised healthcare records from the Secure Anonymised Information Linkage (SAIL) Databank between 1996 and 2023. The SAIL databank (https://saildatabank.com/) holds approximately 88% of the Welsh population primary and secondary care NHS data. Researchers examined prescribing trends for oral and transdermal HRT across Wales, alongside patterns of discontinuation after treatment initiation.
The study found that 40% of women stopped HRT within one year of starting treatment, with one in five receiving only a single prescription.
Researchers identified clear differences in continuation rates depending on the type of HRT prescribed. Women using oral HRT tablets were more likely to continue treatment beyond one year, while those using transdermal formats such as patches and gels were more likely to discontinue.
Age also appeared to play an important role. Women in their mid-40s to early 50s had the highest continuation rates, while younger women aged 40-43 and women in their mid 50s and over were more likely to stop treatment earlier.
The authors suggest that younger women may experience fluctuating hormone levels during perimenopause, which could contribute to side effects from taking HRT, such as irregular bleeding, breast tenderness or mood changes. Meanwhile, older women may discontinue due to changing risk-benefit considerations as they age.
The research also highlighted how historical events and public awareness campaigns may have influenced HRT continuation. Women prescribed HRT after the publication of the Women’s Health Initiative and Million Women Study in the early 2000s were more likely to discontinue treatment, reflecting long-standing safety concerns surrounding HRT.
The highest discontinuation rates were observed during the “Davina Effect” period from 2021 onwards, when menopause awareness and HRT prescribing increased sharply following high-profile media coverage. Researchers suggest this may partly reflect the large number of women starting HRT for the first time, alongside ongoing HRT shortages affecting some transdermal products.
The study also found lower prescribing rates in women living in more deprived areas of Wales, suggesting socio-economic inequalities may still affect access to menopause care despite free NHS prescriptions in Wales since 2007.
Overall, 292,707 women in Wales were prescribed oral or transdermal HRT during the study period. While oral prescriptions declined following safety concerns raised in the early 2000s, transdermal prescribing rose rapidly after 2021.
These findings highlight the need for more personalised menopause care, and further research is needed to understand why some women discontinue HRT, including the role of symptom control, side effects, treatment preferences and healthcare access.
Reference
Andrews R, Lacey A, Bache K, Kidd EJ. Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996–2023: An Observational Study of the Welsh Population. BJOG. 2025. doi:10.1111/1471-0528.18220. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.18220