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Aquino CI, Stampini V, Osella E, Troìa L, Rocca C, Guida M, Faggiano F, Remorgida V, Surico D. Menopausal Hormone Therapy, an Ever-Present Topic: A Pilot Survey about Women's Experience and Medical Doctors' Approach. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:774. [PMID: 38792957 PMCID: PMC11122847 DOI: 10.3390/medicina60050774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
Background and Objective: Menopause can be associated with many clinical manifestations: vasomotor symptoms, urogenital problems, and additional psychological disturbances, such as anxiety, mood changes, and sleep alterations. The prolonged lack of hormones also increases the risk of long-term consequences. Hormone Replacement Treatment (HRT) in menopause consists of the administration of estrogen, alone or associated to progesterone, to relieve these uncomfortable disturbances and to prevent the onset of other pathologic conditions. The aim of this study is to examine the prevalence of HRT use in a sample of menopausal women and their experience with menopause and HRT. This study also investigates the knowledge of general practitioners (GPs) and gynecologists about HRT and its prescription. Materials and Methods: We conducted a cross-sectional population survey on 126 women of 50-59 years in an industrial city in the North of Italy, Vercelli (Novara), in Eastern Piedmont. We also presented a questionnaire on the topic to 54 medical doctors (GPs and gynecologists) of the same area. Results: The prevalence of HRT use in our sample was 11.9%. In total, a good percentage of the users affirmed to be satisfied with HRT. Additionally, a minority of women reported being ideally against the use of replacement hormones, were advised against using HRT by doctors, and did not use it because of the fear of side effects. We found a positive association between patient education, health care attitude, and HRT usage. A significant number of women knew about HRT from the media, and most of them were not informed by a health professional. Despite this, the interviewed doctors considered their knowledge about HRT as 'good' and would recommend HRT: only 5.6% would not prescribe it. Conclusions: Our results highlight the need for information about HRT among patients and health professionals, along with the need for more effective communication, evaluation, and suggestion of treatment.
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Affiliation(s)
- Carmen Imma Aquino
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Viviana Stampini
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Elena Osella
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Libera Troìa
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Clarissa Rocca
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Maurizio Guida
- Department of Neurosciences and Reproductive Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fabrizio Faggiano
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Valentino Remorgida
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Daniela Surico
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
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Zhang G, Basna R, Mathur MB, Lässer C, Mincheva R, Ekerljung L, Wennergren G, Rådinger M, Lundbäck B, Kankaanranta H, Nwaru BI. Exogenous female sex steroid hormones and new-onset asthma in women: a matched case-control study. BMC Med 2023; 21:337. [PMID: 37667254 PMCID: PMC10478448 DOI: 10.1186/s12916-023-03038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Evidence on the role of exogenous female sex steroid hormones in asthma development in women remains conflicting. We sought to quantify the potential causal role of hormonal contraceptives and menopausal hormone therapy (MHT) in the development of asthma in women. METHODS We conducted a matched case-control study based on the West Sweden Asthma Study, nested in a representative cohort of 15,003 women aged 16-75 years, with 8-year follow-up (2008-2016). Data were analyzed using Frequentist and Bayesian conditional logistic regression models. RESULTS We included 114 cases and 717 controls. In Frequentist analysis, the odds ratio (OR) for new-onset asthma with ever use of hormonal contraceptives was 2.13 (95% confidence interval [CI] 1.03-4.38). Subgroup analyses showed that the OR increased consistently with older baseline age. The OR for new-onset asthma with ever MHT use among menopausal women was 1.17 (95% CI 0.49-2.82). In Bayesian analysis, the ORs for ever use of hormonal contraceptives and MHT were, respectively, 1.11 (95% posterior interval [PI] 0.79-1.55) and 1.18 (95% PI 0.92-1.52). The respective probability of each OR being larger than 1 was 72.3% and 90.6%. CONCLUSIONS Although use of hormonal contraceptives was associated with an increased risk of asthma, this may be explained by selection of women by baseline asthma status, given the upward trend in the effect estimate with older age. This indicates that use of hormonal contraceptives may in fact decrease asthma risk in women. Use of MHT may increase asthma risk in menopausal women.
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Affiliation(s)
- Guoqiang Zhang
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Rani Basna
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maya B Mathur
- Quantitative Sciences Unit, Stanford University, Palo Alto, CA, USA
| | - Cecilia Lässer
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roxana Mincheva
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Madeleine Rådinger
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hannu Kankaanranta
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Bright I Nwaru
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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Yasui T, Ideno Y, Nagai K, Hayashi K. Characteristics of HRT users in Japan: Evidence from the Japan Nurses' Health Study. Maturitas 2023; 173:1-6. [PMID: 37105007 DOI: 10.1016/j.maturitas.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/12/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES Little is known about what type of women use hormone replacement therapy (HRT) in Japan. Based on the Japan Nurses' Health Study (JNHS), a large population cohort study, we determined the characteristics of HRT users by comparing the characteristics of new HRT users and the characteristics of women who did not use HRT during a 10-year follow-up period. STUDY DESIGN Of the 15,019 JNHS participants, 4886 women reported an experience of menopausal transition during the 10-year follow-up period. MAIN OUTCOME MEASUREMENT Characteristics of new HRT users. RESULTS The proportion of HRT users during the 10-year period was 8.5 %. Advanced age at menopause was significantly associated with a low rate of use of HRT. Past use of oral contraceptives, dysmenorrhea with disturbance in daily life and vasomotor symptoms were significantly associated with a high rate of use of HRT. The occupations of public health nurse and midwife and a history of bilateral oophorectomy were also significantly associated with a high rate of use of HRT. CONCLUSIONS We determined the characteristics of new HRT users among middle-aged women during a 10-year follow-up period. Women who had sufficient knowledge about endocrinological hormones and women who had less reluctance to visit doctors for gynecological problems were likely to use HRT.
