Substance use and menopausal hormone therapy: Treatment initiation and interruption among US women with and without HIV , 2008–2019

OBJECTIVE: This study compares rates of menopausal hormone therapy (MHT) initiation between perimenopausal and postmenopausal women with moderate-severe vasomotor symptoms (VMS) with and without substance use in a longitudinal cohort of diverse US women with or without HIV. METHODS: Using menopause symptoms, hormone use, and substance use data from Women's Interagency HIV Study biannual visits (10/2008-9/2019), we compared initiation of and breaks in MHT among participants with moderate-severe VMS (1) with or without current substance use and (2) with or without ever using substances. We calculated unadjusted rates and adjusted rate ratios (RR) for demographics and health variables using Poisson regression. RESULTS: The median age of participants (n = 1579) with moderate-severe VMS was 50 years old, with 73% living with HIV, and 68% identifying as Black. They reported ever using tobacco (76%), heavy alcohol (39%), cannabis (45%), and other drugs (43%). Few reported hormonal contraception (5%) or MHT (9%) during the study period. Hormone initiation (overall 3.53 per 100 person-years; 95% confidence interval [CI]: 2.93, 4.26) was less likely with current tobacco use (RR: 0.67, 95% CI: 0.45, 0.99) or ever using other drugs (RR: 0.61; 95% CI: 0.40, 0.91). Hormone breaks (overall 52.58 per 100 person-years [95% CI: 44.52, 61.90]) were not associated with substance use. CONCLUSION: The rate of MHT initiation was low and the rate of MHT breaks was high in this sample of perimenopausal and postmenopausal participants with moderate-severe VMS. Patients and providers might benefit from specific guidance regarding MHT use among individuals with current tobacco use and those who have ever used other drugs.