Hormone replacement therapy use has received significant attention in recent years, even so, hormone replacement therapy use among women of menopausal age is still relatively low – approximately 15% as of February 2023 according to the Department of Health and Social Care. A lack of awareness of the benefits of hormone replacement therapy use in alleviating symptoms, and the misunderstood risks associated, may be a contributor to the limited use. In May 2021, Davina McCall released "Sex, Myths and the Menopause", a documentary with the aim of “busting midlife taboos from sex to hormone treatment”. In the following months female sex hormone prescriptions increased dramatically.
We aim to analyse the effect hormone replacement therapy prescriptions have on health and labour market outcomes of individuals. Our study design uses the timing of the Davina McCall documentary in May 2021, and the resulting increase in hormone replacement therapy prescriptions, to assess its impacts on women’s health and labour outcomes. We hypothesis that hormone replacement therapy use has major implications for women’s overall health, which could lead to beneficial impacts on women’s work outcomes. Our project will seek to assess whether hormone replacement therapy prescriptions do indeed benefit women in this way.
Our analysis will use a two-sample two-stage least squares (TS2SLS) methodology to estimate the impact of hormone replacement therapy (HRT) use on health and labour market outcomes. We will use the timing of Davina McCall’s documentary as an instrument for HRT prescriptions, estimating the first stage using a difference-in-differences approach, CPRD data, and women not of menopausal age as controls. Then, we will use the estimates from this first stage and survey data (Labour Force Survey or Understanding Society) to analyse the impact on women’s health and labour outcomes. The use of the TS2SLS and survey data allows us to access a wider range of outcomes than is available in the CPRD data. The outcomes of interest are: employment status (including working hours, and reason for not currently working), whether had time off due to sickness (including period of sickness) from the Labour Force Survey, and subjective wellbeing, self-assessed general health, and martial stability from Understanding Society. Finally, we will validate our methodological approach design in two ways: using the outcomes of men as a placebo in a reduced form using Labour Force Survey and Understanding Society data, and estimate the effect of the documentary release on a drug we would not expect to be impacted by the documentary.
The Government Equalities Office estimate that in 2017 13 million women are experience the menopause each year and therefore studies assessing the potential benefits of medication which alleviate the symptoms are necessary. This study will contribute evidence of the impacts HRT medication has on women experiencing the menopause. These results will allow policy makers to make informed decisions regarding prioritisation, availability, and accessibility of medications, ultimately aiming to improve the quality of life for women navigating the challenges of menopause.
First stage outcomes: The outcome of interest in the first-stage analysis (using the CPRD) are whether patients’ were prescribed HRT medication and the type of HRT medication prescribed. Outcomes of interest in our analysis are whether patients’ were prescribed HRT medication and the type of HRT medication prescribed. We will consider any ‘BNF code 6.4.1.1: Oestrogens and Hormone Replacement Therapy’ prescription to be HRT prescriptions. We will further analyse progestogen (dydrogesterone, medroxyprogesterone, norethisterone, levonorgestrel and micronised progesterone) and Oestrogen (estradiol, estrone and estriol) prescriptions separately. In the appendix of this protocol, we present the list of medications and the corresponding product codes that we will use in our analysis.
Second-stage outcomes: The estimates from the first stage will then be used to estimate the impact of HRT on employment status (including working hours, whether part-time or full-time, and reason for not currently working), whether had time off due to sickness (including period of sickness, and type of sickness) from the Labour Force Survey, and subjective wellbeing and self-assessed general health from Understanding Society. Further, we will use Understanding Society to analyse the impact of HRT on marital stability through changes in marital status.
Rhys Thomas - Chief Investigator - University of Oxford
Rhys Thomas - Corresponding Applicant - University of Oxford
Brendon McConnell - Collaborator - City University London
Emmanouil Mentzakis - Collaborator - City University London