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Affiliation(s)
- Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Tokushima University Graduate School, Tokushima, Japan.
| | - Yuki Ideno
- Center for Mathematics and Data Science, Gunma University, Maebashi, Japan
| | - Kazue Nagai
- Center for Mathematics and Data Science, Gunma University, Maebashi, Japan
| | - Kunihiko Hayashi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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Calgaro L, Giubilato E, Lamon L, Calore F, Semenzin E, Marcomini A. Emissions of pharmaceuticals and plant protection products to the lagoon of Venice: development of a new emission inventory. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 330:117153. [PMID: 36603246 DOI: 10.1016/j.jenvman.2022.117153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/26/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Estimating the emissions of chemical pollutants to water is a fundamental step for the development and application of effective and sustainable management strategies of water resources, but methods applied so far to build chemicals inventories at the European or national scale show several limitations when applied at the local scale. The issue is particularly relevant when considering contaminants of emerging concern (CECs), whose environmental releases and occurrence are still poorly studied and understood. In this work, an approach to estimate water emissions of nine active pharmaceutical ingredients (APIs) and ten most applied plant protection products (PPPs) is presented, considering proxy indicators (e.g., sales data and census information). The application area is the lagoon of Venice (Italy), a complex transitional environment highly influenced by anthropic pressures (e.g., agricultural and industrial activities, animal breeding, and wastewater discharge). The presented approach can be tailored to the information available for any local scale case study. Data on annual regional sales of PPPs and APIs were integrated with georeferenced demographic and economic statistics (such as census and land-use information) to estimate chemicals emissions to surface water and groundwater. A sensitivity and uncertainty analysis identified the main factors affecting emissions estimates, and those contributing more significantly to results uncertainty. Results showed the highest estimated emissions of APIs for antibiotics (i.e., amoxicillin, clarithromycin, azithromycin, and ciprofloxacin) used for humans and animals, while most of hormones' emission (i.e., 17- α-ethinylestradiol and 17-β-estradiol) derived from animal breeding. Regarding PPPs, glyphosate and imidacloprid emissions were one to two orders of magnitude higher compared to the other chemicals. Uncertainty and sensitivity analysis showed that the variability of each parameter used to estimate emissions depends greatly both on the target chemical and the specific emission source considered. Excretion rates and removal during wastewater treatment were major key parameters for all the target pharmaceutical compounds, while for PPPs the key parameter was their loss into the natural waters after application.
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Affiliation(s)
- Loris Calgaro
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Via Torino 155, 30172, Venice Mestre, Italy.
| | - Elisa Giubilato
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Via Torino 155, 30172, Venice Mestre, Italy.
| | - Lara Lamon
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Via Torino 155, 30172, Venice Mestre, Italy.
| | - Francesco Calore
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Via Torino 155, 30172, Venice Mestre, Italy.
| | - Elena Semenzin
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Via Torino 155, 30172, Venice Mestre, Italy.
| | - Antonio Marcomini
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Via Torino 155, 30172, Venice Mestre, Italy.
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Techatraisak K, Rattanachaiyanont M, Tanmahasamut P, Indhavivadhana S, Wongwananuruk T, Jirakittidul P. Impact of Global Consensus Statement on compliance with hormonal therapy for surgical menopause. Climacteric 2021; 25:300-305. [PMID: 34726130 DOI: 10.1080/13697137.2021.1978424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Initiation of and compliance with menopausal hormonal therapy (MHT) have been dropping due to the 2002 Women's Health Initiative (WHI) publication. We evaluated the change in practice of MHT for surgical menopause after implementing the 2013 'Global Consensus Statement on MHT' to our institutional guideline. METHODS A retrospective study was conducted in surgically menopausal women newly registering at the Siriraj Menopause Clinic in a university hospital, Thailand, from 1995 to 2013. The patients were categorized into four groups according to periods of MHT initiation: 1995-1998 (control), 2000-2003 (WHI affected), 2005-2008 (post WHI) and 2010-2013 (Global Consensus Statement affected). Their 3-year compliance with MHT was compared using forward stepwise regression analysis. RESULTS There were 288, 156, 107 and 104 cases in the 1995-1998, 2000-2003, 2005-2008 and 2010-2013 groups. Their mean age at surgery was 42.8 ± 4.7 years. After the first, second and third years, overall compliance was 82.4%, 70.9% and 61.2%, respectively. The 3-year compliance drastically dropped in the 2000-2003 group, and then improved to control level in the 2010-2013 group (51.9% vs. 77.9%, p = 0.035). CONCLUSION The initiation of MHT continuously dropped during 2000-2013; however, compliance with MHT initiated during 2010-2013 improved after implementing the 2013 'Global Consensus Statement on MHT' to our institutional guideline. Each institute should have a strategy to encourage the initiation of and compliance with MHT for surgical menopause to achieve long-term health benefits.
