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Doamekpor LA, Head SK, South E, Louie C, Zakharkin S, Vasisht K, Bersoff-Matcha S. Determinants of Hormone Replacement Therapy Knowledge and Current Hormone Replacement Therapy Use. J Womens Health (Larchmt) 2023; 32:283-292. [PMID: 36459626 DOI: 10.1089/jwh.2022.0342] [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: 12/05/2022] Open
Abstract
Background: The use of hormone replacement therapy (HRT) to treat menopausal symptoms has declined since the early 2000s, and little is known about the contemporary determinants of use in the United States. We aim to understand women's knowledge of HRT as a treatment of menopausal symptoms and to assess the factors associated with HRT use. Materials and Methods: Weighted multivariate logistic regression models evaluated the correlates of high HRT knowledge and current HRT use among a sample of 2,548 women aged ≥45 years who participated in an online survey between August 2019 and May 2020. Results: In total, 82% of the women surveyed reported experiencing one or more menopausal symptoms, yet only 10.5% reported using HRT. Only 33% reported high HRT knowledge. The odds of reporting high HRT knowledge increased with increasing age. Racial, ethnic minority women were less likely to report high HRT knowledge (adjusted odds ratio [AOR] = 0.69; 95% confidence interval [CI] = 0.5-0.9). Hispanic and non-Hispanic women of other racial and ethnic groups were less likely to use HRT compared with non-Hispanic White women (AOR = 0.3; 95% CI = 0.1-0.6) (AOR = 0.4; CI = 0.2-0.9), respectively. Women experiencing irregular periods were less likely to report current HRT use (AOR = 0.1, 95% CI = 0.4-0.7). Compared with past users, never users appeared to be more risk averse, and reported concern over HRT risks and side effects as reasons for nonuse. Conclusions: Many factors impact women's perceived HRT knowledge level and to a lesser extent HRT use. Future research should better define the most important factors influencing decisions to use HRT for symptom relief.
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Affiliation(s)
- Laurén A Doamekpor
- Office of Women's Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sara K Head
- Office of Women's Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Erin South
- Office of Women's Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Kaveeta Vasisht
- Office of Women's Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Susan Bersoff-Matcha
- Office of Women's Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Combined estrogen replacement therapy on metabolic control in postmenopausal women with diabetes mellitus. Kaohsiung J Med Sci 2014; 30:350-61. [DOI: 10.1016/j.kjms.2014.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 12/17/2013] [Indexed: 01/22/2023] Open
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Fugh-Berman A, McDonald CP, Bell AM, Bethards EC, Scialli AR. Promotional tone in reviews of menopausal hormone therapy after the Women's Health Initiative: an analysis of published articles. PLoS Med 2011; 8:e1000425. [PMID: 21423581 PMCID: PMC3058057 DOI: 10.1371/journal.pmed.1000425] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 02/03/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Even after the Women's Health Initiative (WHI) found that the risks of menopausal hormone therapy (hormone therapy) outweighed benefit for asymptomatic women, about half of gynecologists in the United States continued to believe that hormones benefited women's health. The pharmaceutical industry has supported publication of articles in medical journals for marketing purposes. It is unknown whether author relationships with industry affect promotional tone in articles on hormone therapy. The goal of this study was to determine whether promotional tone could be identified in narrative review articles regarding menopausal hormone therapy and whether articles identified as promotional were more likely to have been authored by those with conflicts of interest with manufacturers of menopausal hormone therapy. METHODS AND FINDINGS We analyzed tone in opinion pieces on hormone therapy published in the four years after the estrogen-progestin arm of the WHI was stopped. First, we identified the ten authors with four or more MEDLINE-indexed reviews, editorials, comments, or letters on hormone replacement therapy or menopausal hormone therapy published between July 2002 and June 2006. Next, we conducted an additional search using the names of these authors to identify other relevant articles. Finally, after author names and affiliations were removed, 50 articles were evaluated by three readers for scientific accuracy and for tone. Scientific accuracy was assessed based on whether or not the findings of the WHI were accurately reported using two criteria: (1) Acknowledgment or lack of denial of the risk of breast cancer diagnosis associated with hormone therapy, and (2) acknowledgment that hormone therapy did not benefit cardiovascular disease endpoints. Determination of promotional tone was based on the assessment by each reader of whether the article appeared to promote hormone therapy. Analysis of inter-rater consistency found moderate agreement for scientific accuracy (κ=0.57) and substantial agreement for promotional tone (κ=0.65). After discussion, readers found 86% of the articles to be scientifically accurate and 64% to be promotional in tone. Themes that were common in articles considered promotional included attacks on the methodology of the WHI, arguments that clinical trial results should not guide treatment for individuals, and arguments that observational studies are as good as or better than randomized clinical trials for guiding clinical decisions. The promotional articles we identified also implied that the risks associated with hormone therapy have been exaggerated and that the benefits of hormone therapy have been or will be proven. Of the ten authors studied, eight were found to have declared payment for speaking or consulting on behalf of menopausal hormone manufacturers or for research support (seven of these eight were speakers or consultants). Thirty of 32 articles (90%) evaluated as promoting hormone therapy were authored by those with potential financial conflicts of interest, compared to 11 of 18 articles (61%) by those without such conflicts (p=0.0025). Articles promoting the use of menopausal hormone therapy were 2.41 times (95% confidence interval 1.49-4.93) as likely to have been authored by authors with conflicts of interest as by authors without conflicts of interest. In articles from three authors with conflicts of interest some of the same text was repeated word-for-word in different articles. CONCLUSION There may be a connection between receiving industry funding for speaking, consulting, or research and the publication of promotional opinion pieces on menopausal hormone therapy.
