Do perceptions of risk and quality of life affect use of hormone replacement therapy by postmenopausal women?

Risk communication in consultations about hormone therapy in the menopause: concordance in risk assessment and framing due to the context

BACKGROUND

It is important for the physician and the patient to have a mutual understanding of the possible consequences of different treatment alternatives in order to achieve a partnership in decision-making.

OBJECTIVE

The aim of this study was to explore to which degree first-time consultations for discussion of climacteric discomfort achieved shared understanding of the risks and benefits associated with hormone therapy in the menopausal transition.

METHODS

Analysis of structure and content of transcribed consultations (n = 20), and follow-up interviews of the women (n = 19 pairs of consultations and interviews), from first-time visits for discussion of climacteric discomfort and/or HT with five physicians at three different outpatient clinics of gynecology in Sweden.

RESULTS

Four distinctively different interpretations of risk, depending on whether or not benefits were discussed in the same context, emerged from the analysis. On average, five advantages (range 0-11) and two (0-3) disadvantages were mentioned during the consultations. In the interviews, the women expressed on average four advantages (0-7) and one disadvantage (0-3). There were major variations between advantages and disadvantages expressed in the consultation and the following interview.

CONCLUSION

Even though the consultations scored high in patient involvement, the information in most consultations was not structured in a way that made it possible to achieve a shared or an informed decision-taking.

Women's Autonomy and the Evaluation of the Information Available on the Internet on Hormone Therapy After Menopause

This study was designed to examine the information in Spanish, provided by different Web sites, related to hormone therapy and climacteric symptoms. Web sites evaluated included those belonging to government and scientific institutions and to a miscellaneous group. In Web sites in Spanish, there was more extensive information on the benefits of hormone therapy than there were on other items. The Web sites of governmental institutions provided significantly more information on the risks (P < .01) and benefits (P = .02) of hormone therapy than did the other sites. Governmental institutions from the United States, unlike those from Spain, did not make recommendations regarding when hormone therapy should be considered and instead emphasized the woman's decision. The variability of information in Spanish on hormone therapy and postmenopausal symptoms presented on the Internet is related to the organization responsible for the Web site. Besides, cultural differences in the concept of patient autonomy could partly explain the differences in emphasis made on women's role in the decision-making process.

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.