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Mejia A, Nyhus K, Burley T, Myhre A, Montes M, Osiecki K, Randolph AC. "Ripping Off the Band-Aid": uncovering future health care Professionals' "Fractured Knowledge" about sexual and reproductive health. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1242885. [PMID: 38590516 PMCID: PMC10999535 DOI: 10.3389/frph.2024.1242885] [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: 06/21/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background Research has shown the role of identity on future health professionals' confidence and competence in addressing the sexual and reproductive health (SRH) needs of their patients. While there has been some work in increasing the sexual health literacy of future providers via various curricular approaches and comprehensive clinical-based training, there are research gaps on how social differences around identity impact future healthcare professionals' knowledge and practices around SRH. Objectives This article presents research findings on the experiences of US undergraduate students attending a campus that provides training in the health sciences and health professions. Our study aims to understand the perspectives of these students as they pertain to their future career choices in healthcare, with a focus on how their past experiences learning about sex, sexuality, and reproduction impact their current and future professional trajectories. Methods We present a qualitative analysis from 40 in-depth interviews with U.S. undergraduates. The interview questions were designed in collaboration with undergraduate researchers interested in sexual health education. These student researchers collected all the interview data and worked with senior researchers to analyze some of these data. Results The themes that emerged from the interviews were around experiences with what students perceived as "fractured" sexual and reproductive health (SRH) knowledge they received as children and adolescents. This knowledge shaped essential aspects of their identity as young adults and future healers. Data indicated unique processes implicated in how past as well as present socialization experiences learning about sex, sexuality, and reproduction positions undergraduates in health professions to see young adulthood as a journey of "catching up" on sexual knowledge but also as an ongoing experience of anticipation and planning influencing their career-building journey. Conclusions The importance of sexual health literacy among healthcare professionals cannot be overstated, as it is vital in providing patient-centered and non-judgmental sexual and reproductive health (SRH) care and services. To date, there is a shortage of studies looking at the impact of sexual health knowledge on healthcare professionals. More research is needed on educational strategies that could be implemented at the intra-personal level to assist college-aged young adults in healthcare career tracks to "catch up" or "fill in the gaps" in their sexual education journey.
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Affiliation(s)
- Angie Mejia
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Kara Nyhus
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, United States
| | - Tessie Burley
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Alexis Myhre
- Augsburg University, Minneapolis, MN, United States
| | - Marcela Montes
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, United States
| | - Kristin Osiecki
- Center for Health Equity, Minnesota Department of Health, Minneapolis, MN, United States
| | - Anita C. Randolph
- Department of Paediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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Vallejo MS, Witis S, Ojeda E, Mostajo D, Morera F, Meruvia N, Martino M, Lima S, Espinoza M, Castillo O, Campostrini B, Danckers L, Blümel JE, Tserotas K, Sánchez H, Salinas C, Saavedra J, Rojas JA, Onatra W, Monterrosa A, Montaño A, Martínez J, González E, Gómez G, Calle A, Broutin G, Bencosme A, Arteaga E, Ayala F, Chedraui P. Does the menopausal status of female gynecologists affect their prescription of menopausal hormone therapy? Climacteric 2016; 19:387-92. [DOI: 10.1080/13697137.2016.1191460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M. S. Vallejo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - S. Witis
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - E. Ojeda
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - D. Mostajo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - F. Morera
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - N. Meruvia
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - M. Martino
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - S. Lima
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - M.T. Espinoza
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - O. Castillo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - B. Campostrini
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - L. Danckers
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - J. E. Blümel
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - K. Tserotas
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - H. Sánchez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - C. Salinas
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - J. Saavedra
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - J. A. Rojas
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - W. Onatra
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - A. Monterrosa
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - A. Montaño
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - J. Martínez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - E. González
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - G. Gómez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - A. Calle
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - G. Broutin
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - A. Bencosme
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - E. Arteaga
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - F. Ayala
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
| | - P. Chedraui
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
- Institute of Biomedicine, Research Area for Women’s Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
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Nappi RE, Kaunitz AM, Bitzer J. Extended regimen combined oral contraception: A review of evolving concepts and acceptance by women and clinicians. EUR J CONTRACEP REPR 2015; 21:106-15. [PMID: 26572318 PMCID: PMC4841029 DOI: 10.3109/13625187.2015.1107894] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: The clinical utility of extended regimen combined oral contraceptives (COCs) is increasingly being recognised. Our objective was to understand the attitudes of women and clinicians about the use of these regimens. We present the rationale for extended regimen COCs from a historical perspective, and trace their evolution and growing popularity in light of their clinical benefits. We conclude by offering potential strategies for counselling women about extended regimen COC options. Methods: We conducted a MEDLINE search to identify and summarise studies of extended regimen COCs, focusing on attitudes of women and clinicians regarding efficacy, safety/tolerability and fewer scheduled bleeding episodes and other potential benefits. Results: The body of contemporary literature on extended regimen COCs suggests that their contraceptive efficacy is comparable to that of conventional 28-day (i.e., 21/7) regimens. For women seeking contraception that allows infrequent scheduled bleeding episodes, particularly those who suffer from hormone withdrawal symptoms and cyclical symptoms (e.g., headache, mood changes, dysmenorrhoea, heavy menstrual bleeding), extended regimen COCs are an effective and safe option. Although satisfaction with extended regimen COCs in clinical trials is high, misperceptions about continuous hormone use may still limit the widespread acceptance of this approach. Conclusions: Despite the widespread acceptance among clinicians of extended regimen COCs as an effective and safe contraceptive option, these regimens are underused, likely due to a lack of awareness about their availability and utility among women. Improved patient education and counselling regarding the safety and benefits of extended regimen COCs may help women make more informed contraceptive choices.