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Affiliation(s)
- K Techatraisak
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - M Rattanachaiyanont
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Tanmahasamut
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Indhavivadhana
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Wongwananuruk
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Jirakittidul
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Menopausal hormone therapy: Characterising users in an Australian national cross-sectional study. PLoS One 2021; 16:e0253725. [PMID: 34379634 PMCID: PMC8357145 DOI: 10.1371/journal.pone.0253725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022] Open
Abstract
Menopausal hormone therapy (MHT) is effective for menopausal symptoms, however, its use is also associated with risks of serious health conditions including breast, ovarian and endometrial cancer, stroke and venous thromboembolism. MHT-related health risks increase with longer durations of use. In Australia, while overall MHT use fell when risk-related findings were published in 2002, a significant number of women continue using MHT long-term. We aimed to examine socio-demographic, health-related and lifestyle characteristics in relation to post-2002 MHT use, and to compare use for <5 and ≥5 years. Data from 1,561 participants from an Australian, national, cross-sectional survey of women aged 50–69 in 2013 were analysed. Odds ratios (ORs) were calculated using logistic regression for characteristics related to overall MHT use post-2002 and multinomial logistic regression for associations between MHT duration of use [never/<5 years/≥5 years] and personal characteristics, adjusting for sociodemographic, reproductive, health and lifestyle factors. Post-2002 MHT use was associated with increasing age (p-trend<0.001), hysterectomy versus no hysterectomy (OR:2.55, 95%CI = 1.85–3.51), bilateral oophorectomy vs no oophorectomy (OR:1.66, 95%CI = 1.09–2.53), and ever- versus never-use of therapies other than MHT for menopausal symptoms (OR:1.93, 95%CI = 1.48–2.57). Women with prior breast cancer (OR:0.35, 95%CI = 0.17–0.74) and with more children (p-trend = 0.034) were less likely than other women to use MHT. Prior hysterectomy was more strongly associated with MHT use for ≥5 years than for <5 years (p = 0.004). Ever-use of non-MHT menopausal therapies was associated with MHT use for <5 years but not with longer-term use (p = 0.004). This study reinforces the need for MHT users and their clinicians to re-evaluate continued MHT use on an ongoing basis.
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Yasui T, Ideno Y, Shinozaki H, Kitahara Y, Nagai K, Hayashi K. Prevalence of the Use of Oral Contraceptives and Hormone Replacement Therapy in Japan: the Japan Nurses' Health Study. J Epidemiol 2020; 32:117-124. [PMID: 33132283 PMCID: PMC8824660 DOI: 10.2188/jea.je20200207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background There have been few community-based epidemiological studies in which the prevalence of exogenous hormone use, including the use of oral contraceptives (OCs) and hormone replacement therapy (HRT), has been accurately assessed in Japan.Methods We have been conducting repeated surveys of participants in the Japan Nurses' Health Study (JNHS), as a nationwide prospective cohort study, since 2001. We determined the prevalence of exogenous hormone use at baseline and during a 10-year follow-up period. A total of 15,019 female nurses participated in the JNHS follow-up cohort. We determined the prevalence of OC use in 14,839 women <60 years of age at baseline and the prevalence of HRT use in 7,915 women, excluding premenopausal women, at the last time they answered a questionnaire. The duration of HRT use was estimated using the Kaplan-Meier method.Results Six percent of the participants used OCs. The proportion of HRT users who stopped HRT before the baseline survey, the proportion of women using HRT during the follow-up period, and the proportion of all of the participants who had used HRT were 3.2%, 10.6%, and 13.8%, respectively. The median duration of HRT use was 2 years.Conclusions The lifetime prevalences of exogenous hormone use during this prospective study conducted in Japanese nurses were 6.0% for OCs and 13.8% for HRT. The information obtained in this study will be useful for clarification of the association between exogenous estrogen exposure and estrogen-related diseases as future research.
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Affiliation(s)
- Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Yuki Ideno
- Center for Mathematics and Data Science, Gunma University
| | | | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine
| | - Kazue Nagai
- Graduate School of Health Sciences, Gunma University
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Techatraisak K, Angsuwathana S, Rattanachaiyanont M, Tanmahasumut P, Indhavivadhana S, Wongwananurak T, Leerasiri P, Jirakittidul P. Compliance and health consequences of menopausal hormonal therapy after surgical menopause: A retrospective study in Thailand. J Obstet Gynaecol Res 2020; 47:208-215. [PMID: 33078538 DOI: 10.1111/jog.14486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 07/01/2020] [Accepted: 08/26/2020] [Indexed: 11/27/2022]
Abstract
AIM To study compliance with menopausal hormonal therapy (MHT) until age ≥ 50 year and health consequences after surgical menopause. METHODS A retrospective cohort study of 1000 consecutive surgically menopausal patients who underwent premenopausal surgery before 50 years of age from benign indications during 1996-2012 was performed. Main outcomes were number in year of MHT compliance and health consequences: hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), ischemic heart disease (IHD)/myocardial infarction (MI), venous thromboembolism (VTE), stoke, osteopenia/osteoporosis, cognitive impairment/dementia/Alzheimer's disease (AD) /Parkinsonism and breast/other cancers. The MHT nonuser subgroup served as the control. RESULTS Of the 1000 patients, 855 cases used MHT. The median overall follow-up time from surgery for 145 MHT nonuser patients, 435 MHT users until age <50 year and 420 MHT users until age ≥50 year was 12.0 years. Compliance until age ≥50 year was only 49.1%. For MHT users, the overall median age of stopping MHT was 47.0 year with a median MHT use of 6.0 year. After age adjustment at the time of follow-up of all subgroups by forward stepwise logistic regression analysis, the only significantly different health consequence was osteopenia (32.4%, 10.6% and 21.4% in the MHT nonusers, users until age <50 year and users until age ≥50 year, respectively [P < 0.001]). Prevalence of breast cancer, colon cancer and other cancers were not different among subgroups. CONCLUSION The majority of patients used MHT with low compliance until age ≥50 year. In addition, MHT initiation after surgery possibly prevented osteopenia compared with MHT nonusers.