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Affiliation(s)
- Adriane Fugh-Berman
- Department of Physiology and Biophysics, Georgetown University Medical Center, Washington, DC, USA.
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Huston SA, Bagozzi RP, Kirking DM. Decision-making about the use of hormone therapy among perimenopausal women. Br J Health Psychol 2010; 15:231-251. [DOI: 10.1348/135910709x457946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Huston SA, Jackowski RM, Kirking DM. Women's Trust in and Use of Information Sources in the Treatment of Menopausal Symptoms. Womens Health Issues 2009; 19:144-53. [DOI: 10.1016/j.whi.2009.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/05/2009] [Accepted: 01/14/2009] [Indexed: 11/16/2022]
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Helenius IM, Korenstein D, Halm EA. Changing use of hormone therapy among minority women since the Women's Health Initiative. Menopause 2007; 14:216-22. [PMID: 17179789 DOI: 10.1097/01.gme.0000233169.65045.b1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There has been a significant shift in the use of hormone therapy (HT) among nonminority women since the publication of results of the Women's Health Initiative (WHI). Little is known about how the WHI results affected minority populations. This survey measured patterns of HT use among inner city women after publication of the WHI results, identified factors involved in the decision to continue or discontinue HT, and characterized the symptom burden and the experience of women who attempted to discontinue HT. DESIGN We conducted a cross-sectional survey of 101 English- and Spanish-speaking women in an inner city general internal medicine clinic from August 2003 to April 2004. All women had been taking HT at the time of the publication of the WHI results. The survey included questions on patient-reported experience with HT, symptoms of menopause, and use of alternative treatments. RESULTS Overall, 101 of 142 (71%) eligible women agreed to participate. The mean age of participants was 60 years; 43% were African American and 46% were Hispanic. The mean duration of HT use was 9.6 years. Three quarters (74%) had heard about the WHI findings, and 87% had attempted to stop taking HT after their publication. The most common reason for attempting to stop HT was concern about an increased risk of cancer or a general increase in risk to health. Of those who stopped HT, the vast majority (85%) reported vasomotor symptoms, and 26% restarted HT, mostly to treat those symptoms. CONCLUSIONS Nearly all minority women in this small sample attempted to stop HT use after the results of the WHI were published. Restarting HT for treatment of symptoms was common.
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Affiliation(s)
- Ira M Helenius
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Sangi-Haghpeykar H, Poindexter AN. Physicians’ views and practices concerning menopausal hormone therapy. Maturitas 2007; 56:30-7. [PMID: 16797148 DOI: 10.1016/j.maturitas.2006.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 05/11/2006] [Accepted: 05/12/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine physicians' views and practices concerning estrogen+progestogen therapy (EPT). DESIGN Questionnaires were mailed to a random sample of physicians in the United States (US) in 2003. A total of 1614 (53.8%) surveys were returned (633 obstetricians and gynecologists (Ob/Gyns), 571 family practitioners, and 410 internists). RESULTS Only a minority of the physicians (16%) would offer EPT to menopausal women in the absence of menopausal symptoms (26% Ob/Gyn, 11% family practitioners, 6% internists, p<0.0001). However, many physicians (62%) believed that EPT could be offered "short term" to menopausal women with menopausal symptoms assuming no contraindications (82% Ob/Gyn, 54% family practitioners, 42% internists; p<0.0001). Irrespective of specialty, the strongest contraindications to EPT use reported by these physicians were personal history of breast cancer (93%), thrombosis (92%), cerebrovascular disease (84%), ischemic heart disease (74%), uterine cancer (73%), as well as women's subjective "concern" about breast cancer (57%). Procedures reported as always required by physicians for continuing women on EPT were breast examination (97%), mammogram (96%), blood pressure measurement (94%), and pelvic examination (91%). CONCLUSIONS Internists and family practitioners address more contraindications to EPT use than Ob-Gyns. Although many physicians appear to be accepting of short-term use of EPT for menopausal indications in the absence of contraindications, the majority would not prescribe it for prophylactic purposes.
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Affiliation(s)
- Haleh Sangi-Haghpeykar
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX 77030, United States.
