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Zhu Y, Yang X, Wang Y, Zhu X. Assessment of knowledge, understanding and awareness of Chinese women clinical staff towards menopause hormone therapy: a survey study. J OBSTET GYNAECOL 2023; 43:2171779. [PMID: 36772932 DOI: 10.1080/01443615.2023.2171779] [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: 02/12/2023]
Abstract
Menopausal Hormone Therapy (MHT) is recommended for climacteric peri- and postmenopausal symptoms. The rate of use of MHT in China is much lower than the western regions. Therefore, a survey was conducted for the understanding and utilization of MHT among clinical staff in various hospitals of China. A total of 3216 eligible questionnaires were included for the evaluation. According to 19.2% participant opinion, MHT could relieve menopausal symptoms, whereas the majority had no knowledge of the benefits and risks of MHT. The most common concern about MHT was the risk of cancer and about 430 (13.4%) and 176 (5.5%) participants were apprehensive that MHT could increase the risk of breast and endometrial cancer, respectively. This survey demonstrated that the knowledge of clinical staff was not comprehensive and they should be educated more about the use of MHT so that this knowledge can be imbibed into the general population.Impact StatementWhat is already known on this subject? Menopausal Hormone Therapy (MHT) is recommended for climacteric peri- and postmenopausal symptoms. The rate of use of MHT in China is much lower than the western regions.What do the results of this study add? Only 19.2% of the respondents were of the opinion that MHT could relieve menopausal symptoms. The most common concern about MHT was the risk of cancer and about 430 (13.4%) and 176 (5.5%) participants were apprehensive that MHT could increase the risk of breast and endometrial cancer.What are the implications of these findings for clinical practice and/or further research? The survey demonstrated that Chinese medical professionals had some understanding about MHT, but their knowledge was not comprehensive. Thus, it is necessary to educate these medical professionals which in turn will help them to imbibe this knowledge among the general population.
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Affiliation(s)
- Ye Zhu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Yanjie Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Xiaodong Zhu
- Department of Immunopharmacology, Mudanjiang Medical University, Mudanjiang, China
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Thomas E, Verdonk P, Rhodius-Meester H, Muller M. Minding menopause in patients with cognitive impairment: a patient's perspective and reflections on clinical practice. BMC Womens Health 2023; 23:591. [PMID: 37950260 PMCID: PMC10638716 DOI: 10.1186/s12905-023-02770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
Many women experience impairment in cognitive function during perimenopause. These symptoms are often not attributed to perimenopause by women themselves, by family and friends, or by healthcare professionals. In this article, we present a case in which perimenopausal complaints were attributed to early dementia and discuss mechanisms contributing to the low level of awareness of perimenopausal symptoms amongst patients and clinicians. Stigma amongst women and healthcare professionals impairs the recognition of perimenopausal complaints, and consideration of treatment options by clinicians. We advocate raising awareness in patients and physicians with more education, and the incorporation of potential menopause-related symptoms in general clinical guidelines.
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Affiliation(s)
- Elias Thomas
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
- Amsterdam Public Health Institute, Ageing & Later Life, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Petra Verdonk
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hanneke Rhodius-Meester
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, VU University Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
| | - Majon Muller
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, the Netherlands
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Kiran A, Schultz NM, Siddiqui E, Todorova L, Van der Poel B, Stoelzel M, Robinson L. Epidemiology and treatment patterns of UK women diagnosed with vasomotor symptoms: Findings from the Clinical Practice Research Datalink GOLD database. Maturitas 2022; 164:1-8. [PMID: 35738198 DOI: 10.1016/j.maturitas.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/20/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe the epidemiology and treatment of vasomotor symptoms (VMS) in the UK. STUDY DESIGN Retrospective study that used electronic medical records from UK primary care centers. MAIN OUTCOME MEASURES The prevalence and incidence of moderate-to-severe VMS, the proportion treated, persistence with initial treatment, treatment patterns, and menopausal hormone therapy (HT) experience were investigated over the study period (Jan. 2009-Dec. 2018). The study population comprised women aged 40-65 years registered at general practitioner clinics. For incident cases, the uptake of pharmacological non-hormonal or hormonal treatment was recorded, which included experience of HT. RESULTS Over the 10-year study period, 1,481,646 women were included from the database, among whom there were 313,031 prevalent and 90,434 incident cases of VMS. Annual prevalence and incidence rates were stable over time, with a weighted average of 21.1 % and 15.3 per 1000 person-years, respectively (results varied across age groups). Among women who were incident VMS cases, 32.4 % (29,275) were initially prescribed non-hormonal treatments for a median of 3.9 months, 49.4 % (44,700) were prescribed hormonal treatments for 4.0 months, and 18.2 % (16,459) had no treatment. Approximately one-third of treated women switched between non-hormonal and hormonal treatments. The HT experience results showed that 52.7 % (47,639) of women were HT-eligible, 13.1 % (11,872) were HT-contraindicated (they may or may not have received HT), and 34.2 % (30,923) did not receive HT. CONCLUSIONS Variations in prescribed treatment patterns suggest that education may be needed for clinicians and women regarding the potential pharmacological options for treating VMS in the UK.
