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Survey of Nurse Practitioners Finds Oral Estrogen Therapy Is Prescribed More Often Than Transdermal And Examines External Influences That Affect Prescribing Practices

Findings presented at Nurse Practitioners in Women's Health 14th Annual Premier Women's HealthCare Conference

AUSTIN, Texas, Oct. 13, 2011 /PRNewswire/ -- The National Association of Nurse Practitioners in Women's Health (NPWH) today revealed data from a national survey of approximately 900 nurse practitioners that explored external factors that impact the type of estrogen therapy (ET) that is prescribed for symptoms associated with menopause.  Studies suggest that transdermal ET may have the potential for fewer health risks and that it controls symptoms of menopause as effectively as oral ET,(1-7) however, more than half of nurse practitioners surveyed reported that their practice most often prescribes oral ET. 

The 30-question survey was hosted by NPWH and was available online from December 23, 2009 to February 17, 2010.  The initiative was supported by Upsher-Smith Women's Health. 

"It appears that personal income and insurance access often drive decisions for the type of hormonal therapy a woman uses," says Susan Wysocki, president and CEO, NPWH.  "Instead, options for hormonal therapy should allow for what is best for the woman.  One size does not fit all."

The survey uncovered that certain factors such as perceived patient income, NP practice setting, and NP geographic area have an impact on the ET formulation prescribed.  With recent studies suggesting a favorable safety profile for transdermal ET,(1-6) efficacy comparable to oral ET for menopause symptoms,(7) and the added benefit of absorbing directly into the bloodstream without having to pass through the liver like oral ET, the authors of the study suggest ongoing educational efforts for NPs to ensure that all patients are getting the most appropriate treatment option.

Additional key findings of the ET prescribing trend survey include:

•The vast majority of the respondents (96%) were aware that the current prescribing guidelines for hormone therapy recommend the lowest effective dose for the shortest duration of time, consistent with the treatment goals, benefits, and risks for the individual patient.(8-10)
•An overwhelming majority of the respondents (90%) were aware that transdermal ET allows for lower dosing since it avoids first-pass metabolism.
•Armed with this knowledge, 52% of nurse practitioners (NPs) reported that their practice prescribes oral ET more often than transdermal ET (36%).
•The majority of NPs reported that they primarily prescribe oral ET (72%) if their practice serves patients with an estimated annual income below $50,000; for patients with an estimated income greater or equal to $50,000, NPs equally prescribe oral and transdermal ET (49% vs 51%); patients with an annual income between $100,000 and $350,000 are significantly more likely to be prescribed transdermal ET.
•NPs in rural and urban offices prescribe oral ET significantly more than transdermal ET.
•Significantly more NPs with practices in the Midwest (67% oral vs 33% transdermal) and in the South (61% vs 39%) prescribe oral ET compared to their Western and Northeastern counterparts.

Survey Demographics

The 30-question, incentive-based survey was hosted by NPWH and available online from December 23, 2009 to February 17, 2010.  Nearly all (99.7%) of the 909 respondents were female.  Over two-thirds (67%) were aged 41-60 years old and 60% had been in practice for more than 11 years. 

About Menopause and Hot Flashes

Menopause is the permanent end of menstruation and fertility, which is confirmed 12 months after the last menstrual period.  Menopause happens naturally when the ovaries stop producing estrogen and progesterone; however it may also occur when the ovaries are surgically removed.  Menopause typically takes place between the ages of 40 and 58, but it may occur earlier or later.(11)

The most common menopause-related discomfort is the hot flash.(11)  A hot flash is a sudden feeling of heat in the upper part or all of the body.(12)  Hot flashes vary in frequency and may range from several in just one day to just a few a week.  As many as three out of four women experience hot flashes.(12)

Symptoms of hot flashes can be mild or they can be severe enough to wake sufferers from a sound sleep (night sweats).(12)  The most common symptoms of hot flashes are: feeling of mild warmth to intense heat spreading through the upper body and face; flushed appearance with red, blotchy skin on face, neck and upper chest; perspiration; and chilled feeling as hot flash subsides.(13)

About The National Association of Nurse Practitioners in Women's Health (NPWH)

The National Association of Nurse Practitioners in Women's Health was founded in 1980.  NPWH's mission is to assure the provision of quality health care to women of all ages by nurse practitioners.  NPWH defines quality health care to be inclusive of an individual's physical, emotional, and spiritual needs.

NPWH recognizes and respects women as decision-makers for their health care. NPWH's mission includes protecting and promoting a woman's right to make her own choices regarding her health within the context of her personal, religious, cultural, and family beliefs.

NPWH represents nurse practitioners that provide care to women in the primary care setting as well as in women's health specialty practices.

NPWH is a trusted source of information on nurse practitioner education, practice, and women's health issues.  NPWH works with a wide range of individuals and groups within nursing, medicine, and the women's health community.

About Upsher-Smith

Upsher-Smith Laboratories, Inc. is a rapidly growing pharmaceutical company that manufactures, distributes, and markets both prescription and consumer products.  Privately held since 1919, the company strives to recognize the unmet healthcare needs of its customers.  Upsher-Smith prides itself on providing safe, effective, and economical therapies to the ever-changing healthcare environment.  For additional information, visit


1.  Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. May 31 2008;336(7655):1227-1231.

2.  Laliberte F, Dea K, Duh MS, Kahler KH, Rolli M, Lefebvre P. Does the route of administration for estrogen hormone therapy impact the risk of venous thromboembolism? Estradiol transdermal system versus oral estrogen-only hormone therapy. Menopause. Jul 27 2011.

3.  Renoux C, Dell'aniello S, Suissa S. Hormone replacement therapy and the risk of venous thromboembolism: a population-based study. J Thromb Haemost. May 2010;8(5):979-986.

4.  Renoux C, Dell'aniello S, Garbe E, Suissa S. Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ. 2010;340:c2519.

5.  Grady D, Vittinghoff E, Lin F, et al. Effect of ultra-low-dose transdermal estradiol on breast density in postmenopausal women. Menopause. May-Jun 2007;14(3 Pt 1):391-396.

6.  Samsioe G, Boschitsch E, Concin H, et al. Endometrial safety, overall safety and tolerability of transdermal continuous combined hormone replacement therapy over 96 weeks: a randomized open-label study. Climacteric. Oct 2006;9(5):368-379.

7.  Nelson HD.  Commonly used types of postmenopausal estrogens for treatment of hot flashes; scientific review. JAMA; 2004: 1610-1620.

8.  Vasomotor symptoms. Obstet Gynecol. Oct 2004;104(4 Suppl):106S-117S.

9.  Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of The North American Menopause Society. Menopause. Mar-Apr 2007;14(2):168-182.

10.  Stephenson J. FDA orders estrogen safety warnings: agency offers guidance for HRT use. JAMA. Feb 5 2003;289(5):537-538.

11.  The North American Menopause Society. Menopause Guidebook. 6th ed. Cleveland, OH: The North American Menopause Society; 2006.

12.  eMedicine Health. Hot Flashes. Available at:  Accessed June 14, 2011.

13.  Hot Flashes: Symptoms, Mayo Clinic.  Accessed June 28, 2011.

SOURCE Upsher-Smith


Posted: October 2011