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Abstract
OBJECTIVE In 2002, the combination estrogen-progestin hormone therapy (HT) treatment arm of the Women's Health Initiative was terminated early because cardiovascular and cancer risks were identified, while the estrogen-only therapy (ET) arm of this trial continued. We investigated hormone therapy prescription practice changes between 2001 and 2003 to explore the effects of the clinical trial results. METHODS Data were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey for the years 2001 through 2003. These nationally representative surveys sample medical encounters in nonfederally employed physician's offices and outpatient departments of nonfederal short-stay and general hospitals. The proportion and rate of visits with ET and HT prescriptions were calculated. Logistic regression was used to estimate change over time accounting for patient and provider characteristics. RESULTS Between 2001 and 2003, the number of visits with menopausal hormone prescriptions fell from 26.5 million to 16.9 million. Almost three-quarters of hormone visits were for ET prescriptions. The decrease in the rate of visits was slightly larger for HT prescription visits (44%) than ET prescription visits (35%). The rate of decline was highest among women 50 years of age and over. After controlling for covariates, there was no significant difference in the decline by hormone type. CONCLUSION These nationally representative data indicate substantial declines in menopausal hormone prescriptions coinciding with clinical trial results on HT. These declines occurred among all types of therapy and patient characteristics. LEVEL OF EVIDENCE II-3.
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Affiliation(s)
- Esther Hing
- Division of Health Care Statistics, and Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
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Huston SA, Kirking DM, Shimp LA. Use, intentions, and beliefs about hormone replacement therapy in women with and without diabetes. Maturitas 2006; 55:58-68. [PMID: 16504429 DOI: 10.1016/j.maturitas.2006.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 01/03/2006] [Accepted: 01/03/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVES (1) Describe women's (a) hormone replacement therapy (HRT) use patterns, (b) intentions to use or continue to use HRT among women in the early and late stages of menopause, and (c) beliefs about using HRT and (2) compare these beliefs, patterns, and intentions between women with and without diabetes 10-12 months after news from the women's health initiative was widely publicized. METHODS A survey mailed to female enrollees of a not-for-profit managed care organization (MCO) between 46 and 60 years of age and with or without diabetes. Descriptive statistics were calculated. Chi-square analysis was used to determine significant differences between four different HRT use and menopause stage groups, (1) early stage never user, (2) late stage never user, (3) late stage current user, and (4) late stage previous user. Analysis of variance (ANOVA) was used to identify significant belief differences between the four groups. Repeated-measures ANOVA was performed to examine differences between women with and without diabetes. RESULTS Most women did not intend to initiate HRT. About 86% of current HRT users intended to continue. Never users with diabetes were significantly more uncertain about HRT intention than non-diabetic women. All beliefs were significantly different (p<0.001) between the four groups, but not between women with and without diabetes. CONCLUSION Women in different groups hold different beliefs about HRT use. Uncertainty among women with diabetes is not resolved as quickly as among women without diabetes.
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Affiliation(s)
- Sally A Huston
- Department of Pharmaceutical Sciences, School of Pharmacy, South University, 709 Mall Boulevard, Savannah, GA 31406, USA.
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Brief report: attitudes toward hormone therapy after the Women's Health Initiative: a comparison of internists and gynecologists. J Gen Intern Med 2005; 20:416-8. [PMID: 15963163 PMCID: PMC1490120 DOI: 10.1111/j.1525-1497.2005.0089.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the Women's Health Initiative (WHI), postmenopausal women receiving combination hormone therapy (HT) experienced more adverse outcomes than placebo recipients. To determine whether gynecologists and internists interpreted the WHI differently, we conducted a survey in which physicians responded to a hypothetical asymptomatic woman who asks whether to continue HT. In response to this scenario, gynecologists were more likely than internists to hold permissive views about prescribing HT (66% vs 35%; P<.001). These results suggest that gynecologists may be less concerned than internists about the adverse events associated with HT, or that gynecologists have stronger beliefs about benefits of HT.
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Parsons E, Newby LK, Bhapkar MV, Alexander KP, White HD, Shah SH, Bushnell CD, Califf RM. Postmenopausal hormone use in women with acute coronary syndromes. J Womens Health (Larchmt) 2005; 13:863-71. [PMID: 15671702 DOI: 10.1089/jwh.2004.13.863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent trials reveal no benefit and possible harm from chronic hormone replacement therapy (HRT). Less is known about intermediate-term outcomes associated with HRT use in the setting of acute coronary syndromes (ACS). METHODS To examine the prevalence of HRT use and relationships with intermediate-term outcomes among women with ACS, we classified as HRT users or nonusers 4029 postmenopausal women (age > 50 years or postmenopausal by case report form) randomized in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-Acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials. Outcomes included 90-day and 1-year death and 90-day stroke, death, or myocardial infarction (MI); death, MI, or stroke; and death, MI, or severe recurrent ischemia (SRI). RESULTS HRT use was 13% overall and varied by region (Asia, 0%; Eastern Europe, 0.2%; Latin America, 0.8%; Western Europe, 4%; Australia/New Zealand, 12%; Canada, 14%; United States, 24%); estrogen-only regimens were most common (90%). HRT users were younger, had higher estimated creatinine clearance, more frequently were smokers and had prior revascularization, but less frequently had diabetes, prior angina, or heart failure. Unadjusted 90-day and 1-year mortality rates were lower among HRT users (hazard ratios [95% CI] 0.48 [0.23-0.98] and 0.35 [0.18-0.68], respectively) but after multivariable adjustment, were not significantly different. Ninety-day stroke and composite end points did not differ between HRT users and nonusers. CONCLUSIONS HRT use (predominantly estrogen-only) was low among patients with ACS but varied by region and was not associated with improved intermediate-term outcomes. These results are consistent with the absence of benefit from HRT use (combination or estrogen only) in previous studies in more stable populations.