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Affiliation(s)
- Amit Kiran
- Advanced Informatics and Analytics, Astellas Pharma Europe Ltd, Addlestone, UK.
| | | | - Emad Siddiqui
- Medical Affairs, Astellas Pharma Europe Ltd, Addlestone, UK.
| | - Lora Todorova
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd, Addlestone, UK.
| | - Bas Van der Poel
- Advanced Informatics and Analytics, Astellas Pharma B.V., Leiden, Netherlands.
| | - Matthias Stoelzel
- Advanced Informatics and Analytics, Astellas Pharma B.V., Leiden, Netherlands.
| | - Lynne Robinson
- Menopause/Reproductive Endocrine Services, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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McCarty ME, Thomas HN. Differences in patient-reported hormone therapy use for menopause symptoms by provider specialty. Climacteric 2021; 24:600-604. [PMID: 34236012 PMCID: PMC9827593 DOI: 10.1080/13697137.2021.1945026] [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: 01/12/2023]
Abstract
OBJECTIVE Hormone therapy (HT) is an effective treatment for menopause symptoms in select women. This study aimed to determine whether there is different prevalence of HT use based on patient report by women who see different provider specialties. METHODS This study was a cross-sectional analysis of published data from the Survey of Midlife in the United States (MIDUS), a telephone or self-administered questionnaire of 3294 participants aged 39-90 years. Postmenopausal women were included. Self-reported HT use and provider specialty seen were each assessed by one question. Univariate logistic regression assessed factors possibly related to HT use. Variables with p < 0.1 were entered into a multivariable logistic regression model. RESULTS Of the 938 postmenopausal respondents, 720 (76%) saw a gynecologist for care. One-hundred and thirty-one (13%) women used HT for menopausal symptoms. Of women using HT, 72 (55%) saw a gynecologist. When controlling for other factors, women who saw a gynecologist had three times higher odds of using HT. The most frequently seen provider specialty was not associated with use. CONCLUSIONS Women who ever see a gynecologist are more likely to use HT for menopausal symptoms, but fewer women see gynecologists as they age. Generalists are the most seen provider specialty, positioning them to counsel patients about HT.
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Yeganeh L, Boyle JA, Wood A, Teede H, Vincent AJ. Menopause guideline appraisal and algorithm development for premature ovarian insufficiency. Maturitas 2019; 130:21-31. [DOI: 10.1016/j.maturitas.2019.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/03/2019] [Accepted: 09/20/2019] [Indexed: 12/22/2022]
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Natari RB, McGuire TM, Baker PJ, Clavarino AM, Dingle KD, Hollingworth SA. Longitudinal impact of the Women’s Health Initiative study on hormone therapy use in Australia. Climacteric 2019; 22:489-497. [DOI: 10.1080/13697137.2019.1593357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. B. Natari
- School of Pharmacy, University of Queensland, Woolloongabba, QLD, Australia
- Department of Pharmacy, Jambi Regional Psychiatric Hospital, Jambi, Indonesia
| | - T. M. McGuire
- School of Pharmacy, University of Queensland, Woolloongabba, QLD, Australia
- Mater Pharmacy Services, Mater Health Services, South Brisbane, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - P. J. Baker
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - A. M. Clavarino
- School of Pharmacy, University of Queensland, Woolloongabba, QLD, Australia
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - K. D. Dingle
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - S. A. Hollingworth
- School of Pharmacy, University of Queensland, Woolloongabba, QLD, Australia
