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Koysombat K, Mukherjee A, Nyunt S, Pedder H, Vinogradova Y, Burgin J, Dave H, Comninos AN, Talaulikar V, Bailey JV, Dhillo WS, Abbara A. Factors affecting shared decision-making concerning menopausal hormone therapy. Ann N Y Acad Sci 2024; 1538:34-44. [PMID: 39014999 DOI: 10.1111/nyas.15185] [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] [Indexed: 07/18/2024]
Abstract
Menopausal hormone therapy (MHT) is an effective treatment for menopause-related symptoms. Menopause management guidelines recommend a personalized approach to menopause care, including MHT use. Decision-making around menopause care is a complex, iterative process influenced by multiple factors framed by perspectives from both women and healthcare providers (HCPs). This narrative review aims to summarize evidence around factors affecting decision-making regarding menopause-related care. For HCPs, the provision of individualized risk estimates is challenging in practice given the number of potential benefits and risks to consider, and the complexity of the data available, especially within time-limited consultations. Women seeking menopause care have the difficult task of making sense of the benefit versus risk profiles to make choices in line with their decisional needs influenced by sociocultural/economic, educational, demographic, and personal characteristics. The press, social media, and influential celebrities also impact the perception of menopause and decision-making around it. Understanding these factors can lead to improved participation in shared decision-making, satisfaction with the decision and decision-making process, adherence to treatment, reduced decisional regret, efficient use of resources, and ultimately long-term satisfaction with care.
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Affiliation(s)
- Kanyada Koysombat
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Sandhi Nyunt
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Hugo Pedder
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Yana Vinogradova
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jo Burgin
- Centre for Academic Primary Care, Bristol Medical School, Bristol, UK
| | - Harshida Dave
- Woman representative with lived-experience of menopause, London, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Julia V Bailey
- eHealth Unit, Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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DePree B, Houghton K, DiBenedetti DB, Shiozawa A, King DD, Kim J, Mancuso S. Practice patterns and perspectives regarding treatment for symptoms of menopause: qualitative interviews with US health care providers. Menopause 2023; 30:128-135. [PMID: 36696636 DOI: 10.1097/gme.0000000000002096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To document health care providers' views regarding treatments for symptoms associated with menopause and discussions with patients about symptoms and treatment decisions. Results informed development of a data collection form for a retrospective medical record review (reported separately). METHODS Registered US gynecologists or primary care providers from all US regions were identified from local association directories and an in-house database and were invited to participate in a qualitative interview if they consulted with three or more patients per week presenting with menopausal symptoms. Participants provided demographic data, information about patients' symptoms, and health care provider and patient views on prescription and nonprescription therapies. Key concepts/themes from interviews were identified. RESULTS Participating health care providers (10 gynecologists, 10 primary care providers) agreed there are effective treatment options for menopausal symptoms, particularly vasomotor symptoms and vaginal dryness and/or atrophy. Health care providers reported that treatment was generally dictated by symptoms that interfered with quality of life and/or daily activities, although patients often had symptoms for months before presentation. All health care providers said they prescribe hormone and/or nonhormone therapies for treatment of menopausal symptoms; half stated that they typically inquire about patients' nonprescription therapy use, and 45% recommend specific nonprescription therapies. The most commonly cited barriers to initiation of any therapy for menopausal symptoms were patient concerns about risks and financial considerations (ie, insurance or cost). CONCLUSIONS US health care providers reported prescribing therapies for menopausal symptoms and noted that these therapies were perceived as generally effective; however, barriers to initiation of prescription therapy exist, and new treatment options are needed.