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Ringa V, Légaré F, Dodin S, Norton J, Godin G, Bréart G. Hormone therapy prescription among physicians in France and Quebec. Menopause 2004; 11:89-97. [PMID: 14716188 DOI: 10.1097/01.gme.0000072202.41124.1b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Our objective was to compare physician characteristics associated with high-frequency hormone therapy (HT) prescription between gynecologists and general practitioners (GPs) within and between France and Quebec, Canada. DESIGN A self-administered mail survey was sent to a representative sample of 2,000 physicians in France and 1,000 physicians in Quebec. High-frequency prescribers were those who reported prescribing HT to more than 70% of their postmenopausal patients. The following characteristics were included in the analysis: country, specialty, age, gender, characteristics of the practice (solo or group, private or public, rural or urban, number of patients seen daily, duration of practice, percentage of women 45 years or older), teaching or research activities, participation in education course on HT, and practice patterns relating to menopausal women (having patient education materials available, providing materials to patients, and discussing the possibility of HT). RESULTS The analysis covered 974 physicians in France (389 GPs and 585 gynecologists) and 452 physicians in Quebec, Canada (318 GPs and 134 gynecologists). Despite differences in health care, in both countries gynecologists were more likely to be high-frequency prescribers than were GPs, although this difference was smaller in Quebec. Canadian physicians were more likely to prescribe HT. The difference between countries was greatest among GPs. Except for nationality and practice patterns designed to provide women with information, none of the physician characteristics was associated with high-frequency prescription among GPs. Among gynecologists, only the number of patients per day and the provision of information were associated with high-frequency prescription. CONCLUSIONS Notwithstanding a common language, differences in the prescription pattern of HT between countries were greatest at the level of primary care than secondary care. In both countries, specialists were more likely to prescribe HT than were GPs. Implementation of clinical practice guidelines to set baseline standards in the field of menopausal health remains a challenge but will need to take into account cultural characteristics as well as level of medical care.
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Affiliation(s)
- Virginie Ringa
- INSERM National Institute of Health and Medical Research U149, Epidemiological Research Unit on Perinatal Health and Women's Health, Villejuif, France.
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Rachoń D, Zdrojewski T, Suchecka-Rachoń K, Szpakowski P, Bandosz P, Manikowski A, Wyrzykowski B. Knowledge and use of hormone replacement therapy among Polish women: estimates from a nationally representative study—HORTPOL 2002. Maturitas 2004; 47:31-7. [PMID: 14706763 DOI: 10.1016/s0378-5122(03)00222-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the knowledge about hormone replacement therapy (HRT) and the prevalence of its current use in Polish female population. METHODS Cross-sectional survey on a representative sample of 1544 women between 18 and 87 years of age. RESULTS Almost half of the Polish women have heard of HRT. Depending on the education level, 26-38% of women knew that HRT alleviates the physical and psychological symptoms of menopause and 18-32% knew that HRT reduces the risk of developing osteoporosis. Forty-three percent of all the women with a higher level of education were aware that HRT increases the risk of breast and uterine cancer. The prevalence of current HRT use among women aged 45-64 was 12%. Women who had only basic education were less likely to use HRT than those with a medium and higher education level. Lack of information about HRT was the main cause of not using it. Forty-four percent of the perimenopausal women (age range 45-54 years) have never heard of HRT and 36% were never told by their healthcare providers that they could use it. Nineteen percent of perimenopausal women were not using HRT because they were afraid of the HRT related risks. Sixty-four percent of women who were using HRT were prescribed oral HRT preparations. CONCLUSIONS A fairly small proportion of Polish women currently uses HRT, largely because most remain poorly informed about the therapy.
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Affiliation(s)
- Dominik Rachoń
- Department of Immunology of the Medical University of Gdańsk, ul. Debinki 1, 80-210 Gdańsk, Poland.
