Abstract
Objectives:
Local estrogen therapy (LET) has many benefits, but little is known regarding adherence and reasons for discontinuation. We aimed to evaluate fill/continuation rates of LET and assess factors associated with not filling/discontinuation.
Materials and Methods:
Prospective observational study of adult women newly prescribed LET. Participants completed Pelvic Floor Distress Inventory 20 (PFDI-20) and the Day-to-Day Impact of Vaginal Aging (DIVA) at baseline, 3-, 6-, and 12-months from initial prescription. Participants who discontinued LET were queried regarding reason for discontinuation.
Results:
A total of 155 participants were included. Mean age was 65 (+/−10) and 57% had private insurance. The most common indications for prescription with LET were atrophic vaginitis 61 (39%) and recurrent urinary tract infection 34 (22%). At baseline, 94% filled initial prescription. Continuation rates were 78%, 90%, and 79% at 3-, 6-, and 12-months, respectively, but 93 (60%) were lost to follow-up over the study period. Common reasons for not starting LET included cost (33%) and concern for side effects (22%). Common reasons for discontinuing were mess of using therapy (19%) and concern for side effects (16%). PFDI-20 and DIVA domain scores except self-concept decreased across all timepoints for all participants with no difference between women who continued versus discontinued LET. Univariate analysis did not find any factors associated with LET discontinuation.
Conclusions:
LET use is associated with improved pelvic floor and vaginal symptoms up to 12 months following initiation. Prospective evaluation was challenging due to high loss to follow-up. A total of 26% discontinued LET over 1 year. Barriers to initiation and discontinuation such as cost, mess, and concern for side effects are potentially modifiable factors that physicians can address to improve adherence.
Get full access to this article
View all access options for this article.