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Affiliation(s)
- Rossella E Nappi
- a Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Department of Obstetrics and Gynaecology , IRCCS San Matteo Foundation, University of Pavia , Pavia , Italy
| | - Andrew M Kaunitz
- b Department of Obstetrics and Gynecology , University of Florida College of Medicine-Jacksonville , Jacksonville , FL , USA
| | - Johannes Bitzer
- c Department of Obstetrics and Gynaecology , Basel University Hospital , Basel , Switzerland
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Hubacher D, Akora V, Masaba R, Chen M, Veena V. Introduction of the levonorgestrel intrauterine system in Kenya through mobile outreach: review of service statistics and provider perspectives. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:47-54. [PMID: 25276562 PMCID: PMC4168611 DOI: 10.9745/ghsp-d-13-00134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/26/2013] [Indexed: 02/03/2023]
Abstract
Limited introduction of the LNG IUS through mobile outreach in Kenya, without any special promotion, resulted in good uptake. And providers viewed it positively, particularly because of its noncontraceptive benefits. Increased provision of the LNG IUS can improve options for women needing highly effective reversible contraception. Background: The levonorgestrel intrauterine system (LNG IUS) was developed over 30 years ago, but the product is currently too expensive for widespread use in many developing countries. In Kenya, one organization has received donated commodities for 5 years, providing an opportunity to assess impact and potential future role of the product. Methods: We reviewed service statistics on insertions of the LNG IUS, copper intrauterine device (IUD), and subdermal implant from 15 mobile outreach teams during the 2011 calendar year. To determine the impact of the LNG IUS introduction, we analyzed changes in uptake and distribution of the copper IUD and subdermal implant by comparing periods of time when the LNG IUS was available with periods when it was not available. In addition, we interviewed 27 clinicians to assess their views of the product and of its future role. Results: When the LNG IUS was not available, intrauterine contraception accounted for 39% of long-acting method provision. The addition of the LNG IUS created a slight rise in intrauterine contraception uptake (to 44%) at the expense of the subdermal implant, but the change was only marginally significant (P = .08) and was largely attributable to the copper IUD. All interviewed providers felt that the LNG IUS would increase uptake of long-acting methods, and 70% felt that the noncontraceptive benefits of the product are important to clients. Conclusions: The LNG IUS was well-received among providers and family planning clients in this population in Kenya. Although important changes in service statistics were not apparent from this analysis (perhaps due to the small quantity of LNG IUS that was available), provider enthusiasm for the product was high. This finding, above all, suggests that a larger-scale introduction effort would have strong support from providers and thus increase the chances of success. Adding another proven and highly acceptable long-acting contraceptive technology to the method mix could have important reproductive health impact.
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Affiliation(s)
| | | | | | - Mario Chen
- FHI 360, Research Triangle Park, NC , USA
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Lete I, Pérez-Campos E. Differences in contraceptive use between Spanish female healthcare providers and Spanish women in the general population aged 23 to 49 years: the HABITS Study. EUR J CONTRACEP REPR 2014; 19:161-8. [PMID: 24666213 DOI: 10.3109/13625187.2014.893424] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the contraceptive modalities used in the general female population with those of female healthcare providers (HCPs) in Spain. METHODS A nationwide survey of a representative sample of Spanish women and female Spanish HCPs aged 23 to 49 years (total sample size: 3200). RESULTS The condom was the most widely used contraceptive method in both groups (30% and 23% in the general population and among HCPs, respectively). The reasons cited for relying on this method were ease of use (19% and 13%, respectively; p = 0.2), effectiveness (16% and 22%, respectively; p = 0.2), absence of side effects (14% and 22%, respectively; p = 0.1), and fear of side effects associated with oral contraception (13% and 2%, respectively; p < 0.0001). After the condom, oral contraceptives, the intrauterine device and the vaginal ring were the most widely used methods among HCPs (13% each). CONCLUSIONS The spectrum of contraceptive methods used by female HCPs differs from that of women in the general Spanish population. HCPs opt more often for long-acting reversible contraceptives because of their effectiveness and safety whereas women in the general population rely more frequently on the condom and surgical methods.
