Use of systemic menopausal hormone therapy among French women: a descriptive nationwide study over the 2011 to 2024 period

Abstract Background Worldwide use of systemic menopausal hormone therapy (MHT) declined sharply after 2002 following reports of increased breast cancer and cardiovascular risks. Evidence that the benefit-risk balance depends on initiation timing and treatment patterns has renewed clinical interest in MHT recently. A comprehensive characterisation of utilisation patterns is thus needed to assess alignment with guidelines. We describe systemic MHT use among women aged ≥45 years in France between 2011 and 2024. Methods In this descriptive nationwide study using the French National Health Data System (SNDS), we included 21,983,503 women aged ≥45 years affiliated with the main health insurance scheme between 2011 and 2024. Systemic MHT was identified from reimbursements for drugs containing systemic oestrogen. Users had at least two reimbursements for systemic oestrogen (unopposed or with a progestogen) within 12 months, and initiators had no reimbursements in the preceding five years. Annual prevalence, initiation and discontinuation proportions were estimated overall and by age group. Results We identified 1,250,037 systemic MHT users and 578,668 initiators between 2011 and 2024. Annual prevalence decreased from 4.3% in 2011 to 2.0% in 2022, then stabilised, with a slight increase after 2022 among women aged 45-59 years. Prevalence was consistently highest among women aged 55-59 years. Initiation declined from 0.5% of women in 2011 to 0.2% in 2022, before increasing to 0.3% in 2024, and was highest among women aged 50-54 years. Discontinuation was highest among women aged 45-49 years, peaking in 2019, and remained stable in older age groups. Median age at initiation was 52 (Interquartile Range [IQR] 50-55) years, and median treatment duration was 2.1 (IQR 0.6-6.1) years. Most initiators (79.3%) started combined oestrogen-progestogen therapy. Oestradiol was used almost exclusively (98.5%), mainly transdermally (74.2%). Micronised progesterone was the predominant progestogen, used exclusively by 62.9% of combined therapy initiators, followed by dydrogesterone (9.2%). Conclusion After prolonged declining use, systemic MHT initiation increased modestly after 2022. Prescribing appeared broadly aligned with current recommendations favouring transdermal oestradiol combined with micronised progesterone, for relatively short durations. These findings provide a benchmark for public health authorities to monitor alignment between prescribing patterns and guidelines and inform future decisions.