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Affiliation(s)
| | | | | | | | | | - Janet Kim
- Astellas Pharma, Inc., Northbrook, IL
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Kanadys W, Barańska A, Błaszczuk A, Polz-Dacewicz M, Drop B, Kanecki K, Malm M. Evaluation of Clinical Meaningfulness of Red Clover ( Trifolium pratense L.) Extract to Relieve Hot Flushes and Menopausal Symptoms in Peri- and Post-Menopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:nu13041258. [PMID: 33920485 PMCID: PMC8069620 DOI: 10.3390/nu13041258] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 12/18/2022] Open
Abstract
The meta-analysis presented in this article covered the efficacy of red clover isoflavones in relieving hot flushes and menopausal symptoms in perimenopausal and postmenopausal women. Studies were identified by MEDLINE (PubMed), Embase, and the Cochrane Library searches. The quality of the studies was evaluated according to Cochrane criteria. A meta-analysis of eight trials (ten comparisons) demonstrated a statistically significant reduction in the daily incidence of hot flushes in women receiving red clover compared to those receiving placebo: weighted mean difference (WMD—weighted mean difference) −1.73 hot flushes per day, 95% CI (confidence interval) −3.28 to −0.18; p = 0.0292. Due to 87.34% homogeneity, the performed analysis showed substantive difference in comparisons of postmenopausal women with ≥5 hot flushes per day, when the follow-up period was 12 weeks, with an isoflavone dose of ≥80 mg/day, and when the formulations contained a higher proportion of biochanin A. The meta-analysis of included studies assessing the effect of red clover isoflavone extract on menopausal symptoms showed a statistically moderate relationship with the reduction in the daily frequency of hot flushes. However, further well-designed studies are required to confirm the present findings and to finally determine the effects of red clover on the relief of flushing episodes.
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Affiliation(s)
- Wiesław Kanadys
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
| | - Agnieszka Barańska
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
- Correspondence:
| | - Agata Błaszczuk
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Bartłomiej Drop
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Warsaw Medical University, 02-007 Warsaw, Poland;
| | - Maria Malm
- Department of Informatics and Medical Statistics, Medical University of Lublin, 20-090 Lublin, Poland; (W.K.); (B.D.); (M.M.)
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Hunter MM, Huang AJ, Wallhagen MI. "I'm going to stay young": Belief in anti-aging efficacy of menopausal hormone therapy drives prolonged use despite medical risks. PLoS One 2020; 15:e0233703. [PMID: 32469976 PMCID: PMC7259599 DOI: 10.1371/journal.pone.0233703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Over a third of menopausal hormone therapy (HT) prescriptions in the US are written for women over age 60. Use of HT more than 5 years is associated with increased risk for cardiovascular disease; breast, ovarian, and endometrial cancers; thromboembolic stroke; gallbladder disease; dementia; and incontinence. OBJECTIVES To explore older women's perceptions of the benefits and risks of long-term HT and examine factors influencing their decisions to use HT > 5 years despite medical risks. METHODS A qualitative approach was selected to broadly explore thought processes and social phenomena underlying long-term users' decisions not to discontinue HT. Interviews were conducted with 30 women over age 60 reporting use of systemic HT more than 5 years recruited from an urban area in California and a small city in the Rocky Mountain region. Transcripts of interviews were analyzed using conventional grounded theory methods. RESULTS Women reported using HT to preserve youthful physical and mental function and prevent disease. Gynecologists had reassured participants regarding risk, about which all 30 expressed little concern. Participants, rather than providers, were the principal drivers of long-term use. CONCLUSIONS Participants perceived estrogen to have anti-aging efficacy, and using HT imparted a sense of control over various aspects of aging. Maintaining this sense of control was prioritized over potential risk from prolonged use. Our findings provide an additional perspective on previous work suggesting the pharmaceutical industry has leveraged older women's self-esteem, vanity, and fear of aging to sell hormones through marketing practices designed to shape the beliefs of both clinicians and patients. Efforts are needed to: 1) address misconceptions among patients and providers about medically supported uses and risks of prolonged HT, and 2) examine commercial influences, such as medical ghostwriting, that may lead to distorted views of HT efficacy and risk.