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Affiliation(s)
- Kitirat Techatraisak
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Angsuwathana
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manee Rattanachaiyanont
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prasong Tanmahasumut
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suchada Indhavivadhana
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanyarat Wongwananurak
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Preeyaporn Jirakittidul
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Garg N, Behbehani S, Kosiorek H, Wasson M. Hormone Replacement Therapy Prescription after Premature Surgical Menopause. J Minim Invasive Gynecol 2020; 27:1618-1623. [PMID: 32173578 DOI: 10.1016/j.jmig.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To assess hormone replacement therapy (HRT) prescription pattern in patients undergoing premature surgical menopause on the basis of surgical indication. DESIGN Retrospective cohort study. SETTING Academic tertiary care center. PATIENTS Surgically menopausal patients aged ≤45 years who underwent a minimally invasive hysterectomy with salpingo-oophorectomy. INTERVENTIONS HRT prescription in the 6-week postoperative period. MEASUREMENTS AND MAIN RESULTS A total of 63 patients met inclusion criteria. Of these, 52% (n = 33) were prescribed HRT in the 6-week postoperative period. Indications for surgical menopause included pelvic pain or endometriosis (31.7%), gynecologic malignancy (20.6%), BRCA gene mutation (17.4%), breast cancer (9.5%), Lynch syndrome (4.8%), and other (15.8%). In total, 80% of patients with pelvic pain, 25% with gynecologic malignancies, 45% with BRCA gene mutations, 33.3% with breast cancer, and 66.6% with Lynch syndrome used HRT postoperatively. In patients who used HRT postoperatively, 76% were offered preoperative HRT counseling. This is in contrast with those patients who did not use HRT postoperatively, of whom only 33% were offered HRT counseling (p <.001). Perioperative complications were not predictive of HRT use postoperatively. In patients who did not use HRT postoperatively, 13.3% used alternative nonhormonal therapy. CONCLUSION In patients who underwent premature surgical menopause, 52% used HRT postoperatively. Patients with pelvic pain and Lynch syndrome were more likely to use HRT, whereas those with gynecologic or breast malignancies and BRCA gene mutations were less likely to use HRT. Preoperative HRT counseling was associated with postoperative HRT use.
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Affiliation(s)
- Nisha Garg
- Department of Obstetrics and Gynecology, University of California, Irvine (Dr. Garg)
| | - Sadikah Behbehani
- Department of Obstetrics and Gynecology, University of California, Riverside (Dr. Behbehani), California.
| | - Heidi Kosiorek
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale (Ms. Kosiorek)
| | - Megan Wasson
- Department of Gynecology, Mayo Clinic Arizona, Phoenix (Dr. Wasson), Arizona
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Manson JE, Aragaki AK, Bassuk SS, Chlebowski RT, Anderson GL, Rossouw JE, Howard BV, Thomson CA, Stefanick ML, Kaunitz AM, Crandall CJ, Eaton CB, Henderson VW, Liu S, Luo J, Rohan T, Shadyab AH, Wells G, Wactawski-Wende J, Prentice RL. Menopausal Estrogen-Alone Therapy and Health Outcomes in Women With and Without Bilateral Oophorectomy: A Randomized Trial. Ann Intern Med 2019; 171:406-414. [PMID: 31499528 PMCID: PMC8120507 DOI: 10.7326/m19-0274] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Whether health outcomes of menopausal estrogen therapy differ between women with and without bilateral salpingo-oophorectomy (BSO) is unknown. OBJECTIVE To examine estrogen therapy outcomes by BSO status, with additional stratification by 10-year age groups. DESIGN Subgroup analyses of the randomized Women's Health Initiative Estrogen-Alone Trial. (ClinicalTrials.gov: NCT00000611). SETTING 40 U.S. clinical centers. PARTICIPANTS 9939 women aged 50 to 79 years with prior hysterectomy and known oophorectomy status. INTERVENTION Conjugated equine estrogens (CEE) (0.625 mg/d) or placebo for a median of 7.2 years. MEASUREMENTS Incidence of coronary heart disease and invasive breast cancer (the trial's 2 primary end points), all-cause mortality, and a "global index" (these end points plus stroke, pulmonary embolism, colorectal cancer, and hip fracture) during the intervention phase and 18-year cumulative follow-up. RESULTS The effects of CEE alone did not differ significantly according to BSO status. However, age modified the effect of CEE in women with prior BSO. During the intervention phase, CEE was significantly associated with a net adverse effect (hazard ratio for global index, 1.42 [95% CI, 1.09 to 1.86]) in older women (aged ≥70 years), but the global index was not elevated in younger women (P trend by age = 0.016). During cumulative follow-up, women aged 50 to 59 years with BSO had a treatment-associated reduction in all-cause mortality (hazard ratio, 0.68 [CI, 0.48 to 0.96]), whereas older women with BSO had no reduction (P trend by age = 0.034). There was no significant association between CEE and outcomes among women with conserved ovaries, regardless of age. LIMITATIONS The timing of CEE in relation to BSO varied; several comparisons were made without adjustment for multiple testing. CONCLUSION The effects of CEE did not differ by BSO status in the overall cohort, but some findings varied by age. Among women with prior BSO, in those aged 70 years or older, CEE led to adverse effects during the treatment period, whereas women randomly assigned to CEE before age 60 seemed to derive mortality benefit over the long term. PRIMARY FUNDING SOURCE The WHI program is funded by the National Heart, Lung, and Blood Institute; National Institutes of Health; and U.S. Department of Health and Human Services. Wyeth Ayerst donated the study drugs.