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Affiliation(s)
- Iñaki Lete
- * Servicio de Ginecología, Hospital Universitario Araba, Vitoria, & Facultad de Medicina, Universidad del País Vasco , Vitoria , Spain
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Makuch MY, D Osis MJ, de Pádua KS, Bahamondes L. Use of hormonal contraceptives to control menstrual bleeding: attitudes and practice of Brazilian gynecologists. Int J Womens Health 2013; 5:795-801. [PMID: 24399887 PMCID: PMC3876489 DOI: 10.2147/ijwh.s52086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study was to assess the attitudes and prescribing practices of Brazilian obstetricians and gynecologists regarding use of contraceptive methods to interfere with menstruation and/or induce amenorrhea. Methods We undertook a nationwide survey of Brazilian obstetricians and gynecologists selected using a computer-generated randomization system. Participants completed a questionnaire on prescription of contraceptives and extended/continuous regimens of combined oral contraceptives (COCs). Results In total, 79.2% of Brazilian obstetricians and gynecologists reported that 20%–40% of their patients consulted them for menstrual-related complaints and 26%–34% of the gynecologists reported that 21%–40% of their patients consulted them for reduction in the intensity, frequency, and/or duration of menstrual bleeding. Overall, 93% stated that medically induced amenorrhea represents no risk to women’s health and 82.5% said that they prescribed contraceptives to control menstruation or induce amenorrhea. The contraceptives most commonly prescribed were extended-cycle 24/4 or 26/2 COC regimens and the levonorgestrel-releasing intrauterine system. Poisson regression analysis showed that Brazilian obstetricians and gynecologists prescribing contraceptives to control menstruation or induce amenorrhea consider extended-use or continuous-use COC regimens to be effective for both indications (prevalence ratio 1.23 [95% confidence interval 1.09–1.40] and prevalence ratio 1.28 [95% confidence interval 1.13–1.46], respectively). They also prescribed COCs with an interval of 24/4 or 26/2 to control bleeding patterns (prevalence ratio 1.10 [95% confidence interval 1.01–1.21]). Conclusion Brazilian obstetricians and gynecologists were favorably disposed toward prescribing extended-use or continuous-use COC regimens for control of menstrual bleeding or to induce amenorrhea on patient demand.
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Affiliation(s)
- María Y Makuch
- Center for Research in Reproductive Health (CEMICAMP), São Paulo, Brazil
| | - Maria José D Osis
- Center for Research in Reproductive Health (CEMICAMP), São Paulo, Brazil
| | - Karla Simonia de Pádua
- Center for Research in Reproductive Health (CEMICAMP), São Paulo, Brazil ; Prof Dr José Aristodemo Pinotti Women's Hospital, University of Campinas, São Paulo, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, and National Institute of Hormones and Women's Health, Campinas, São Paulo, Brazil
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Gemzell-Danielsson K, Cho S, Inki P, Mansour D, Reid R, Bahamondes L. Use of contraceptive methods and contraceptive recommendations among health care providers actively involved in contraceptive counseling — results of an international survey in 10 countries. Contraception 2012; 86:631-8. [DOI: 10.1016/j.contraception.2012.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 11/26/2022]
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Disparity in menopausal hormone therapy use between women obstetrician gynecologists and women overall: are obstetrician gynecologists underserving their patients? Menopause 2012; 19:1070-1. [PMID: 22929036 DOI: 10.1097/gme.0b013e318261f25e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Castelo-Branco C, Ferrer J, Palacios S, Cornago S, Peralta S. Spanish post-menopausal women's viewpoints on hormone therapy. Maturitas 2007; 56:420-8. [PMID: 17174045 DOI: 10.1016/j.maturitas.2006.11.006] [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] [Received: 08/30/2006] [Revised: 10/16/2006] [Accepted: 11/08/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to identify women's socio-demographic and climacteric factors, as well as other variables related to health care, associated with the prescription of the treatment during menopause and to investigate the prevalence of certain conditioning factors in early discontinuation in women aged 40-65 years in a population of post-menopausal women in Spain. STUDY DESIGN Cross-sectional survey. SETTING Four of the most inhabited cities in Spain (Madrid, Barcelona, Seville and Valencia). POPULATION A total of 270 symptomatic post-menopausal women. METHODS A personal interview with a semi-structured questionnaire specifically designed to collect information on treatments for climacteric-related complaints. MAIN OUTCOME MEASURES The reasons for HRT, the evaluation of alternative therapies, the reasons for choosing one therapy or another and reasons for discontinuation. RESULTS Of all the subjects included, 180 were still taking any type of treatment and 90 were former HRT users or had never used HRT. Among the latter, 43% of women expressed fear of the side effects and 38% gave the risk of breast cancer as the main reason for not using HRT. Of them, 58% receive phytoestrogens. Media and negative data from medical journals influenced this attitude in 67% of the women. On the other hand, only 9.4% of HRT users were reluctant to receive the therapy and the main reasons for maintaining HRT were its efficacy against climacteric symptoms, medical prescription and life quality. CONCLUSIONS Side effects and fear of cancer were the most common reasons for not using HRT; and medical prescription, symptomatic improvement and quality of life were the main reasons for using it. Negative data from journals have an important effect on women's attitudes to HRT.