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Affiliation(s)
- Mary M. Hunter
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Alison J. Huang
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Margaret I. Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
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Menopausal hormone therapy trends before versus after 2002: impact of the Women's Health Initiative Study Results. Menopause 2019; 26:588-597. [PMID: 30586004 DOI: 10.1097/gme.0000000000001282] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To better understand how to educate patients and providers about study findings relevant to treatment guidelines, we assessed pre- versus post-Women's Health Initiative (WHI) differences in menopausal hormone therapy (MHT) initiation and continuation and their correlates, and in women's reasons for initiation and discontinuation. METHODS We analyzed survey data from up to 14 approximately annual visits over 17 years (1996-2013) from 3,018 participants in the Study of Women's Health Across the Nation, a prospective cohort study. We used logistic regression to compare pre- versus post-WHI associations of covariates with MHT initiation and continuation, and to compare pre- versus post-WHI reasons for initiation and continuation. RESULTS MHT initiation dropped from 8.6% pre-WHI to 2.8% post-WHI (P < 0.0001), and the corresponding decrease in MHT continuation was 84.0% to 62.0% (P < 0.0001). Decreases in MHT initiation and continuation occurred across a range of participant subgroups, consistent with wide dissemination of post-WHI recommendations. However, contrary to current guidelines, we found large declines in MHT use in subgroups for whom MHT is often recommended, that is, younger women and those with more vasomotor symptoms. Post-WHI, women's reasons for MHT initiation and discontinuation reflected concerns highlighted by WHI results. The largest declines in initiation reasons were for reducing risks of osteoporosis and heart disease, whereas the largest increases in discontinuation reasons were for media reports and provider advice. CONCLUSIONS Immediate post-WHI recommendations for MHT use were widely adopted. MHT risks documented in older women, however, may have led younger symptomatic women to forgo MHT for symptom relief.
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Tatlock S, Abraham L, Bushmakin A, Moffatt M, Williamson N, Coon C, Arbuckle R. Psychometric evaluation of electronic diaries assessing side-effects of hormone therapy. Climacteric 2018; 21:594-600. [PMID: 30372631 DOI: 10.1080/13697137.2018.1517738] [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: 10/28/2022]
Abstract
OBJECTIVES Postmenopausal women (PMW) can experience side-effects (breast pain/tenderness and vaginal spotting/bleeding) associated with estrogen plus progestin therapies (EPTs). To assess these outcomes, the Breast Pain and Tenderness Daily Diary (BPT-DD) and the Vaginal Bleeding and Spotting Daily Diary (VBS-DD) were developed for electronic completion (eDiaries). This study evaluated the psychometric properties of the eDiaries. METHODS The eDiaries were completed daily for 28 days by 202 PMW experiencing breast pain/tenderness and/or vaginal spotting/bleeding while on EPTs. Confirmatory factor analysis (CFA) investigated the BPT-DD structure. Response distributions, test-retest reliability (intraclass correlation coefficient [ICC]), internal consistency (BPT-DD only), and construct validity (via known groups and convergent validity analyses) were assessed. RESULTS Completion rates were high: over 90% of women missed <3 daily entries. CFA supported the BPT-DD unidimensional structure (Bentler's Comparative Fit Index >0.98). BPT-DD inter-item correlations (r = 0.77-0.89) and internal consistency (Cronbach's alpha = 0.95-0.97) were high and good test-retest reliability was demonstrated (ICC ≥ 0.70). The eDiaries correlated moderately (>0.40), in a logical pattern with other instruments, supporting convergent validity. Known-groups analyses indicated both measures demonstrated significant differences between patients of differing severity (p < 0.001). CONCLUSION The study provides evidence of strong psychometric properties for the BPT-DD and VBS-DD to assess breast pain/tenderness and spotting/bleeding in PMW.