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Neuner JM, McCarthy EP, Davis RB, Phillips RS. Physician counseling on hormone replacement therapy and bone loss: do socioeconomic and racial characteristics of women influence counseling? J Womens Health (Larchmt) 2003; 12:495-504. [PMID: 12869297 DOI: 10.1089/154099903766651621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although women consider multiple issues when deciding to take hormone replacement therapy (HRT), both women's use and physician counseling about HRT are strongly associated with sociodemographic factors. As prevention of bone loss is the best established long-term benefit of HRT, we sought to determine (1) if counseling about bone loss is included in discussions of HRT and (2) if sociodemographic factors affect the preventive content of HRT counseling. METHODS We evaluated reports of counseling on estrogen and bone loss from 1404 women aged 40-60 who reported any counseling on HRT in the 1994 National Health Interview Survey (NHIS). We also examined the association between these reports and sociodemographic factors, adjusting for clinical history, physician specialty, and physician visits. RESULTS We found that 80% of the women reported counseling on the effects of estrogen on bone loss. After adjustment, high school graduates (adjusted odds ratio [AOR] 1.68, confidence interval [CI] 1.02, 2.77) and college graduates (AOR 2.45, CI 1.33, 4.52) were much more likely to be counseled than women without a high school diploma. Black women were less likely to be counseled about bone loss (AOR 0.55, CI 0.33, 0.93). Although general health and menopausal symptoms were strongly associated with counseling on HRT and bone loss, neither of the osteoporosis risk factors of low body mass index (BMI) and smoking influenced counseling. CONCLUSIONS Most patients who discussed HRT with their providers discussed the effects of HRT on bone loss. For those who did not, several sociodemographic factors associated with any counseling on HRT are also associated with the content of HRT counseling. Understanding and addressing counseling inequities could reduce the effect of such factors on osteoporosis assessment and treatment.
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Affiliation(s)
- Joan M Neuner
- Division of General Internal Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Levy BT, Ritchie JM, Smith E, Gray T, Zhang W. Physician Specialty Is Significantly Associated With Hormone Replacement Therapy Use. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200301000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leisure-Time Activity among Older U.S. Women in Relation to Hormone-Replacement-Therapy Initiation. J Aging Phys Act 2003. [DOI: 10.1123/japa.11.1.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hormone-replacement therapy (HRT) and physical activity are both related to aging and health. U.S. minorities are more likely to be inactive and less likely to initiate HRT than are non-Hispanic White women. The purpose of this investigation was to examine the relationship of race and HRT use with physical inactivity among older women (60+ years). The authors used data from 3,479 women who had participated in the Third National Health and Nutrition Examination Survey (NHANES III), conducted in 1988-1994. NHANES III included an in-person interview and a medical examination. The prevalence of physical inactivity among women who reported ever having used HRT was 28.5% (CI 22.9–34.1%), compared with 40.0% (CI 35.9–44.1%) among those who had never used HRT. Mexican American and non-Hispanic Black women reported higher levels of inactivity than did non-Hispanic White women across HRT-use categories. To promote successful aging, physicians should educate postmenopausal women on the possible health benefits of HRT combined with an active lifestyle.
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Hormone Replacement Therapy Regimens and Breast Cancer Risk. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200212000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Friedman-Koss D, Crespo CJ, Bellantoni MF, Andersen RE. The relationship of race/ethnicity and social class to hormone replacement therapy: results from the Third National Health and Nutrition Examination Survey 1988-1994. Menopause 2002; 9:264-72. [PMID: 12082362 DOI: 10.1097/00042192-200207000-00007] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To use a nationally representative sample to examine the prevalence of hormone replacement therapy (HRT) use and its relationship to different markers of social class in American women 60 years of age and older. DESIGN Nationally representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 3,479 women aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans, non-Hispanic blacks and much older women were oversampled to produce reliable estimates for these groups. RESULTS Overall, the number of women who reported ever having used HRT was 37% [confidence interval (CI), 33%-40%] of all women older than 60 years of age; 40% (CI, 37%-41%) of older, non-Hispanic white women; 20% (CI, 14%-25%) of non-Hispanic black women; and 24% (CI, 20%-29%) of Mexican American women. HRT was used by 43% (CI, 38%-47%) of women 60 to 70 years old, 37% (CI, 32%-41%) of those 71 to 80 years old, and 20% (CI, 13%-26%) of women older than 80. HRT use was lowest among women who did not complete high school or among those in the lowest family income categories. Among women more than 60 years old who reported having a hysterectomy, 51% (CI, 47%-55%) reported using HRT, whereas only 20% (CI, 17%-23%) of those who had a natural menopause reported using HRT. CONCLUSIONS Although many women can benefit from HRT, the number of American women who report they have ever used it remains low. More research is needed to examine the implications of racial differences in compliance, patient and physician attitudes toward HRT, and possible environmental barriers that may prevent use.
