Hormone Replacement Therapy (HRT): Utilisation Rates, Determinants and Impact on Health-Related Quality of Life in a Multi-Ethnic Asian Population

Abstract

Introduction: Hormone Replacement Therapy (HRT) is widely prescribed to provide relief from unpleasant climacteric symptoms, however for several decades, the benefits and risks of HRT have been debated. Most of the current HRT literature is focused on western population, with very less available information on Asians. Aim: To examine the HRT utilisation rate, determinants and impact on Health-Related Quality Of Life (HRQOL) in a multiethnic Asian population in Singapore. Materials and Methods: A total of 3408 women from the Singapore Epidemiology of Eye Diseases study, comprising Chinese (n=1215), Malay (n=1091) and Indian (n=1102) were included in the analyses. HRT utilisation was self-reported and HRQOL was assessed using the EuroQoL-5 Dimensions questionnaire. Multivariable logistic and linear regression models were used to elucidate the determinants of HRT utilisation and its association with HRQOL, respectively. Results: The age-standardised HRT utilisation rate was 8.80%, with majority being Chinese. Aged between 50-69 years, have reading literacy, of Christian religion and history of oophorectomy were independent determinants of HRT utilisation. Ethnicitystratified analyses found that monthly income (≥SG$1,000) in Indians, and older age of menstruation cessation in Chinese, were independently associated with HRT utilisation. Malay, Indian and Chinese women using HRT had worse mobility, pain/discomfort, and anxiety/depression, respectively, compared to non-users. Conclusion: HRT utilisation rates in this Asian sample were relatively low compared to most Western countries, and with the Chinese being the highest users. The factors associated with HRT utilisation appeared to be multifactorial and usage is associated with poorer HRQOL in some aspects, varied by ethnicity.

Keywords

• ethnicity
• oestrogen
• prevalence
• progestins