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Affiliation(s)
- Camil Castelo-Branco
- Gynecology, Obstetrics and Neonatology Institute (ICGON), Hospital Clínic Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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Lund E, Bakken K, Dumeaux V, Andersen V, Kumle M. Hormone replacement therapy and breast cancer in former users of oral contraceptives—The Norwegian Women and Cancer study. Int J Cancer 2007; 121:645-8. [PMID: 17372914 DOI: 10.1002/ijc.22699] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Combined estrogen-progestin menopausal therapy (HRT) and combined estrogen-progestin contraceptives (OC) both increase breast cancer risk during current use and a few years after. We investigated risk of breast cancer in women who were users of HRT dependant on former history of OC use in a large, national population-based cohort study, the Norwegian Women and Cancer study (NOWAC). Exposure information was collected through postal questionnaires. Based on follow-up of 30,118 postmenopausal women by linkage to national registers of cancer, deaths, and emigration we revealed 540 incident breast cancer cases between 1996 and 2004. Compared to never users of either drugs current use of HRT gave a significant (p = 0.002) higher risk of breast cancer in former OC users, RR = 2.45 (95% CI 1.92-3.12), than among never users of OCs, RR = 1.67 (1.32-2.12). Relative risk of current use of HRT was similar for estrogen only and combinations with progestin added in ever users of OCs. The increased risk of breast cancer in current HRT users with a history of former OC use could have potential great impact on postmenopausal breast cancer risk as the proportion of postmenopausal women with former OC use will continue to increase.
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Affiliation(s)
- Eiliv Lund
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
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Graziottin A. The woman patient after WHI. Maturitas 2005; 51:29-37. [PMID: 15883106 DOI: 10.1016/j.maturitas.2005.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2004] [Revised: 01/24/2005] [Accepted: 01/31/2005] [Indexed: 10/25/2022]
Abstract
An epidemic of fear and distrust has infected women (and physicians) after publication of the Women's Health Initiative (WHI). The overinflated negative data emerging from the oestroprogestinic arm of WHI have frightened women and gave rise to the most difficult emotions to cope with. Keywords such as cancer, death and hormones combined together, have potentiated an avoidant attitude towards hormonal therapy (HT) driven more emotionally than rationally. This negative aura has not been dissipated by the positive data from the oestrogen-only arm of WHI. This paper will discuss: women's different emotional reactions to and coping strategies for HT-related fear after WHI; the communication skills physicians should use in focusing on positive messages emerging from WHI; predictors of current HT use; the meaning of the higher use of HT in postmenopausal highly-educated women and women gynaecologists; the importance of increasing healthy life-styles as a taking of responsibility towards aging by every woman; shifting from passivity to active sharing of the decision making process with the caring physician; and the use of an individually tailored HT, when appropriate, as part of an active strategy in the pursuit of a longer health expectancy.
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Affiliation(s)
- Alessandra Graziottin
- Center of Gynecology and Medical Sexuology, H. San Raffaele Resnati, Via Enrico Panzacchi 6, 10123 Milano, Italy.
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Santoro NF. Does oral contraceptive use lead to hormone therapy use in women doctors? Our bodies, our choices, our practice. Menopause 2003; 10:109-10. [PMID: 12627035 DOI: 10.1097/00042192-200310020-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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