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Affiliation(s)
- Diana Friedman-Koss
- Johns Hopkins School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, Maryland 21224, USA
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Cook A, Pennington G. Phytoestrogen and multiple vitamin/mineral effects on bone mineral density in early postmenopausal women: a pilot study. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2002; 11:53-60. [PMID: 11860725 DOI: 10.1089/152460902753473462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of the study was to assess the effect of a combination regimen of herbs, vitamins, and minerals on bone mineral density (BMD) in early postmenopausal women via a 2-year, single-blind, uncontrolled, prospective trial. BMD was measured by dual energy x-ray absorptiometry (DEXA) at baseline and at 6, 12, and 24 months. Results of lumbar spine, hip, and forearm densities did not differ significantly from historical controls derived from other recent trials using a similar patient population. Bone mineral losses are reported on an annualized basis over the 2 years for the 12 women who completed the trial: spine (-1.42% per year), hip (-0.43% per year), forearm (-1.42% per year). Six women were withdrawn from the trial by the investigators because of excessive losses of bone mineral, and 1 of these women was diagnosed with hyperparathyroidism. There were no metabolic diseases to explain the losses in the remaining 5 withdrawn subjects. Four of 21 subjects experienced adverse side effects, necessitating dropping out by 3 of these women. In conclusion, the combined treatment regimen of a menopause symptom-oriented herbal blend plus a high potency vitamin/mineral was unsuccessful in protecting women against the predictable acceleration of bone mineral losses associated with early postmenopause.
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Affiliation(s)
- Alan Cook
- Osteoporosis Diagnostic Center, Eureka, California 95503, USA
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Gallagher TC, Geling O, Comite F. Use of multiple providers for regular care and women's receipt of hormone replacement therapy counseling. Med Care 2001; 39:1086-96. [PMID: 11567171 DOI: 10.1097/00005650-200110000-00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior research has explored women's lifetime receipt of HRT counseling and correlates of counseling, but has not explored receipt of counseling by current health care provider(s). The number and type(s) of provider(s) that women see for their regular care may be an important enabling factor in women's receipt of HRT counseling. OBJECTIVES Whether there is an association between the number and specialties of physicians that women use for regular care and their receipt of HRT counseling by a current regular physician is explored. RESEARCH DESIGN A self-administered mail survey was sent to 1,500 female members (ages 40-69) of a Connecticut IPA-model health plan. RESULTS One thousand seven completed questionnaires were received (response rate = 69%). Twenty-eight percent of women reported seeing only a family practitioner or internist (no OB/GYN) for their regular care; 11% saw an OB/GYN only; and 59% saw both a family practitioner/internist and an OB/GYN. After adjustment for women's other predisposing and enabling characteristics, women who used both a family practitioner/internist and an OB/GYN were 3.1 times as likely (95% CI, 2.02, 4.66) as those seeing only a family practitioner/internist to have been counseled about HRT by a current provider, and those using only an OB/GYN were 2.5 times as likely (95% CI, 1.34, 4.61). CONCLUSIONS The number and specialty of physician(s) that women use for their regular care is an important enabling factor in women's receipt of HRT counseling. Changes in the organization and delivery of women's primary care may help increase the receipt of female-specific clinical preventive services, particularly among women less likely to use an OB/GYN for regular care, such as low-income and older women.
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Affiliation(s)
- T C Gallagher
- Department of Community Health, University of Illinois at Urbana-Champaigne, USA
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Newell DA, Markides KS, Ray LA, Freeman JL. Postmenopausal hormone replacement therapy use by older Mexican-American women. J Am Geriatr Soc 2001; 49:1046-51. [PMID: 11555065 DOI: 10.1046/j.1532-5415.2001.49207.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the prevalence of current hormone replacement therapy (HRT) use and describe its correlates among community-dwelling, Mexican-American women aged 67 and older. DESIGN A population-based survey of older Mexican-Americans conducted in 1995/1996. SETTING Five Southwestern states: Texas, New Mexico, California, Arizona, and Colorado. PARTICIPANTS An area probability sample of 1,424 noninstitutionalized Mexican-American women aged 67 and older (mean age = 75.1) completed the survey instrument via a 90-minute in-home interview, which included examination and recording of all medications taken. MEASUREMENTS Current use of HRT. RESULTS In this sample of older Mexican-American women, 4.7% were current users of HRT. Controlling for sociodemographic characteristics (age, marital status, living arrangements, years of education, income, language of interview), current HRT use is significantly related to years of education (per each year) (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.05-1.20), having had a hysterectomy (OR = 4.37; 95% CI 2.50-7.64), a diagnosis of osteoporosis (OR = 3.40, 95% CI = 1.58-7.33), age at menopause (per each year) (OR = 1.07; 95% CI = 1.03-1.12), ever having a mammogram (OR = 3.72; 95% CI = 1.66-8.37), ever having a Pap test/pelvic examination (OR = 2.11; 95% CI = 1.08-4.12), having spoken with a pharmacist within the past year regarding health conditions (OR = 1.96; 95% CI = 1.06-3.65), and having Medicare plus private insurance (OR = 2.13; 95% CI = 1.14-3.97). CONCLUSION The prevalence of HRT use is lower than that reported in the older non-Hispanic white female population. In general, these findings indicate that access to and utilization of the traditional U.S. health care system are indicators of HRT use.
