Knowledge and beliefs about menopause in a general population sample of mid-aged women

Women's perceptions of hormone replacement therapy: risks and benefits (1980–2002). A literature review

OBJECTIVES

Many postmenopausal women are reluctant to take hormone replacement therapy (HRT) and those who do are likely to discontinue within 1 year. Setting aside the beliefs and prejudices of the prescriber, women's own perceptions of risks and benefits may influence their willingness to accept and then persevere with HRT. We conducted a systematic literature review relating women's beliefs about HRT to acceptance and adherence.

METHODS

Using standard guidelines for systematic search procedures, we identified 112 papers (published during 1980-2002) from databases such as Medline, PsycINFO and the NHS and Cochrane libraries.

RESULTS

Women hold both positive and negative beliefs about HRT. Their perceptions of benefits are often countered by concerns over potential adverse effects, beliefs that are sometimes at odds with the clinical evidence. The use and discontinuation of HRT are influenced more by short-term symptom relief than by considerations of long-term benefits. Many women who refuse HRT believe that the menopause is a natural event that does not warrant 'chemical' intervention. Doctors and nurses are not used to their full capacity as an education and information resource to counter the possibility of unbalanced stories in the media.

CONCLUSIONS

Addressing women's preconceptions about HRT should be an important part of the process of prescribing and review. Such an approach will help ensure that a woman's decision to start or continue HRT is informed by an understanding of the known risks and benefits, rather than by myths or mistaken beliefs about the menopause or HRT.

Health information seeking in context: how women make decisions regarding hormone replacement therapy

This multimethod study explored women's information seeking behaviour and decision making regarding menopause, hormone replacement therapy (HRT), and use of complementary and alternative medicines (CAM) during menopause. This research was underway during the mass media release of the Women's Health Initiative (WHI) estrogen-progestin trial results, allowing an examination of the impact of this news on women's decisions. There were two studies: first, 20 women who currently were or previously had used HRT were interviewed about their experiences with menopause and HRT-related information seeking and decision making. Following this, 285 demographically representative Canadian women aged 45-65 who were current or former HRT users completed a questionnaire. Results indicate that women's information behaviour differed according to which decision they were making (starting versus stopping HRT, considering CAM), as did the sources they consulted. In general, there has been a paucity of good information to help women who are deciding to stop HRT. The types and sources of CAM information often are found to be less than credible and helpful. When information is lacking, women rely on informal sources, and on their own judgement, to make decisions. The results are discussed in the context of information behaviour and help-seeking theory.

Women's education level as an influence on hormone replacement therapy being suggested at the menopause

This research investigates the extent to which a woman's education level both influences information-seeking about hormone replacement therapy (HRT) and whether or not HRT is suggested as a treatment when presenting to the GP with a range of menopausal symptoms. A random sample of 1200 women was generated from family health services authority records and a questionnaire distributed. The questionnaire inquired about the participant's information-seeking strategies about HRT, her recent menopausal symptoms, whether a GP had been consulted, and whether HRT had been suggested. Results indicate that participants who had more educational qualifications were more successful in finding information about HRT. Furthermore, although there were no significant differences in the number of reported symptoms, GPs were significantly more likely to suggest HRT to the less educated women. The implications for health centre practice are discussed.

Preparation for menopause: prospective evaluation of a health education intervention for mid-aged women

Many women approach menopause with uncertainty about what will happen and how to deal with changes that occur. The current study aimed to evaluate the short-term outcome of a health education intervention devised to prepare 45-year old women in general practices. One hundred and seventy-eight 45-year old women registered at five general practices in south London were targeted for the research; 106 of the women responded and 86 of these women formed a usable pre-menopausal sample which was randomly allocated to the preparation intervention and control conditions. Preparation involved two health education sessions carried out in small groups and covering information and discussion of the normal menopause transition in the context of mid-life. The women completed pre- and post-intervention (3 and 15 months) questionnaires which assessed knowledge and beliefs about menopause and a number of health-related behaviours. Knowledge improved significantly at the follow-up assessments for the preparation group but not for the control group. On the whole, the prepared women's beliefs about menopause became less negative following the intervention, although there were also some changes reported by the control group. The proportion of smokers decreased from 25 to 20% for the prepared women although this did not reach statistical significance. There was no change in the prevalence of regular exercise. There was also a decrease in the intention to take hormonal treatments following the intervention. Suggestions for further development of health promotion services for mid-aged women and more holistic health care practices are proposed.