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Affiliation(s)
- JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.E.M., S.S.B.)
| | - Aaron K Aragaki
- Fred Hutchinson Cancer Research Center, Seattle, Washington (A.K.A., G.L.A., R.L.P.)
| | - Shari S Bassuk
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.E.M., S.S.B.)
| | - Rowan T Chlebowski
- City of Hope National Medical Center, Duarte, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California (R.T.C.)
| | - Garnet L Anderson
- Fred Hutchinson Cancer Research Center, Seattle, Washington (A.K.A., G.L.A., R.L.P.)
| | - Jacques E Rossouw
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.E.R.)
| | - Barbara V Howard
- MedStar Health Research Institute, Bonita Springs, Florida, and Georgetown-Howard Universities, Washington, DC (B.V.H.)
| | - Cynthia A Thomson
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (C.A.T.)
| | | | - Andrew M Kaunitz
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida (A.M.K.)
| | - Carolyn J Crandall
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (C.J.C.)
| | - Charles B Eaton
- Alpert Medical School of Brown University, Providence, Rhode Island (C.B.E., S.L.)
| | | | - Simin Liu
- Alpert Medical School of Brown University, Providence, Rhode Island (C.B.E., S.L.)
| | - Juhua Luo
- Brown University, Providence, Rhode Island; Indiana University, Bloomington, Indiana (J.L.)
| | - Thomas Rohan
- Albert Einstein College of Medicine, Bronx, New York (T.R.)
| | - Aladdin H Shadyab
- University of California, San Diego School of Medicine, La Jolla, California (A.H.S.)
| | | | - Jean Wactawski-Wende
- University at Buffalo, the State University of New York, Buffalo, New York (J.W.)
| | - Ross L Prentice
- Fred Hutchinson Cancer Research Center, Seattle, Washington (A.K.A., G.L.A., R.L.P.)
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Abstract
OBJECTIVE The aim of the study was to assess the prevalence and factors associated with hormone therapy (HT) use among Canadian women. METHODS Baseline data from the Tracking cohort of the Canadian Longitudinal Study on Aging (CLSA) was used for this analysis. The main outcome was HT use among women aged 45-85 years, defined as current, past, and never users. Multinomial logistic regression models were used to examine the differences between current, past, and never HT users in terms of sociodemographic, health behavior, and health-related variables. RESULTS Overall, 9.5% of the sample reported current use of HT, whereas 21.9% reported past use. The main factors associated with a lower likelihood of current HT use were older age (>80 y), nonwhite ethnic background, current employment, regular smoking, obesity, and breast cancer. By contrast, alcohol consumption, and the presence of allergies or mood disorders were positively associated with current HT use. CONCLUSIONS These findings provide a recent national picture of HT use in Canada that may be used to inform opportunities for improved physician-patient communication regarding menopause management.
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Hormonal contraception and postmenopausal hormone therapy in Spain: time trends and patterns of use. Menopause 2016; 22:1138-46. [PMID: 26125537 DOI: 10.1097/gme.0000000000000487] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to describe time trends in and patterns of use of hormonal contraception and postmenopausal hormone therapy and to identify factors associated with their use among Spanish women. METHODS We performed a cross-sectional analysis using data from 1,954 population controls (aged 24-85 y) in 12 provinces of Spain who were enrolled in the Multi Case-Control Spain study (2007-2013). Data were collected from a questionnaire conducted face-to-face by trained personnel. We collected information on sociodemographic factors, lifestyle, sleep patterns, reproductive history, and occupational history. RESULTS Overall, 48.5% of Spanish women reported ever use of hormonal contraception, and 9.8% of women in the postmenopausal group reported use of postmenopausal hormone therapy. Younger cohorts used hormonal contraception for a longer period, whereas postmenopausal hormone therapy use dramatically dropped in the 2000s. Women with higher education levels (including education of partners) and smoking history were the most probable users of hormonal contraception, whereas inverse associations were observed among housewives, obese women, and nulliparous women. Postmenopausal hormone therapy use was associated with a surgical or therapeutic cause of menopause and with occupational history of rotating shifts. CONCLUSIONS In this Spanish population, several demographic, lifestyle, occupational, and reproductive factors are associated with use of hormonal compounds. Characterizing hormonal users and monitoring trends in the use of these hormonal compounds are essential from a public health perspective.
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Gambineri A, Fanelli F, Prontera O, Repaci A, Di Dalmazi G, Zanotti L, Pagotto U, Flacco ME, Guidi J, Fava GA, Manzoli L, Pasquali R. Prevalence of hyperandrogenic states in late adolescent and young women: epidemiological survey on italian high-school students. J Clin Endocrinol Metab 2013; 98:1641-50. [PMID: 23436925 DOI: 10.1210/jc.2012-3537] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Most of the estimates of the prevalence of hyperandrogenic states refer to the general adult population. OBJECTIVE The objective of the study was to estimate the prevalence of hyperandrogenic states in late adolescence and youth and to evaluate potential independent predictors. DESIGN This was a cross-sectional study. SETTING The study was conducted in high schools. PATIENTS Patients included female students, aged 16-19 years. MAIN OUTCOME MEASURES The study protocol was designed with 3 possible levels of participation: the first level consisted of a self-compiled questionnaire; the second level added a medical examination; and the third level added a blood sample for laboratory testing. Liquid chromatography-tandem mass spectrometry was used to measure total testosterone, and a reference interval was established in-house. RESULTS We offered participation to 2052 students, and 1469 of those compiled the questionnaire. Of these, 1038 were examined, and 519 also provided blood samples. Two hundred three of the 1038 examined students and 125 of the 519 students who provided blood samples were subsequently excluded because of treatment with oral contraceptives or because of endocrine disorders. In the sample of women with a questionnaire + a medical examination, 13% were affected by isolated menstrual irregularity, 16.1% by isolated clinical hyperandrogenism, and 3.8% by both states. A similar prevalence of isolated menstrual irregularity (10.2%) and isolated clinical hyperandrogenism (16.7%) was found in the subsample of women with laboratory tests; in addition, 6.6% showed isolated hyperandrogenemia, and 4.3% proved to be affected by polycystic ovary syndrome. CONCLUSIONS This study provides for the first time a reliable assessment of the prevalence of hyperandrogenic states in late adolescent and young females and confirms that hyperandrogenic disorders originate at a young age.