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Affiliation(s)
- S Tatlock
- a Adelphi Mill , Adelphi Values , Bollington , Cheshire , UK
| | - L Abraham
- b Pfizer Ltd , Tadworth , Surrey , UK
| | | | - M Moffatt
- b Pfizer Ltd , Tadworth , Surrey , UK
| | - N Williamson
- a Adelphi Mill , Adelphi Values , Bollington , Cheshire , UK
| | - C Coon
- d Outcometrix , Essex , MA , USA
| | - R Arbuckle
- a Adelphi Mill , Adelphi Values , Bollington , Cheshire , UK
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Coon C, Bushmakin A, Tatlock S, Williamson N, Moffatt M, Arbuckle R, Abraham L. Evaluation of a crosswalk between the European Quality of Life Five Dimension Five Level and the Menopause-Specific Quality of Life questionnaire. Climacteric 2018; 21:566-573. [DOI: 10.1080/13697137.2018.1481381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C. Coon
- Outcometrix, Ipswich, MA, USA
| | | | - S. Tatlock
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - N. Williamson
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | | | - R. Arbuckle
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
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Item Reduction, Scoring, and First Validation of the ACCEPTance by the Patients of their Treatment (ACCEPT©) Questionnaire. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:81-92. [PMID: 27456210 DOI: 10.1007/s40271-016-0187-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objectives of this study were to finalize, develop the scoring, and explore the psychometric properties of the ACCEPTance by the Patients of their Treatment (ACCEPT©) questionnaire, as well as to provide the first elements for its interpretation and guidance for its future use. METHODS ACCEPT© was finalized according to reference methods including testing in a pilot study, i.e., a multi-center, observational, longitudinal study conducted in France, in collaboration with a network of pharmacists. Principal component analysis using Varimax rotation was performed. The loadings of items on components in the principal component analysis were used to inform item selection. Validity of the measurement model of ACCEPT© was confirmed using Multi-trait/Multi-item Analysis based on item-scale Spearman correlations. Internal consistency reliability of the questionnaire was assessed by determining the Cronbach's α coefficient. Linear and logistic regressions were used to identify predictors of general acceptance, and to study predictors of persistence. RESULTS A total of 189 patients were included. The final version of ACCEPT© is composed of 25 items, distributed in seven dimensions providing a comprehensive appraisal of acceptance of long-term medication, with six scores measuring acceptance of treatment specific attributes and one score measuring general treatment acceptance. The measurement properties of ACCEPT© were overall fairly satisfactory. Regressions showed that Acceptance/Effectiveness is a predictor of general acceptance. However, no predictor of persistence could be identified. CONCLUSION The self-administered ACCEPT© questionnaire is a valid and reliable instrument for the assessment of patients' acceptance of long-term medication. Disease-specific and large prospective studies are needed to assess the ability of ACCEPT
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Ohn Mar S, Malhi FS, Syed Rahim SH, Soe MM. Chinese and Indian women's experience with alternative medications for menopause related symptoms: A qualitative analysis. Chin J Integr Med 2017:10.1007/s11655-017-2780-6. [PMID: 28914436 DOI: 10.1007/s11655-017-2780-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore women's rationalization for using alternative medications, their experience and view on safety of long-term use. METHODS Two focus group discussions, involving 5 participants each for Chinese and Indian groups, were conducted separately. Participant's personal information was collected anonymously. The discussion covered 5 areas: determinants for taking medications; reason for choosing alternative medications rather than hormone replacement therapy (HRT); how these medications help them; their view on cost-effectiveness and concerns over long-term use. The discussions were audio-taped, transcribed and analyzed. RESULTS Chinese participants took supplements for controlling symptoms while Indian participants used herbs as a preventive measure during menopause according to their tradition. Women of both groups mentioned that they did not take HRT because of fear of side effects. Chinese group mentioned that medications remarkably improved their symptoms whereas Indian participants appreciated their herbals more for improvement in general wellbeing than for specific symptoms. All members agreed that using alternative medication was cost-effective. Both Chinese and Indian participants were quite confident in saying that long-term use will not be associated with any side effects. However, Indian group emphasized that proper preparation of herbal compound using different types of leaves, is essential in order to avoid untoward effects. CONCLUSIONS Chinese and Indian women used alternative medicine in prevention and treatment of menopause-related problems even as they were avoiding HRT because of the fear of side effects. They believed that their supplements were effective, safe and cost-beneficial even with long-term use.
