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Hormone Therapy Use in Women Veterans Accessing Veterans Health Administration Care: A National Cross-Sectional Study

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ABSTRACT

The majority of women Veterans using VA (Veterans Administration) care fall in the 45–65 year-old age range. Understanding how menopause is managed in this group is of importance to optimizing their health.

OBJECTIVE

National population estimates showed a prevalence of hormone therapy (HT) use by women over 45 years of 4.7 % (2009–2010). Our study described the frequency of HT use among women Veterans in VA, and examined whether mental health (MH) was predictive of HT use.

DESIGN

This was a cross-sectional analysis of national VA administrative data for fiscal year 2009.

PARTICIPANTS

Women Veterans over the age of 45 (N = 157,195) accessing VA outpatient care were included in the analysis.

MAIN MEASURES

Logistic regression analyses using HT use as the dependent variable.

KEY RESULTS

Mean age was 59.4 years (SD =12.2, range =46–110), and 16,227 (10.3 %) of all women used HT. Hysterectomy (OR 3.99 [3.53, 4.49]) and osteoporosis (1.34 [1.27, 1.42]) were the strongest medical indicators of HT use. A total of 49,557 (31.5 %) women in the sample received at least one primary diagnosis of a MH disorder and were more likely to use HT than women with no MH diagnoses (unadjusted OR 1.56, 95 % CI [1.50, 1.61]). Women Veterans with a mood disorder (depression/bipolar) or anxiety disorder [post-traumatic stress disorder (PTSD), other anxiety diagnoses] were more likely to use HT after controlling for demographics and medical comorbidity.

CONCLUSION

The prevalence of HT use among women Veterans using VA is more than twice that of the general population. Prior work suggested that women Veterans were discontinuing HT at comparable rates, but these data demonstrate that decline in VA HT use has not kept pace with that of civilian medical care. The association of MH diagnosis with HT use suggests that MH plays an important role in VA rates. Further study is needed to understand contributing patient and provider factors.

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Acknowledgements

The authors wish to acknowledge the assistance of Melissa Skanderson, MSW.

Funding to support database creation was provided by National Center for PTSD (NCPTSD), U.S. Department of Veterans Affairs, Executive Division, White River Junction, VT.

This work was supported in part by Career Development Award (Japuntich) #1IK2CX000918-01A1from the United States Department of Veterans Affairs Clinical Sciences Research and Development Service.

This study was presented in abstract form at the Society for General Internal Medicine (SGIM), 36th Annual Meeting, April 26, 2013, Denver, CO.

The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the United States Government.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Women Veterans Program, VA Boston Healthcare System, 150 S. Huntington Avenue PC11/WHC, Jamaica Plain, MA, Boston, 02130, USA

    Megan R. Gerber MD, MPH

  2. Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Megan R. Gerber MD, MPH

  3. National Center for PTSD, Women’s Health Sciences Division, VA Boston Healthcare System, Jamaica Plain, Boston, MA, USA

    Matthew W. King PhD, Suzanne L. Pineles PhD, Shannon Wiltsey-Stirman PhD & Sandra J. Japuntich PhD

  4. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Matthew W. King PhD, Suzanne L. Pineles PhD, Shannon Wiltsey-Stirman PhD & Sandra J. Japuntich PhD

  5. VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Bevanne Bean-Mayberry MD, MHS

  6. Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Bevanne Bean-Mayberry MD, MHS

  7. Department of Medicine, VA Connecticut Healthcare System, Section of General Internal Medicine, West Haven, CT, USA

    Sally G. Haskell MD

  8. Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Sally G. Haskell MD

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  1. Megan R. Gerber MD, MPH
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  2. Matthew W. King PhD
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Correspondence to Megan R. Gerber MD, MPH.

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Gerber, M.R., King, M.W., Pineles, S. et al. Hormone Therapy Use in Women Veterans Accessing Veterans Health Administration Care: A National Cross-Sectional Study. J GEN INTERN MED 30, 169–175 (2015). https://doi.org/10.1007/s11606-014-3073-9

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  • DOI: https://doi.org/10.1007/s11606-014-3073-9

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