Trends of menopausal hormone therapy across Canadian provinces in 2018-2023

OBJECTIVES: Menopausal hormone therapy (MHT) is guideline-recommended as the first-line treatment for vasomotor symptoms in women without contraindications. Despite this, use of MHT remains low with persistent concerns about safety following the Women's Health Initiative. Contemporary population-level data on the trends of MHT use in Canada over the years, as well as differences across provinces, are limited. This study examines recent trends and interprovincial variation in MHT expenditure among Canadian provinces. METHODS: We conducted a retrospective time-series study of MHT dispensing trends across Canadian provinces (December 2017-November 2023) using IQVIA CompuScript. Use was standardized to defined daily dose (DDD) as set by the World Health Organization. The purchasing data is shown as DDD per 1000 women per day, normalized by provincial population of women aged 45-65 years for oral, transdermal, and vaginal MHT. RESULTS: National MHT use increased from 59.1 to 83.4 DDD/1000 women/day during the study period. Growth was driven by vaginal (14.9-29.2) and transdermal MHT (18.4-26.8) formulations, while use of oral MHT remained stable (25.8-27.3). In 2023, Quebec had the highest rate of MHT dispensing at 162 DDD/1000 women/day, followed by British Columbia and Nova Scotia (84.3 and 83.1 DDD/1000 women/day, respectively). CONCLUSIONS: MHT use in Canada is increasing but remains modest and variable across formulations and provinces. Markedly higher use of MHT in Quebec may be partly explained by a more comprehensive drug coverage. Our findings highlight gaps in uptake of guideline-recommended therapy and provide a foundation for future research and policy considerations.