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Affiliation(s)
- D A Newell
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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22
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Abstract
This study focuses on midlife women aged 40-65 years who were in transition to menopause, were menopausal or had a hysterectomy, to examine and better understand hormone therapy (HT) choices women make. Among the nationally representative sample of women in the Commonwealth Fund 1998 Survey of Women's Health (n = 884), 39% of the menopausal women reported current HT use. The two primary reasons for initiating HT are following a doctor's recommendation and seeking relief of menopausal symptoms. Age, education, race, hysterectomy status, having health insurance, use of calcium supplements and comfort in communicating with a doctor are important factors associated with HT use. This study underscores the importance of physicians and other health professionals providing accurate HT information to assist women in making HT decisions.
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Affiliation(s)
- A MacLaren
- School of Nursing, University of Washington, Seattle, WA, USA
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23
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Rousseau ME. Evidence-based practice in women's health: hormone therapy for women at menopause. J Midwifery Womens Health 2001; 46:167-80. [PMID: 11480749 DOI: 10.1016/s1526-9523(01)00116-7] [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] [Indexed: 10/18/2022]
Abstract
Women's health providers, especially midwives, must take into account the known benefits and risks, as well as the "unknown," when recommending the use of hormone therapy for menopausal women, especially as it relates to heart disease, breast cancer, impaired cognition, and osteoporosis. The most recent evidence available from various studies about the benefits and risks of estrogen and hormone therapy at menopause suggests that, although hormone therapy may be protective in some women against heart disease and osteoporosis, evidence is less certain about the benefits of hormone protection against impaired cognition and the risks of breast cancer with use. The clinical approach used by midwives in which individualizing care based on each woman's health status history as well as preferences is highly appropriate for women in the perimenopausal and menopausal period.
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Huston S, Sleath B, Rubin RH. Physician gender and hormone replacement therapy discussion. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2001; 10:279-87. [PMID: 11389788 DOI: 10.1089/152460901300140031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hormone replacement therapy (HRT) is a major issue confronting millions of women today, and general internal medicine and family practice physicians are an important source of information and counseling on this issue. Previous studies have suggested that HRT discussion and prescribing are more frequent with female than with male physicians, but others have suggested age and practice setting may be the reason for observed differences. We attempted to determine if physician gender influenced HRT discussion frequency between physicians and their patients using cross-sectional, secondary analysis of data collected at general internal medicine and family practice clinics at the University of New Mexico Health Sciences Center. Twenty-seven family practice and internal medicine resident physicians (15 female, 12 male) participated. There were 127 female patients age 45 and older. Audio-taped observations of patient-physician visits collected during 1995 for a study on patient-physician communication and patient satisfaction were used. There was less frequent discussion with female than male physicians (OR = 0.42, p = 0.0014). HRT was discussed during 51 visits. Patients initiated HRT discussion in 39.2% of visits in which it was discussed. Patients with diabetes were less likely to discuss HRT (OR = 0.25, p = 0.0122). Increasing year of physician residency was associated with decreased discussion of HRT (OR = 0.51, p < 0.0001). In this health sciences center, with physicians similar in age and training, male physicians discussed HRT significantly more often than did female physicians.
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Affiliation(s)
- S Huston
- University of Michigan, College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109-1065, USA
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Shah S, Harris TJ, Cook DG. Differences in hormone replacement therapy use by social class, region and psychological symptoms. BJOG 2001; 108:269-75. [PMID: 11281467 DOI: 10.1111/j.1471-0528.2001.00076.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the relationship between socio-demographic factors, heart disease risk factors, psychological symptoms and the use of hormone replacement therapy by English women. DESIGN Cross-sectional analysis of a population-based survey. SETTING England. POPULATION 13,214 women aged 40-69 years who participated in the nurse-administered schedule of the Health Survey for England between 1993 and 1996. OUTCOME Current hormone replacement therapy use. RESULTS Women from social classes II and I and women who live in the south of England were more likely to use hormone replacement therapy independently of a range of socio-demographic factors including education. The adjusted odds ratio for social classes II and I compared with social classes IV and V was 1.51 (95% CI 1.20 to 1.91) and for women in the South of England was 1.38 (95% CI 1.18 to 1.62). Women with a history of heart disease and those with high cholesterol levels were less likely to use hormone replacement therapy. Women with psychological symptoms were more likely to be prescribed hormone replacement therapy, as were those who had recently seen a doctor. CONCLUSION There is marked socio-demographic inequity in use of hormone replacement therapy. This may accentuate existing inequalities in health and reduce any potential benefits of Hormone Replacement Therapy for public health. The relationship between psychological symptoms, use of medical services and use of hormone replacement therapy suggests that hormone replacement therapy is prescribed for the management of psychological symptoms.