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Taylor HS, Kagan R, Altomare CJ, Cort S, Bushmakin AG, Abraham L. Knowledge of clinical trials regarding hormone therapy and likelihood of prescribing hormone therapy. Menopause 2018; 24:27-34. [PMID: 27575548 DOI: 10.1097/gme.0000000000000711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to examine whether physicians who are better informed about large, published hormone therapy (HT) trials (eg, the Women's Health Initiative) are more likely to prescribe HT for menopausal symptoms. METHODS US obstetricians/gynecologists and primary care physicians completed a 15- to 20-minute Internet-based survey. Knowledge was assessed via nine true-false statements about HT trials (range: 0-9). Prescribing practices were assessed via six case studies with a seven-point response scale of "extremely unlikely" to "extremely likely" in relation to treatment options (range: 6-42). The primary analysis examined the correlation between HT trial knowledge and likelihood of prescribing HT. Secondary analyses gauged knowledge and prescribing practices based on practice type, sex, and years in practice. RESULTS Among 501 physicians who completed the survey (representing 10.7% of those invited; median age: 51.0 y; female: 26.9%; obstetricians/gynecologists: 49.9%; median 19.0 y in practice), HT knowledge (mean [SD] 3.8 [2.3]), and prescribing (mean [SD] 24.5 [5.6]) exhibited a statistically significant, moderate positive correlation (0.30; 95% CI, 0.21-0.37; P < 0.0001). Obstetricians/gynecologists were significantly (P < 0.0001) more knowledgeable and more likely to prescribe HT than primary care physicians. Male physicians were more likely (P < 0.05) to prescribe HT but not more knowledgeable about it than female physicians. Knowledge (but not likelihood of prescribing) significantly increased as a function of years in practice. CONCLUSIONS Physicians who are more knowledgeable about large, published HT trials are more likely to prescribe HT for menopausal symptoms.
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Affiliation(s)
- Hugh S Taylor
- 1Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 2University of California, San Francisco, CA 3East Bay Physicians Medical Group, Berkeley, CA 4Pfizer Inc, New York, NY 5Pfizer Inc, Groton, CT 6Pfizer Ltd, Tadworth, Surrey, UK
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Yeganeh L, Boyle J, Teede H, Vincent A. Knowledge and attitudes of health professionals regarding menopausal hormone therapies. Climacteric 2017; 20:348-355. [DOI: 10.1080/13697137.2017.1304906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- L. Yeganeh
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menopause Unit, Monash Health, Melbourne, Victoria, Australia
| | - H. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
- Monash Partners Academic Health Sciences Centre, Melbourne, Victoria, Australia
| | - A. Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menopause Unit, Monash Health, Melbourne, Victoria, Australia
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Knowledge and personal use of menopausal hormone therapy among Chinese obstetrician-gynecologists: results of a survey. Menopause 2015; 21:1190-6. [PMID: 24736196 DOI: 10.1097/gme.0000000000000233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obstetrician-gynecologists' (ob-gyns) knowledge of the benefits and risks of-and attitude toward-menopausal hormone therapy (HT) have evolved since the publication of the Heart and Estrogen/progestin Replacement Study and the Women's Health Initiative. The survey investigated Chinese ob-gyns' perception and personal use of-and attitude toward-HT. METHODS A total of 2,000 self-administered questionnaires were sent to female ob-gyns who attended gynecological endocrinology workshops in 15 provinces and cities in China from February to May 2013. RESULTS A total of 904 eligible questionnaires were collected (response rate, 45.2%). Most of the respondents knew that HT could relieve menopausal symptoms (97.7%) and prevent osteoporosis (93.5%). Most (69.4%) of the respondents thought that HT would increase the risk of breast cancer, and 52.9% thought that HT would increase the risk of endometrial cancer. The most common concern regarding adverse effects of HT was risk of breast cancer, followed by risk of endometrial cancer, risk of venous thrombosis, and weight gain. One hundred twenty-three of 324 symptomatic respondents (38.0%) reported HT use, and a further 28 respondents (8.6%) had tried transdermal and vaginal estrogen creams. CONCLUSIONS These findings show better knowledge of HT among Chinese ob-gyns compared with the general Chinese population. However, HT use is relatively low, and ob-gyns seem to be overconcerned with the risks of HT. HT education must be promoted among Chinese ob-gyns to enhance the proper use of HT in the general population.
