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Clinical background of women prescribed tibolone or combined estrogen + progestogen therapies: a UK MediPlus® study

Objectives To describe and compare the history and clinical characteristics of women who were prescribed tibolone or one of the following combined estrogen + progestogen therapies (CEPT): sequential conjugated equine estrogens (CEE)/norgestrel, sequential CEE/medroxyprogesterone acetate (MPA), continuous CEE/MPA or continuous estradiol/norethisterone acetate (NETA). Methods This was a descriptive study using MediPlus®, a UK Primary Care database; 3762 women participated who, between July 1st, 1999 and June 30th, 2001, were prescribed either tibolone or one of the CEPT regimens mentioned above. Risk factors associated with endometrial cancer and breast cancer were assessed. Results The results of this study suggest that the clinical background of women who were prescribed tibolone differed from that of the women who were prescribed the combination products. More frequently than expected women who were most recently prescribed tibolone have a history of chronic breast disease, a personal history of breast cancer or a history of being prescribed (long-term) estrogen-only therapy. Furthermore, this group of women more frequently had hypertension and performed uterine procedures recorded in their medical records. This preferential prescribing of tibolone occurs at first-ever prescription of hormone therapy but is, in some instances, the underlying reason for switch behavior. Conclusion In the UK, general practitioners seem to preferentially prescribe tibolone to women with an increased risk for breast and endometrial cancer, as compared to women being prescribed other CEPT products.