Knowledge and use of hormone replacement therapy among Polish women: estimates from a nationally representative study—HORTPOL 2002

Risk of Depression during Menopause in Women from Poland, Belarus, Belgium, and Greece

Introduction: Menopause is a physiological period in a woman’s life, but it is often accompanied by symptoms that affect mental well-being and general health, including a tendency for depression. Aim of the study: To evaluate the predisposition to the symptoms of depression in women from Poland, Belarus, Belgium, and Greece. Material and methods: the method of diagnostic survey was used, and the research tools were: The Menopause Rating Scale, the Kupperman Index, Beck Depression Inventory, and a self-made survey questionnaire. Results: Hormone replacement therapy (HRT) was used by 15.8% of Polish, 19% of Belgian, 14.3% of Belarusian, and 15.2% of Greek women patients. The mean value of the Kupperman Index (range 0–63) in Poland was 14.8 ± 8.6, in Belgium—15.5 ± 6.6, Belarus—14.0 ± 9.4, and Greece—10.8 ± 6.5, while the total measure of Menopause Rating Scale (MRS) (range 0–44) was 12.2 ± 7.6 in Poland, 13.8 ± 6.5 in Belgium, 10.8 ± 8.0 in Belarus and 12.9 ± 7.4 in Greece. The severity of mental distress followed a similar pattern across all countries (slightly stronger than mild). The results for somatic complaints were similar, whereas the level of sexual issues varied, with the highest in Belgium and the lowest in Belarus. The mildest symptoms of menopause were experienced by Belarusian women and the most severe by Belgian women. The severity of depression, according to the Beck Depression Inventory (range 0–63), was as follows: Poland 10.5 ± 7.9; Belgium—11.1 ± 5.7; Belarus—13.7 ± 5.7; Greece—11.8 ± 6.6. Conclusions: The differences between the development of perimenopausal-related symptoms across countries were statistically significant. The incidence and severity of depression showed statistically significant differences between the countries studied—the highest was in Belarus and the lowest in Poland. Depression levels were not differentiated by subjects’ age or the use of hormone therapy but by subjects’ education. In Poland and Belarus, increased menopausal pain measured by the Kupperman Index altered levels of depression; in Belgium, there were no such correlations, and in Greece, the correlation was statistically significant, but its strength was negligible. A clearer correlation of the effects of development in menopausal symptoms on the level of depression was shown when measured with the MRS scale—in Greece and Belgium, the correlation was relatively weak, but in Poland and Belarus, it was relatively high.

The effects of postmenopausal hormone therapy on social activity, partner relationship, and sexual life - experience from the EPHT trial

BACKGROUND

With the exception of sexual functioning and weight, social and behavioural effects of postmenopausal hormone therapy (HT) have not been reported from trials. This paper reports such results from the EPHT-trial in Estonia.

METHODS

A randomized trial, with a blind and non-blind sub-trial in Estonia. From 1999-2001, 1778 women were recruited. The mean follow-up was 3.6 years. Women's experiences were asked in the first and final study year by mailed questionnaires (74 and 81% response rates). Comparisons of the groups were made by cross-tabulation and logistic regression, adjusting for age.

RESULTS

There were no differences between the HT and non-HT groups in regard to being employed, the extent of social involvement or marital status or opinions on aging. There was no difference in the frequency of free-time exercise, or overweight. Some of the indicators suggested less sexual inactivity, but the differences were small.

CONCLUSION

In a trial setting, postmenopausal hormone therapy did not influence work or social involvement or health behaviour.

Menopausal hormone therapy in Germany. Results of three national surveys from 1997 to 2003

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.

Effects of dietary equol administration on ovariectomy induced bone loss in Sprague-Dawley rats

Oestrogen deficiency leads to a considerable bone loss, thus, osteopenia and osteoporosis are serious complications after menopause.

OBJECTIVES

To evaluate the effects of a daidzein metabolite equol on bone mass density (BMD) and markers of bone remodelling in an ovariectomized (ovx) rat model of postmenopausal bone loss and compare them with the effects of 17beta-estradiol.

METHODS

Twenty-eight female Sprague-Dawley rats were ovx and fed soy-free chow only (control group, n = 8), or with the addition of oestradiol-3 benzoate (E2B) (10mg/kg, n = 10) or equol (400 mg/kg, n = 10). At baseline and after 6-week treatment period, proximal tibia and lumbar spine BMD were measured using computer tomography. Animals were then sacrificed, blood was collected and uteri were removed.