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Lakey SL, Reed SD, LaCroix AZ, Grothaus L, Newton KM. Self-reported changes in providers' hormone therapy prescribing and counseling practices after the Women's Health Initiative. J Womens Health (Larchmt) 2010; 19:2175-81. [PMID: 21062201 DOI: 10.1089/jwh.2010.2047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prescribing and counseling practices in hormone therapy (HT) since publication of the Women's Health Initiative (WHI) trials have changed. Our objective was to compare changes by practice field and region. METHODS Between December 2005 and May 2006, we mailed surveys to 938 practitioners from two large integrated health systems in the Northeastern and Northwestern United States. We received 736 responses and excluded 144 who do not prescribe/counsel about HT, leaving 592. Data included prescriber characteristics, knowledge about HT trials, and self-reported HT counseling and prescribing changes. We compared provider characteristics and HT counseling and prescribing by region and practice field (obstetrician/gynecology [OB/GYN] or primary care). RESULTS Respondents included 79 OB/GYNs and 513 primary care providers. OB/GYNs were more likely, than primary care providers to consider themselves experts regarding the Heart and Estrogen/progestin Replacement Study (HERS) and WHI trials (30.4% vs. 8.2%, p < 0.001). The majority (87%) were cautious about HT use, especially primary care providers (p < 0.01 compared to OB/GYNs). Respondents reported prescribing less oral unopposed estrogen (64%) and combination estrogen/progestin (81%) post-WHI. OB/GYNs were less likely to report decreases in oral unopposed estrogen use (p = 0.006). Use of lower-dose and transdermal products (low-dose estrogen, vaginal estrogen, estradiol vaginal ring) increased, especially by OB/GYNs. CONCLUSIONS Our study highlights numerous HT prescribing and counseling differences between primary care and OB/GYN providers. Reasons for these differences are unknown but may be related to self-reported WHI/HERS knowledge. HT formulations used in the WHI trials are being replaced by low-dose and alternate formulations. Studies to support this practice are needed.
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Affiliation(s)
- Susan L Lakey
- Group Health Research Institute, Seattle, Washington, USA.
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Abstract
OBJECTIVE No guidelines or randomized trials address best practices for hormone therapy (HT) discontinuation. METHODS We conducted a survey study to explore HT discontinuation practices at Group Health and Harvard Vanguard, large integrated health systems in the Northwest and Northeast United States, focusing on differences between specialties and study site. RESULTS The response rate to the written questionnaire (mailed between December 2005 and May 2006) was 78.5% (736/928); this article reports the results for 483 eligible physicians. To discontinue oral HT, most physicians (91%) advised tapering, not immediate cessation (8%), and most (60%) suggested decreasing both dose and days per week. Almost 60% of physicians reported no experience with tapering patches. Harvard Vanguard physicians were more likely than Group Health physicians to encourage discontinuing HT and less likely to recommend resuming HT when a woman's symptoms returned after discontinuing HT. Physicians were most strongly influenced by their own experience (48%), advice from colleagues (25%), and the woman's preference (19%) when choosing a discontinuation strategy; only 2% relied on research evidence. Physicians endorsed various approaches to manage symptoms after HT discontinuation, most often behavioral changes (44%) and increased exercise (37%), and these approaches were more often endorsed by Harvard Vanguard physicians and obstetrician/gynecologists than Group Health physicians or family practitioners or internists. CONCLUSIONS Two health plans in the Northwestern and Northeastern United States have no standard protocol for HT discontinuation. Physicians customized approaches, influenced by their location, colleagues, and specialty. Research is needed to guide approaches to HT discontinuation.
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Abstract
OBJECTIVE The aim of this study was to identify provider characteristics associated with hormone therapy prescribing. METHODS The study design is cross-sectional. In December 2005, we mailed surveys to providers practicing in two integrated healthcare delivery systems located in the northwestern and northeastern United States; 379 responded (74%) and 249 (49% of total) granted access to their automated data. Data included provider demographics, practice characteristics, and perceptions about hormone therapy. Provider-specific annual hormone therapy prescribing frequency was calculated as days supply of hormone therapy filled divided by the number of visits (among women aged 45-80 y). Factors associated with higher rates of hormone therapy prescribing were identified using bivariate and multivariate analyses. RESULTS We report results separately for primary care providers (internists and family practitioners) and obstetrician/gynecologists because significant correlates differed in these two groups. For both primary care providers and obstetrician/gynecologists, in multivariate analyses, hormone therapy prescribing varied by site (P < or = 0.002) and years at the healthcare organization (P < or = 0.01). For primary care providers only, higher hormone therapy prescribing was associated with reported expert knowledge of the hormone therapy trials (P < or = 0.001). For obstetrician/gynecologists, higher hormone therapy prescription was related to feeling well prepared to counsel women on hormone therapy (P < or = 0.007), believing that the risks of estrogen with progestogen had been exaggerated (P = 0.04), and seeing younger aged patients (P = 0.03). CONCLUSIONS After the release of the Women's Health Initiative findings and practicing under similar clinical guidelines, hormone therapy prescribing is associated with providers' confidence, practice location, and time with a healthcare organization.
