Associations between attitudes toward hormone therapy and current use of it in middle-aged women

Symptom reporting and quality of life in the Estonian Postmenopausal Hormone Therapy Trial

BACKGROUND

The aim of the study was to determine the effect of postmenopausal hormone therapy on women's symptom reporting and quality of life in a randomized trial.

METHODS

1823 women participated in the Estonian Postmenopausal Hormone Therapy (EPHT) Trial between 1999 and 2004. Women were randomized to open-label continuous combined hormone therapy or no treatment, or to blind hormone therapy or placebo. The average follow-up period was 3.6 years. Prevalence of symptoms and quality of life according to EQ-5D were assessed by annually mailed questionnaires.

RESULTS

In the hormone therapy arms, less women reported hot flushes (OR 0.20; 95% CI: 0.14-0.28), sweating (OR 0.56; 95% CI: 0.44-0.72), and sleeping problems (OR 0.66; 95% CI: 0.52-0.84), but more women reported episodes of vaginal bleeding (OR 19.65; 95% CI: 12.15-31.79). There was no difference between the trial arms in the prevalence of other symptoms over time. Quality of life did not depend on hormone therapy use.

CONCLUSION

Postmenopausal hormone therapy decreased vasomotor symptoms and sleeping problems, but increased episodes of vaginal bleeding, and had no effect on quality of life.

TRIAL REGISTRATION NUMBER

ISRCTN35338757.

Women's attitudes to hormone replacement therapy in the aftermath of the Women's Health Initiative study

AIM

This paper is a report of a study conducted in 2004 on the determinants of attitudes towards hormone replacement therapy in the aftermath of the report on the findings of the Women's Health Initiative study.

BACKGROUND

The unexpected findings of the Women's Health Initiative study, published in July 2002, showed that the risk of using combined hormones exceeded their benefits. This complicated women's decision-making about hormone use and made it important to study the determinants of their attitudes to hormone therapy, as these are likely to influence their behaviour.

METHODS

A cross-sectional design was conducted with a sample of 561 women drawn from the National Registry of Iceland. A self-administered questionnaire, measuring attitudes towards hormone replacement therapy, attitudes towards menopause, extent and source of menopausal education, symptom experience, health and lifestyle and knowledge about the findings of the Women's Health Initiative, was used. The overall response rate was 56%. Attitudes to hormone replacement therapy were compared using anova, t-tests and correlations.

RESULTS

Participants generally had positive attitudes. Knowledge about the Women's Health Initiative study was not associated with more negative attitudes. However, receiving the information from and discussing it with a doctor were associated with more positive attitudes. Positive attitudes towards hormone therapy were also associated with higher age, time since last menstrual period and current use of hormone replacement therapy. Negative attitudes were associated with use of natural remedies and receiving information from or discussing hormone therapy with family or friends.

CONCLUSION

Research is needed to identify the dynamics of the medical interview, and the nature of input from friends, spouse and other family members. The content of these messages may be different and conflicting, for example, between doctors and family members. The nature of this conflict and conflicts of interests need to be identified in order to inform women's decision-making. In addition, action needs to be taken in order to strengthen the advisory role of nurses.

Postmenopausal hormone therapy: who now takes it and do they differ from non-users?

BACKGROUND

Considerable changes in hormone therapy use have taken place in the last few years.

AIMS

To determine current usage of postmenopausal hormone therapy and assess the trend and rate of change in hormone therapy usage over the last 13 years. Additionally, to assess differences between current users and non-users for health-related and risk factor variables.

METHODS

Questions regarding hormone therapy use have been included in an annual face to face population health survey of South Australians eight times since 1991. In 2004, additional questions on health status and quality of life were included.

RESULTS

In 2004, current use of hormone therapy was 15.4, 19.8 and 31.2% in all women over 40, 50 and 50-59 years, respectively. Ever use of hormone therapy among all women over 50 years was 46.5% with a mean duration of use of 7.46 years. Hormone therapy users did not differ from non-users in chronic disease indicators, body mass index, complementary medicine or therapist use, other health service use, socioeconomic status or quality of life. Increased hormone therapy use was associated with higher income, better educated, employed and married women in their sixth decade. Current use has varied over the years, with an increase to 2000, but a drop in 2003 and 2004.

CONCLUSION

Apart from menopausal symptoms, there is no evidence to support differences between users and non-users in terms of quality of life or health characteristics, requiring more appropriate selection of women for hormone therapy.

Trends in middle-aged women's reports of symptoms, use of hormone therapy and attitudes towards it

OBJECTIVES

To investigate changes in middle-aged women's attitudes towards hormone therapy (HT), use of HT and reports of symptoms between 1995 and 2003.

METHODS

All women (n = 2209) in two primary health-care districts received a questionnaire, when aged 45, 50, 55 or 60. The questionnaire consisted of quality of life instruments and items concerning menopause, health, symptoms, attitudes towards HT and use of it.

RESULTS

A total of 1681 women (76%) responded to the questionnaire. Thirty-one percent had used HT, with a mean duration of 4 years. A shift from mainly positive attitudes towards HT and increasing use of HT in the 1990s to largely negative attitudes and decreasing use became evident in 2002-2003. In comparison, current HT users in 2002-2003 were older and had used HT for longer than users in previous years. The number of general symptoms reported tended to increase successively and satisfaction with health to decrease during the period. Women with a history of HT continuously reported a greater number of symptoms than those women who had never used it. Reports of vasomotor symptoms did not change over time.

CONCLUSIONS

The changes that have occurred in beliefs regarding HT have had an impact both on attitudes towards HT and on use of HT among the women we surveyed. The increase in number of general symptoms is discussed in relation to perception of menopause, prescription patterns of HT and changes at the societal level.

Development of nocturia in relation to health, age and the menopause

OBJECTIVES

To analyse the relationship between nocturia, age, the menopausal transition, parturition and hormone replacement treatment (HRT) in women.

MATERIAL AND METHODS

A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about health, the occurrence of somatic diseases and symptoms, habits, health care and medication.

RESULTS

In univariate analyses age, menopausal state and HRT, but not parturition, were associated with increased nocturia. In a multiple logistic regression analysis, independent correlates for two or more nocturnal micturition episodes versus no more than one episode were: health, poor versus good 2.9 (2.1-3.8); <5 years after the menopause versus before 1.8 (1.3-2.5); 5-9 years after the menopause versus before 2.1 (1.5-3.0); > or =10 years after the menopause versus before 3.1 (2.3-4.2). Age and HRT were deleted by the logistic regression model.

CONCLUSION

The present data indicate that menopausal state, but not age, parturition and HRT are independent correlates of nocturia in 40-64-year-old women.