RESULTS

Similarly to E2B, dietary equol decreased weight gain and showed mild uterotropic activity. E2B attenuated ovx induced BMD loss at proximal tibia whereas equol had no effect. At lumbar spine, however, equol not only attenuated trabecular bone loss but also increased its density. This effect was also apparent in animals treated with E2B. Cortical BMD at proximal tibia and lumbar spine were not very much influenced by ovx and treatment with E2B or equol did not induce significant changes at these sites. Plasma osteocalcin and type I collagen fragments (cross-laps) in equol treated animals did not differ from the controls whereas in E2B treated animals they were both significantly decreased.

CONCLUSIONS

In spite of its mild uterotropic potential, dietary equol shows limited bone sparing effects in ovx rats.

Effects of dietary equol on body weight gain, intra-abdominal fat accumulation, plasma lipids, and glucose tolerance in ovariectomized Sprague-Dawley rats

OBJECTIVE

To evaluate the effects of dietary equol, a metabolite of the phytoestrogen daidzein, on body weight gain, intra-abdominal fat accumulation, plasma leptin, lipids, and glucose tolerance in ovariectomized rats and to compare them to the effects of 17beta-estradiol.

DESIGN

Twenty-eight female Sprague-Dawley rats were ovariectomized and fed soy-free chow with the addition of estradiol-3 benzoate (E2B) (10 mg/kg, n=10) or equol (400 mg/kg, n=10). The control group (n=8) received soy-free chow only. Weight and food intake were recorded once weekly. After 6 weeks, intra-abdominal fat was measured using computed tomography, and the intraperitoneal glucose tolerance test was performed. In the seventh week, the animals were killed, blood was collected for plasma, and uteri were removed.

RESULTS

Dietary equol significantly increased uterine mass. This effect was, however, 3.5 times lower in magnitude compared to E2B. Similar to E2B, dietary equol decreased weight gain, intra-abdominal fat accumulation, and plasma leptin levels. Equol-treated animals had also lower plasma total cholesterol and triglyceride levels compared to controls. E2B treatment also decreased plasma total cholesterol as well as high-density lipoprotein and low-density lipoprotein cholesterol. In the glucose tolerance test, the area under the curve was significantly smaller in the E2B- and equol-treated animals compared to controls. Also, E2B-treated animals had lower fasting plasma insulin levels.

CONCLUSIONS

In ovariectomized rats, dietary equol administration attenuates weight gain and shows favorable metabolic effects. However, because of its mild uterotrophic activity, its use in the prevention of postmenopausal weight gain and related metabolic disorders in women with an intact uterus is questionable in terms of safety and warrants further studies.

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.

Physicians and the prescription of hormone replacement therapy in Spain

OBJECTIVES

The purpose of this study was to determine the frequency of hormone replacement therapy (HRT) prescription and identify women's sociodemographic and climacteric factors, as well as variables related to healthcare, associated with the treatment's prescription in women aged 45-65 years in the reference population of a primary healthcare centre in the city of Granada (Spain).

METHODS

A descriptive cross-sectional telephone survey was conducted in July 2002 with women aged 45-65 years from the reference population of a primary healthcare centre. The information was gathered using a semi-structured questionnaire specifically developed to gather information on the prescription of HRT.

RESULTS

22.3% of the sample had ever been prescribed with HRT. Regarding compliance with the treatment, 44.2% of the women prescribed with this therapy took it partially, and 8.1% did not begin with the treatment. The variables independently associated with HRT prescription were having the menopause (OR=2.81; IC 95%: 1.08-7.28), having psychological symptoms (OR=2.77; IC 95%: 1.19-6.46), going to see the gynaecologist (OR=4.41; IC 95%: 1.87-10.36), and the fact that the doctor worked in the private healthcare sector (OR=3.55; IC 95%: 0.92-13.65).

CONCLUSIONS

The frequency of HRT prescription in Spain is high, as well as the non-compliance rate. Reaching the menopause and going to the gynaecologist are determinant in HRT prescription. It would be desirable to use similar methodological approaches in studies of this controversial therapy, in order to obtain consensus on the real impact on the female population, particularly in view of the results of the latest clinical trials.