Treatments in women experiencing natural menopause: a cohort study from the USA, the UK and Germany

This study aimed to describe treatment patterns among naturally menopausal women from the USA, the UK and Germany. Using health claims (the USA) and electronic health records (the UK and Germany), women aged 40–65 years with a first record of natural menopause (index date) from 2009 to 2022 were identified. Women with a history of bilateral oophorectomy, total hysterectomy, endocrine therapy for breast cancer or hormone/non-hormone therapy for menopausal symptoms were excluded. Treatments evaluated following the index date were hormone therapy, benzodiazepines, antidepressants, anticonvulsants and the antihypertensive clonidine. In total, 1,260,742 (the USA), 214,374 (the UK) and 124,542 (Germany) women were included, and treatments were recorded in 38.8%, 33.4% and 28.8%, respectively. Among these, the majority received one treatment class, mostly hormone therapy (44.2% for the USA, 41.1% for the UK, 92.6% for Germany), benzodiazepines (25.3% for the USA, 6.8% for the UK, 2.2% for Germany) and antidepressants (18.6% for the USA, 33.5% for the UK, 4.1% for Germany). Discontinuation rates at 6 months from starting initial treatment were 75.0–88.0% for hormone therapy, 65.0–85.0% for antidepressants and ≥98% for benzodiazepines. Treatment switches occurred in 25.4% (the USA), 21.8% (the UK) and 1.7% (Germany). Continuation rates with current treatments for women experiencing natural menopausal symptoms are low, indicating an unmet need for effective and acceptable therapies. Menopausal women can experience a range of symptoms, several of which can be bothersome such as hot flashes, nights sweats, sleep problems and mood swings. Various hormonal and non-hormonal treatments are available via prescription for these symptoms, yet few studies have explored which treatments are actually used. This study aimed to fill this knowledge gap. Using the anonymized health records of more than a million women who had reached natural menopause from the USA, the UK and Germany, the study evaluated which prescription therapies they received that were available for treating menopausal symptoms. The study found that hormone therapy was the most commonly used treatment, which was prescribed to 44% of women in the USA, 41% in the UK and 93% in Germany. The second most commonly used treatments in the USA were benzodiazepines, which were prescribed to 25% of women. In the UK and Germany, antidepressants were the second most commonly prescribed treatment, being prescribed to 34% of women in the UK and 4% of women in Germany. However, a large proportion of women prescribed these treatments did not persist with their treatments. For example, among women prescribed hormone therapy, only 25% of women from the USA, 17% from the UK and 12% from Germany remained on treatment after 6 months from starting treatment. The treatment continuation rates for other medications were even lower. Our study shows that there is, therefore, a need for new effective, safe and tolerable therapies for women with menopausal symptoms.