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Affiliation(s)
- Saw Ohn Mar
- Faculty of Medicine, University Kuala Lumpur, Royal College of Medicine Perak, Ipoh, 30450, Malaysia.
| | - Fatehpal Singh Malhi
- Faculty of Medicine, University Kuala Lumpur, Royal College of Medicine Perak, Ipoh, 30450, Malaysia
| | - Syed Hamid Syed Rahim
- Faculty of Medicine, University Kuala Lumpur, Royal College of Medicine Perak, Ipoh, 30450, Malaysia
| | - Myint Myint Soe
- Faculty of Medicine, University Kuala Lumpur, Royal College of Medicine Perak, Ipoh, 30450, Malaysia
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What you don't know can hurt you: more information and communication are needed regarding menopausal therapies. Menopause 2017; 24:1116-1117. [PMID: 28742628 DOI: 10.1097/gme.0000000000000963] [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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Marant C, Longin J, Gauchoux R, Arnould B, Spizak C, Marrel A, Patrick DL, Van Ganse E. Long-term treatment acceptance: what is it, and how can it be assessed? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 5:239-49. [PMID: 23116323 DOI: 10.2165/11631340-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Understanding the link between patients' beliefs and behavior may help explain their attitude to their treatment. How patients' personal experience of their treatment results in their decision to accept taking it or not and to persist in taking it remains to be explored more thoroughly. Acceptance is hypothesized to be the balance patients establish between their medication's advantages and its disadvantages, based on their personal experience with the medication. Measuring patients' acceptance of their medication is likely to predict their behavior (adherence and persistence) towards their treatment. OBJECTIVE Our objective was to develop a generic medication acceptance measure assessing how patients weigh advantages and disadvantages of long-term medications. METHODS A literature review was conducted using keywords related to acceptance, perceptions, motivations, and barriers linked to treatment. Exploratory interviews were performed with five pharmacists and 19 patients. Interviews were systematically analyzed in order to complete the initial conceptual model. Questionnaire items were generated for each concept identified, using patients' words. The resulting test version was tested for relevance and comprehension with six patients and revised accordingly; the new version was tested on a second set of five patients and revised to create the pilot version of the questionnaire. RESULTS Items generated for each concept identified were organized into six domains: drug characteristics, duration, constraints, side effects, efficacy, and global acceptance of treatment. Except for a few items that were modified or deleted following patients' suggestions and some minor modifications in the answer choices, the questionnaire was globally well accepted, easy to complete, and considered relevant and appropriate by patients. The pilot version of the ACCEPT© questionnaire contains 32 questions divided into the same six domains as the test version. CONCLUSIONS The existence of the hypothesized concept of medication acceptance was confirmed. The ACCEPT© questionnaire will allow assessment of the acceptance of a wide range of long-term medications based on patient experience. Further study will examine how well this measure predicts and explains adherence to these medications.
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Barnes EL, Long MD. Colorectal cancer in women: hormone replacement therapy and chemoprevention. Climacteric 2012; 15:250-5. [DOI: 10.3109/13697137.2012.659450] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Duffy OK, Iversen L, Hannaford PC. The impact and management of symptoms experienced at midlife: a community-based study of women in northeast Scotland. BJOG 2012; 119:554-64. [DOI: 10.1111/j.1471-0528.2012.03276.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tao M, Teng Y, Shao H, Wu P, Mills EJ. Knowledge, perceptions and information about hormone therapy (HT) among menopausal women: a systematic review and meta-synthesis. PLoS One 2011; 6:e24661. [PMID: 21949743 PMCID: PMC3174976 DOI: 10.1371/journal.pone.0024661] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/16/2011] [Indexed: 11/19/2022] Open
Abstract
Background The use of hormone therapy (HT) by menopausal women has declined since the Women's Health Initiative randomized trial (WHI) in 2002 demonstrated important harms associated with long-term use. However, how this information has influenced women's knowledge and attitudes is uncertain. We aimed to evaluate the attitudes and perceptions towards HT use, as well as specific concerns and information sources on HT since the WHI trial. Method/Results We did a systematic review to assess the attitudes and knowledge towards HT in women, and estimate the magnitude of the issue by pooling across the studies. Using meta-synthesis methods, we reviewed qualitative studies and surveys and performed content analysis on the study reports. We pooled quantitative studies using a random-effects meta-analysis. We analyzed 11 qualitative studies (n = 566) and 27 quantitative studies (n = 39251). Positive views on HT included climacteric symptom control, prevention of osteoporosis and a perceived improvement in quality of life. Negative factors reported included concerns about potential harmful effects, particularly cancer risks. Sources of information included health providers, media, and social contact. By applying a meta-synthesis approach we demonstrate that these findings are broadly applicable across large groups of patients. Conclusions Although there are clear hazards associated with long-term HT use, many women view HT favorably for climacteric symptom relief. Media, as a source of information, is often valued as equivalent to health providers.
