Treatment patterns of menopausal hormone therapy in South Korea: a nationwide cohort study

Menopausal hormone therapy (MHT) is the most effective treatment for menopausal symptoms. While guidelines recommend an individualized risk-benefit assessment of MHT, real-world studies on use of MHT are limited. Nationwide claims data in South Korea (2015-2020) were used to assess the prevalence of hospital visits for menopausal symptoms and use of MHT among women aged 40-59 years. MHT was classified into three classes including estrogen therapy (ET), estrogen plus progestogen therapy (EPT) and tibolone, with routes of administration categorized as systemic (oral, transdermal) and local (transvaginal). A longitudinal study was conducted to evaluate treatment patterns of MHT. Approximately 9% of women visited hospitals for menopausal symptoms, with fewer than half prescribed MHT. Of 1,774,674 women with menopausal symptoms, 1,036,294 were prescribed MHT: 89,237 patients were started on systemic ET, 300,999 on systemic EPT, 306,538 on tibolone and 378,764 on local ET. Use of tibolone and local ET increased over time, while systemic ET and EPT decreased. Systemic MHT was discontinued after an average of 13.2 months, while local MHT was discontinued after 2.4 months. Despite guidelines recommending MHT for treating menopausal symptoms, many women remain untreated and continued MHT for an average of only 1 year.