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Affiliation(s)
- Alessandra Gambineri
- Endocrinology Unit, Department of Clinical Medicine, St Orsola-Malpighi Hospital, Bologna, Italy
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Riska A, Martinsen JI, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Occupation and risk of primary fallopian tube carcinoma in Nordic countries. Int J Cancer 2011; 131:186-92. [PMID: 21805475 DOI: 10.1002/ijc.26337] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/05/2011] [Indexed: 12/27/2022]
Abstract
The aetiology of primary Fallopian tube carcinoma (PFTC) is poorly understood. Occupational exposures may contribute to PFTC risk. We studied incidence of PFTC in occupational categories in the Nordic female population aged 30-64 years during the 1960, 1970, 1980/1981 and/or 1990 censuses in Denmark, Finland, Iceland, Norway and Sweden. Standardized incidence ratios (SIRs) for the years following inclusion in the study up to 2005 were calculated for 53 occupations; the expected numbers of cases were based on PFTC incidence in the national populations. Altogether 2,206 PFTC cases were detected during follow up via data linkages with the Nordic cancer registries. Significantly increased risks of PFTC were observed for smelting workers (SIR 3.99, 95% confidence interval 1.46-8.68, Obs = 6), artistic workers (2.64, 1.44-4.43, Obs = 14), hairdressers (2.18, 1.41-3.22, Obs = 25), packers (1.62, 1.11-2.29, Obs = 32), nurses (1.49, 1.14-1.92, Obs = 60), shop workers (1.25, 1.07-1.46, Obs = 159) and clerical workers (1.20, 1.07-1.35, Obs = 271) and these sustained over times and different Nordic countries. There was a nonsignificant increased risk for PFTC among welders, printers, painters and chemical process workers. The risk was significantly and consistently low for women working in farming (0.68, 0.47-0.95, Obs = 34) and among economically inactive women (0.88, 0.82-0.94, Obs = 833). The possible role of occupational exposures to the PFTC risks found in this study must be further evaluated in studies with a possibility to adjust for possible confounding factors, such as reproductive and life-style factors, which was not possible in our study.
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Affiliation(s)
- A Riska
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland.
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Chubaty A, Shandro MTL, Schuurmans N, Yuksel N. Practice patterns with hormone therapy after surgical menopause. Maturitas 2011; 69:69-73. [PMID: 21396791 DOI: 10.1016/j.maturitas.2011.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe practice patterns with hormone therapy (HT) in women after a surgical menopause and to describe their experience of hot flashes and other menopausal symptoms. METHODS This was a cross-sectional chart-review with telephone follow up interview of women between the ages of 20 and 50 years who had a hysterectomy and bilateral salpingo-oophorectomy (BSO) before menopause at an academic teaching facility in Edmonton, Canada between December 1, 2006 and November 30, 2007. RESULTS Seventy women were interviewed. Mean respondents age at surgery was 44.3 (±5.2) years and mean time since surgery was 10.2 (±3.8) months. Twenty-eight women (40%) were started on HT after surgical menopause; 23 (33%) were still taking HT at the time of the interview. Estrogen therapy (ET) was the only HT prescribed in all instances, with over half the women on transdermal estrogen at time of the interview and 70% on ET doses equivalent to 0.625mg conjugated estrogens. Women not taking HT were more likely to experience daily hot flashes (74% vs 30%, p=0.006) and to classify them as moderate or severe intensity (57% vs 47%, p=0.033). Night sweats and difficulty sleeping were reported equally in both groups. CONCLUSIONS Over 2/3rd of women were not on HT after a surgical menopause and many of these women were still having daily hot flashes. Targeted patient education prior to surgery or at discharge may help improve the management of menopausal symptoms and long term health consequences in women after a surgical menopause.
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Nappi RE, Lello S, Melis GB, Albani F, Polatti F, Genazzani AR. LEI (Lack of tEstosterone Impact) survey in a clinical sample with surgical menopause. Climacteric 2009; 12:533-40. [DOI: 10.3109/13697130902972005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Parazzini F. Trends of determinants of hormone therapy use in Italian women attending menopause clinics, 1997-2003. Menopause 2008; 15:164-70. [PMID: 17581495 DOI: 10.1097/gme.0b013e318057782b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Analysis of patterns of hormone therapy (HT) use among postmenopausal Italian women, before and after publication of results from the Heart and Estrogen/progestin Replacement Study and the Women's Health Initiative. DESIGN This was a cross-sectional study conducted between 1997 and 2003 on the characteristics of women around the age of menopause. The study population consisted of 106,784 women (mean age 53 y) attending menopause clinics in Italy. Postmenopausal women were defined as women with surgical menopause (ie, bilateral oophorectomy with or without hysterectomy), women older than 55 years who underwent hysterectomy without bilateral oophorectomy, and women whose menstrual cycles had stopped more than 1 year before their interview. RESULTS A total of 15,657 women (14.7%) reported ever using HT. The prevalence of HT prescription was 17.6% among women observed in 1997-1998, 14.9% in 1999, 12.2% in 2000, 12.1% in 2001, and 11.4% in 2002-2003. HT use was related to age at menopause and level of education in all the periods considered and was more frequent in women reporting surgical menopause. The odds ratio of HT prescription tended to decrease in women with surgical menopause, with slight fluctuations in the intermediate years. Ever users of oral contraceptives and nulliparae were more frequently HT users. CONCLUSIONS In our population the percentage of current HT users dropped from 17.6% in 1997-1998 to 11.4% in 2002-2003. However, the determinants of use were largely unchanged during the study period: women with higher education, nulliparae, and smokers reported more frequent HT use.