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Affiliation(s)
- MinFang Tao
- Department of Gynecology, Shanghai Jiaotong University, Affiliated Sixth People's Hospital, Shanghai, China.
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Carpenter JS, Byrne MM, Studts JL. Factors related to menopausal symptom management decisions. Maturitas 2011; 70:10-5. [DOI: 10.1016/j.maturitas.2011.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 06/02/2011] [Indexed: 12/28/2022]
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Duffy O, Iversen L, Hannaford PC. The menopause ‘It's somewhere between a taboo and a joke’. A focus group study. Climacteric 2011; 14:497-505. [DOI: 10.3109/13697137.2010.549974] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Long MD, Martin CF, Galanko JA, Sandler RS. Hormone replacement therapy, oral contraceptive use, and distal large bowel cancer: a population-based case-control study. Am J Gastroenterol 2010; 105:1843-50. [PMID: 20354510 PMCID: PMC2916940 DOI: 10.1038/ajg.2010.123] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Lower incidence rates of distal large bowel cancer in women when compared with men support the protective role of female hormones. We aimed to determine the associations between hormone replacement therapy, oral contraceptive use, and distal large bowel cancer. METHODS We conducted a population-based case-control study of incident distal large bowel cancer in North Carolina between 2001 and 2006. Data on hormone replacement therapy, oral contraceptive use, demographics, and risk factors were obtained through in-person interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between oral contraceptive use, hormone replacement therapy, and distal large bowel cancer were estimated through unconditional logistic regression models overall, by duration of use, and within strata of race. RESULTS There were a total of 443 women with distal large bowel cancer and 405 controls. Ever use of hormone replacement therapy was strongly associated with a reduced risk of distal large bowel cancer (OR 0.52, 95% CI 0.38-0.72). Further reduction of distal large bowel cancer risk occurred with increased duration of use (<4 years (OR 0.77, 95% CI 0.44-1.35), 4-8 years (OR 0.64, 95% CI 0.37-1.10), 9-14 years (OR 0.47, 95% CI 0.27-0.81), and >or=15 years (OR 0.34, 95% CI 0.20-0.58)). Ever use of oral contraceptives was not associated with reduced incidence of distal large bowel cancer (OR 0.95, 95% CI 0.67-1.34) nor was duration of use. There were no differences by race. CONCLUSIONS Hormone replacement therapy is associated with a lower risk of distal large bowel cancer. This risk is further reduced with increased duration of use. Hormone replacement therapy may be partially responsible for the reduced incidence of distal large bowel cancer in women compared with men.
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Affiliation(s)
- Millie D. Long
- University of North Carolina – Chapel Hill, Division of Gastroenterology and Hepatology,University of North Carolina – Chapel Hill, Department of Epidemiology
| | - Christopher F. Martin
- University of North Carolina – Chapel Hill, Division of Gastroenterology and Hepatology,University of North Carolina – Chapel Hill, Department of Epidemiology
| | - Joseph A. Galanko
- University of North Carolina – Chapel Hill, Division of Gastroenterology and Hepatology
| | - Robert S. Sandler
- University of North Carolina – Chapel Hill, Division of Gastroenterology and Hepatology,University of North Carolina – Chapel Hill, Department of Epidemiology
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Abstract
OBJECTIVE There is currently a gap in treatment options for menopausal symptoms and a need for comprehensive therapies that are safe and effective for postmenopausal women. This review discusses challenges in the management of menopausal symptoms and the effect of the Women's Health Initiative (WHI) study findings on current treatment patterns. It also examines present and future therapies. RESEARCH DESIGN AND METHODS A literature search was conducted using Medline, the Cochrane Database, and the National Heart Lung and Blood Institute WHI website with the following search terms: primary care, menopause, vasomotor symptoms, hormone therapy, osteoporosis, and vaginal atrophy. Searches were limited to articles published between 1995 and 2009. RESULTS Comprehensive therapies that target several aspects of menopause, such as vasomotor symptoms and chronic disease prevention, are currently hormone based. These hormone-based approaches are considered more effective than currently available nonhormonal therapies for the relief of menopausal symptoms. However, hormone therapy is not recommended for women at high risk for venous thromboembolic events, cardiovascular disease, and/or breast cancer. A need exists for novel therapies that mitigate menopausal symptoms, provide protection from osteoporosis, and encourage patient compliance without promoting cancer, heart disease, or stroke. Emerging modalities and strategies, such as the tissue selective estrogen complex (TSEC), Org 50081, MF101, and desvenlafaxine, may provide improved options for postmenopausal women. CONCLUSIONS Several new menopausal therapies that may help to address the ongoing unmet need for safe and effective therapies for postmenopausal women are currently in development. In particular, the TSEC, which provides the benefits of both a selective estrogen receptor modulator and conjugated estrogens with an improved tolerability profile, may offer advantages over currently available treatment options. Limitations of this review include the narrow search criteria and limited search period.