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Heier M, Moebus S, Meisinger C, Jöckel KH, Völzke H, Döring A, Alte D. Menopausal hormone therapy in Germany. Results of three national surveys from 1997 to 2003. Maturitas 2008; 62:9-15. [PMID: 19028032 DOI: 10.1016/j.maturitas.2008.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 09/25/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine regional variations in the prevalence and applied therapy regimes of current menopausal hormone therapy (HT) in Germany. METHODS Three population-based surveys, analysing data of 45-74 years old women, were compared: The Study of Health in Pomerania (SHIP; 1123 participants; northeast Germany, October 1997-May 2001), Cooperative Health Research in the Augsburg Region Survey 2000 (KORA; 1253 participants; south Germany, October 1999-April 2001) and Heinz Nixdorf Recall Study (HNR; 2257 participants; west Germany, December 2000-August 2003). A standardized interview technique provided data on current medication. RESULTS The age-standardized prevalence of HT was 17.0% (95% confidence interval (CI): 14.9-19.1) in SHIP, 25.9% (95% CI: 23.6-28.3) in KORA and 24.7% (95% CI: 22.9-26.4) in HNR. Mean average time of intake of HT was 5.1 (SHIP), 7.5 (KORA) and 10.1 years (HNR). The use of estrogen plus progestogen combinations was equally common in all three surveys with proportions of about 15%, the use of unopposed estrogen in KORA and HNR was twice as high as in SHIP. In all three surveys oral estradiol was taken most often. Transdermal estradiol was preferred by KORA women whereas conjugated estrogens were taken most frequently by HNR women. CONCLUSIONS Compared to northeast Germany HT was more often applied in the south and west of Germany. HT as long-term therapy was more common in West than in East Germany. In each study region there was a specific pattern of used HT components.
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Affiliation(s)
- Margit Heier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany.
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Bush TM, Bonomi AE, Nekhlyudov L, Ludman EJ, Reed SD, Connelly MT, Grothaus LC, LaCroix AZ, Newton KM. How the Women's Health Initiative (WHI) influenced physicians' practice and attitudes. J Gen Intern Med 2007; 22:1311-6. [PMID: 17634782 PMCID: PMC2219779 DOI: 10.1007/s11606-007-0296-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 05/31/2007] [Accepted: 07/05/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The landmark Women's Health Initiative (WHI) Postmenopausal Hormone Therapy Trial published in 2002 showed that the health risks of combination hormone therapy (HT) with estrogen and progestin outweighed the benefits in healthy postmenopausal women. Dissemination of results had a major impact on prescriptions for, and physician beliefs about HT. No study has fully examined the influence of the widely publicized WHI on physicians' practice and attitudes or their opinions of the scientific evidence regarding HT; in addition, little is known about how physicians assist women in their decisions regarding HT. DESIGN AND PARTICIPANTS We conducted in-depth telephone interviews with family practitioners, internists, and gynecologists from integrated health care delivery systems in Washington State (n = 10 physicians) and Massachusetts (n = 12 physicians). Our objectives were to obtain qualitative information from these physicians to understand their perspectives on use of HT, the scientific evidence regarding its risks and benefits, and counseling strategies around HT use and discontinuation. APPROACH We used Template Analysis to code transcribed telephone interviews and identify themes. RESULTS Physicians were conflicted about the WHI results and its implications. Seven themes identified from in-depth interviews suggested that the WHI (1) was a ground-breaking study that changed clinical practice, including counseling; (2) was not applicable to the full range of patients seen in clinical practice; (3) raised concerns over the impact of publicized health information on women; (4) created uncertainty about the risks and benefits of HT; (5) called for the use of decision aids; (6) influenced discontinuation strategies; and (7) provided an opportunity to discuss healthy lifestyle options with patients. As a result of the WHI, physicians reported they no longer prescribe HT for prevention and were more likely to suggest discontinuation, although many felt women should be in charge of the HT decision. CONCLUSIONS Physicians varied in their opinions of HT and the scientific evidence (positive and negative). Whereas the WHI delineated the risks and benefits of HT, physicians reported that decision aids are needed to guide discussions with women about menopause and HT. Better guidance at the time of WHI study publication might have been valuable to ensure best practices.
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Affiliation(s)
- Terry M Bush
- Group Health Center for Health Studies, Seattle, WA 98101, USA.
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