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Huang WF, Tsai YW, Hsiao FY, Liu WC. Changes of the prescription of hormone therapy in menopausal women: an observational study in Taiwan. BMC Public Health 2007; 7:56. [PMID: 17439639 PMCID: PMC1871579 DOI: 10.1186/1471-2458-7-56] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 04/17/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the impact of the 2002 Women's Health Initiative (WHI) study results on the prescription of menopausal hormone therapy (MHT) to treat menopause-related symptoms in Taiwan. METHODS This retrospective study participant data collected from women interviewed in 2001 Taiwan's National Health Interview Survey (NHIS) and the National Health Insurance (NHI) outpatient claims for women being treated for menopause-related symptoms. We compared prescriptions made for MHI to women seeking outpatient treatment for menopause-related symptoms before and after the publication of the 2002 WHI to study its effect of prescription behavior in Taiwan. There was one dichotomous outcome variable, which was whether MHT was prescribed or not in an outpatient visit to treat menopause-related symptoms. RESULTS Our study included 504 women 45 years old or above whose outpatient visits for menopause-related symptoms were covered by National Health Insurance in 2002. In total, these 504 women made 2549 outpatient visits to be treated for these symptoms. The proportion of outpatient visits in which MHT was prescribed dropped from 83.0% (n = 1,155) before WHI to 73.0% (n = 844) after WHI. We found a decrease in likelihood that women would be prescribed MHT for menopause-related symptoms after the release of the WHI report (OR = 0.36, 95% CI = 0.25 to 0.52, p < 0.05). Gynecologists and obstetricians are more likely to prescribe MHT than physicians with other medical specialties (5.34; 95% CI = 3.45 to 8.26, p < 0.05). Women with college level educations or higher became less likely to be prescribed MHT (Model 2; OR 0.30; 95% CI 0.11-0.83), and academic medical centers became less likely to prescribe MHT than other medical care institutions (Model 3; OR 0.15; 95% CI 0.34-0.63). CONCLUSION The WHI report caused a substantial decline in the use of MHT to treat menopause-related symptoms in Taiwan. It was found to exert most of its influence in patients with higher educations, physicians with specialties other than gynecologists and obstetricians, and academic medical centers.
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Affiliation(s)
- Weng-Foung Huang
- Institutes of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Wen Tsai
- Institutes of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
- Division of Health Policy Research, National Health Research Institutes, Miaoli, Taiwan
| | - Fei-Yuan Hsiao
- Division of Health and Welfare Policy Management, Institutes of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chun Liu
- Taiwan Joint Commission on Hospital Accreditation, Taipei, Taiwan
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Lucas R, Barros H. Life prevalence and determinants of hormone replacement therapy in women living in Porto, Portugal. Maturitas 2007; 57:226-32. [PMID: 17293067 DOI: 10.1016/j.maturitas.2006.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 12/07/2006] [Accepted: 12/27/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To survey the life prevalence and determinants of hormone replacement therapy (HRT) in Portugal. METHODS We evaluated 908 women with mean age (standard deviation) 62.3 (9.6) years, as part of the assembling of a cohort of adults, representative of Porto inhabitants. Extensive data collection was conducted and included socio-demographic, lifestyle and clinical characterisation. The latter comprised gynecologic and obstetric history, as well as lifetime use and duration of HRT. RESULTS Life prevalence of hormone replacement therapy was 26.8% (95% confidence interval: 23.9-29.8). Prevalence of lifetime HRT was higher in younger (born after 1949: 37.1%) and more educated women (over 12 schooling years: 48.7%), as in white-collar workers (36.8%), and women using private healthcare (39.4%). HRT use was also more frequent among ever smokers (43.1%), and in women reporting regular sports practice (35.6%). Ever users of oral contraceptives underwent HRT more frequently (33.3%) and women who experienced menopause more recently were more likely to use HRT (after 1994: 40.5%). No differences were found in the prevalence of HRT according to whether women had been hysterectomised or oophorectomised. Education, regular sports practice and menopause year were independent determinants of HRT. Median duration of therapy was 2 years. Short-term HRT users were more educated, and had more recent menopause. Long-term HRT users were more educated, engaged in sports more frequently, and were more frequently oophorectomised. CONCLUSIONS Prevalence of hormone replacement therapy increased until 2001 and was mainly determined by high socioeconomic status, regardless of important therapeutic indications, such as oophorectomy and hysterectomy.
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Affiliation(s)
- Raquel Lucas
- Department of Hygiene and Epidemiology, University of Porto Medical School, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.
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Nagel G, Lahmann PH, Schulz M, Boeing H, Linseisen J. Use of hormone replacement therapy (HRT) among women aged 45-64 years in the German EPIC-cohorts. Maturitas 2006; 56:436-46. [PMID: 17194554 DOI: 10.1016/j.maturitas.2006.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 11/01/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the prevalence and to assess type and indicators of hormone replacement therapy (HRT) use in the two German EPIC-cohorts. METHODS Approximately 30,000 women predominantly aged 35-65 years were recruited in EPIC-Heidelberg and EPIC-Potsdam between 1994 and 1998. Information on diet and lifestyle, medical history and use of hormone therapy was collected at recruitment. Prevalence and type of HRT-regime was described and logistic regression models used to examine correlates of HRT-use. RESULTS Among women aged 45-64 years, 37.9% in Heidelberg and 35.8% in Potsdam were current HRT users. Among current users without bilateral oophorectomy, 40.5% in Heidelberg and 23.7% in Potsdam used HRT for at least 5 years. Most women in Heidelberg were taking cyclic combined or estrogen monotherapy, whereas in Potsdam both continuous combined and cyclic combined therapies were most frequently used. In both centres, older age, ever use of oral contraceptives, and alcohol consumption were indicators for both current and ever HRT-use. HRT-use was less frequent in obese women as compared to women with lower BMI. In Potsdam, but not in Heidelberg, higher education and current smoking were associated with HRT-use. CONCLUSION In both German EPIC-cohorts, the prevalence of medication with HRT is high compared to other European countries. Types of exogenous hormones used differed by centre. Various reproductive and lifestyle characteristics were identified as correlates of HRT-use.