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Affiliation(s)
- Vivian Lewis
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Kolip P, Hoefling-Engels N, Schmacke N. Attitudes toward postmenopausal long-term hormone therapy. QUALITATIVE HEALTH RESEARCH 2009; 19:207-215. [PMID: 19050178 DOI: 10.1177/1049732308328053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In this article we address the question of why postmenopausal women undergo hormone therapy. Thirty-five women aged 46 to 75 years living in Bremen (Germany) and taking postmenopausal hormones for at least 12 months were interviewed. Following Fritz Schütze, the interviews were analyzed according to a reconstructive analytical procedure. Five different types of users were identified. They differed from each other in terms of their reasons for using hormones, their expectations of this type of therapy, and their personal habits and circumstances, including an integrity-preserving attitude, a performance-oriented attitude, a searching attitude, a faith-in-medicine attitude, and a benefit-generalizing attitude. The interviews show that there is a need for target-oriented counseling, taking into account the individual attitudes toward menopause and postmenopausal hormone therapy.
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Johansen OE, Qvigstad E. Rationale for low-dose systemic hormone replacement therapy and review of estradiol 0.5 mg/NETA 0.1 mg. Adv Ther 2008; 25:525-51. [PMID: 18568306 DOI: 10.1007/s12325-008-0070-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The menopausal transition is associated with several symptoms, for which both non-pharmacological and pharmacological measures are available to provide relief. However, present knowledge indicates that the former is not highly effective, and that the latter, in terms of systemic oestrogen and progestogen-based hormone replacement therapy (HRT), although being effective (e.g. on vasomotor symptoms, bleeding control, bone mineral density, vaginal atrophy and quality of life), can be associated with some caveats. Amongst these are an increased risk for coronary heart disease, breast cancer, venous thromboembolism and stroke. In recent years, literature has indicated a dose dependency for HRT on some of the caveats, hence authorities (Food and Drug Administration, and the European Medicines Agency) and menopause societies (International Menopause Society and North American Menopause Society) now recommend that women deemed in need of HRT should receive the lowest possible dose without compromising the effect of symptom relief. Estradiol 0.5 mg/norethisterone acetate (NETA) 0.1 mg, despite being a lower dose than conventional hormones, is a compound, among a few other low-dose options, that can be used in such therapy. As a first-line oral option, it has demonstrated its effectiveness (which seems comparable to other compounds), with high tolerability and, apparently, no safety concerns, in a 6-month study. Further long-term clinical trials and observational studies are mandatory in order to capture any potential harm as well as to elucidate this compound's full potential. Following a thorough literature search using PubMed and MEDLINE from the earliest publication dates through to January 2008, including results from various types of clinical trials and statements on HRT, we review the rationale for these recommendations. We also review the effects and safety of a novel 'ultra-low-dose' oral continuous combined HRT tablet, estradiol 0.5 mg/NETA 0.1 mg.
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Theroux R. Postmenopausal hormone use: what does the latest evidence show? Nurs Womens Health 2008; 12:56-61. [PMID: 18257887 DOI: 10.1111/j.1751-486x.2007.00276.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Rosemary Theroux
- Graduate School of Nursing, University of Massachusetts, Worcester, MA, USA.
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