Characterising treatment pathways for natural menopausal symptoms in UK women

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Objectives: Treatments for menopause symptoms include hormone therapy (HT) and nonhormonal treatments (non-HTs); clonidine is the only UK-approved non-HT for vasomotor symptoms (VMS). Real-world data on medication use are limited. This study described treatment pathways for menopause symptoms in UK women. Methods: This retrospective cohort study was conducted with Clinical Practice Research Datalink Aurum (01/2009-03/2021). Treatment pathways for menopause symptoms followed by >30 women were assessed in women aged 40-65 after first diagnosis of natural menopause. Gaps of <30 days between prescriptions indicated a combination of treatments; ≥30 days, a switch. Sensitivity analyses with increased gaps (60, 90, 180 days) were conducted. Results: The study included 214,374 women (57.2% aged 50-59). 79,826 (37.2%) followed a treatment pathway consisting of >30 women. Of these, 55,761 (69.9%) had only one treatment line; most prescribed were estrogens alone (19.9%), combined progestogens+estrogens (9.1%), amitriptyline (8.6%), sertraline (6.1%), and citalopram (5.5%). Two or more treatment lines were reported in 24,065 (30.1%); first-line estrogens and second-line progestogens+estrogens (3.5%) was the most common pathway, followed by switches from estrogens to amitriptyline (1.1%) or sertraline (1.0%). Across all treatment pathways, amitriptyline was the most prescribed non-HT (15.8%), with fewer clonidine prescriptions (7.3%). Sensitivity analyses yielded similar results.

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