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Affiliation(s)
- Gabriele Nagel
- Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany.
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van Duijnhoven FJB, van Gils CH, Bezemer ID, Peeters PHM, van der Schouw YT, Grobbee DE. Use of hormones in the menopausal transition period in the Netherlands between 1993 and 1997. Maturitas 2006; 53:462-75. [PMID: 16198516 DOI: 10.1016/j.maturitas.2005.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 08/04/2005] [Accepted: 08/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the patterns and to assess the indicators of hormone use during the menopausal transition period in a Dutch population. METHODS Between 1993 and 1997, 17,357 women aged 49-70 years participated in the Prospect-EPIC (European Prospective Investigation into Cancer and Nutrition) cohort and filled out an extensive questionnaire, which included information about hormone use during menopausal transition and other medical and lifestyle characteristics. Patterns of hormone use were described and various characteristics were evaluated as indicators of current hormone use by logistic regression. RESULTS Overall, 13% of women were current hormone users, which was highest in the 49-54 age group (19%). Hysterectomized women and older non-hysterectomized women mainly used unopposed estrogen therapy (ET), whereas younger non-hysterectomized women mainly used oral contraceptives or combined estrogen+progestogen therapy. Of all ever users, 61% used hormones for more than 1 year and 28% for more than 5 years. The most important indicators of hormone use for women without a surgical menopause were age, alcohol use, smoking, parity, ever use of oral contraceptives and family history of breast cancer. For women with a surgical menopause age, parity, ever use of oral contraceptives, diastolic blood pressure and the number of removed ovaries were the most relevant indicators. CONCLUSIONS The frequency of hormone use during menopausal transition in the Netherlands is low compared to other western countries, but the duration of use is quite long. Hormone use seems to be largely determined by factors that are known to affect endogenous estrogen levels.
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Affiliation(s)
- Fränzel J B van Duijnhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Greendale GA, Gold EB. Lifestyle factors: are they related to vasomotor symptoms and do they modify the effectiveness or side effects of hormone therapy? Am J Med 2005; 118 Suppl 12B:148-54. [PMID: 16414341 DOI: 10.1016/j.amjmed.2005.09.049] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reviews and summarizes published literature in order to address the following questions: (1) Are lifestyle factors (alcohol use, cigarette exposure, and physical activity) and body mass index (BMI) related to the occurrence of vasomotor symptoms in perimenopausal and postmenopausal women? (2) Do lifestyle factors or BMI modify the effectiveness or side effects of menopausal hormone therapy (HT)? Information was culled from a nonstructured review of English-language literature. Low levels of alcohol consumption (< or =1 drink per day for women) do not have a measurable effect on occurrence of vasomotor symptoms; whether greater amounts of alcohol intake would promote vasomotor symptoms cannot be addressed by available literature. Most published studies report that active cigarette smoking is positively associated with vasomotor symptoms. However, a large study found that passive (but not active) smoking (i.e., secondhand smoke exposure) was related to vasomotor symptoms. Studies to date do not support a relation between physical activity and vasomotor symptoms. However, rates of vasomotor symptom reporting were low in these studies, potentially limiting the ability to detect an effect of physical activity. Greater BMI is a risk factor for more vasomotor symptom reporting. The scarcity of data that directly address whether lifestyle factors or BMI modify the effects of HT precludes a substantive response to this question at present. Available literature suggests that smoking and greater body weight are risk factors for vasomotor symptoms; women with vasomotor symptoms who smoke may benefit from smoking cessation, and women who are heavier than ideal body weight may benefit from weight reduction. Whether certain behaviors or BMI raise or lower the risks or benefits of HT remains largely unknown and should be the focus of future research.
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Affiliation(s)
- Gail A Greendale
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, California 90095-1687, USA.
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Vorobjov S, Hovi SL, Veerus P, Pisarev H, Rahu M, Hemminki E. Treatment adherence in the Estonian postmenopausal hormone therapy (EPHT) trial [ISRCTN35338757]. Maturitas 2005; 52:286-95. [PMID: 16055284 DOI: 10.1016/j.maturitas.2005.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Revised: 05/03/2005] [Accepted: 05/04/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate treatment adherence and factors related to non-adherence in the Estonian postmenopausal hormone therapy (EPHT) trial. METHODS A total of 1823 postmenopausal women aged 50-64 years were recruited into the EPHT trial from 1999 to 2001. They were randomised into the blind group receiving continuous orally administered postmenopausal hormone therapy (PHT) or a placebo and to a non-blind group receiving open-label PHT or no drugs. A woman was classified as non-adherent, if she had stopped treatment for at least 6-month period in treatment arms or used PHT for at least 6-month period in the control group. Adherence was calculated by the Kaplan-Meier method, and factors affecting adherence were studied with Cox proportional hazard modelling. RESULTS The rate of adherent women declined approximately 50% during the first year in all treatment arms. Less than 10% of the control group women started taking prescribed PHT. Older women, with lower education, with only one birth, never used oral contraceptives (OC), with lower physical activity or who were dissatisfied with the information received from the trial staff, were more likely to discontinue. In treatment arms, the two most often cited reasons for non-adherence were side-effects and woman's loss of interest in participation. Control group women started PHT due to the menopausal symptoms or on doctor's recommendation. CONCLUSIONS The adherence was similar to that found for PHT use in everyday life. Higher adherence was related to younger age, higher education, previous OC use, physical activity and satisfaction with received information.
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Affiliation(s)
- Sigrid Vorobjov
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
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