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Affiliation(s)
- S Shah
- Department of Public Health Sciences, St George's Hospital Medical School, London, UK
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26
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Shah S, Harris TJ, Cook DG. Differences in hormone replacement therapy use by social class, region and psychological symptoms. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0306-5456(00)00076-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gallagher TC, Geling O, FitzGibbons J, Aforismo J, Comite F. Are women being counseled about estrogen replacement therapy? Med Care Res Rev 2001; 57 Suppl 2:72-92. [PMID: 11105507 DOI: 10.1177/1077558700057002s05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The U.S. Preventive Services Task Force and several medical professional associations have published guidelines recommending that all women be counseled around the time of menopause about the benefits and risks of estrogen replacement therapy (ERT) so that they may make an informed decision about its use. Despite the proliferation of ERT counseling guidelines, little is known about whether these guidelines are being followed. There were 1,500 female members (aged 40 to 69) of a Northeastern U.S. Independent Practice Association--model Health Maintenance Organization who were surveyed, and 51 percent reported that a health care provider had talked with them about the benefits and risks of ERT. In multivariate analyses, a woman's demographic characteristics (age, race, income), stage of menopause, severity of menopausal symptoms, and body weight were the major correlates of receipt of ERT counseling. Women at greater risk for osteoporosis or heart disease were no more likely to be counseled, although those with diagnosed osteoporosis were. What appear to be selective ERT counseling practices will need to be modified if the goal of providing universal ERT counseling to midlife women is to be attained.
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King KB, Quinn JR, Delehanty JM, Rizzo S, Eldredge DH, Caufield L, Ling FS. Reasons for use of hormone replacement therapy in women undergoing coronary angiography. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2000; 9:1081-7. [PMID: 11153104 DOI: 10.1089/152460900445992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The recommendation has been made that all women be counseled about the risks and benefits of hormone replacement therapy (HRT). Use of HRT among women undergoing coronary angiography was explored to assess whether patterns of use were similar to data drawn from community samples. Using a descriptive design, a convenience sample of 414 postmenopausal women was interviewed. Fifty-eight percent had never used HRT, 18.3% were past users, and 23.7% were currently using HRT. The primary reason given for ever using HRT was for symptoms of menopause. Less than 14% of women cited coronary heart disease (CHD) or osteoporosis as their primary reason for using HRT. The most common reasons for stopping HRT were side effects and fear of cancer. The most common reasons given for never having used HRT were that their healthcare provider had never talked about it and that they had never thought about it. Use of HRT among women undergoing coronary angiography is similar to that found in community samples. The challenge is to promote patient-provider interactions that include information about HRT based on the scientific model as well as attention to women's individual concerns.
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Affiliation(s)
- K B King
- University of Rochester School of Nursing, Rochester, New York 14642, USA
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Gomez-Panzani E, Williams MB, Kuznicki JT, Myers WR, Zoller SA, Bixler CA, Winkler LC. Application and maintenance habits do make a difference in adhesion of Alora transdermal systems. Maturitas 2000; 35:57-64. [PMID: 10802401 DOI: 10.1016/s0378-5122(00)00100-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To explore and evaluate Alora placebo patch application and maintenance habits of women in order to identify the factors that influence adhesion success. METHODS This single-center, open-label, placebo, randomized, multiple-application, parallel-group study involved 99 healthy naïve users of transdermal patches. Participants applied and wore an Alora placebo patch for ten consecutive applications of approximately 3.5 days each and evaluated adhesion of the patches twice-daily. Three subgroups comprising participants achieving low, moderate or high adhesion success took part in focus groups to discuss their wear habits, practices and attitudes regarding transdermal patches. RESULTS There was a significant behavioral component involved in patch adhesion. The habits, practices and attitudes of high achievers were clearly different from the other two subgroups. The three most important issues identified to improve adhesion were: mastering the removal of the patch liner, identifying the best site of application, and developing and implementing techniques to maintain patch adhesion. The Alora placebo patch was well tolerated throughout the study. CONCLUSION The data showed that there is a learning curve involved in achieving maximal adhesion with a transdermal patch. During the study, a novel patch application method ('press, fold and slide') was demonstrated for the participants. This method was very well received by all participants and was more easily executed than the previous method. An adaptation of this method was incorporated into the Alora patient information leaflet, together with several other changes to help improve adhesion success.
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Affiliation(s)
- E Gomez-Panzani
- Procter & Gamble Pharmaceuticals, Health Care Research Center, 8700 Mason-Montgomery Road, Mason, OH, USA.
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30
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Appling SE, Allen JK, Van Zandt S, Olsen S, Brager R, Hallerdin J. Knowledge of menopause and hormone replacement therapy use in low-income urban women. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2000; 9:57-64. [PMID: 10718507 DOI: 10.1089/152460900318975] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hormone replacement therapy (HRT) can have significant long-term health benefits in postmenopausal women, yet rates of HRT use are low, especially in low-income urban women. Previous research has revealed that knowledge of menopause is a key predictor of HRT use in this population. A descriptive cross-sectional survey of 215 perimenopausal and postmenopausal low-income urban women was carried out to characterize knowledge of menopause and HRT and factors associated with knowledge level. Sociodemographic characteristics, patterns of HRT use, and knowledge about menopause and HRT were collected through a structured interview. Results revealed a general lack of knowledge about menopause and HRT, particularly relative to heart disease and the role of HRT in prevention. Major independent predictors of increased knowledge (R2 = 0.31) were having talked with a healthcare provider about HRT, having at least a high school education, and being less than 60 years of age. These findings emphasize the key role of providers in educating this vulnerable population about menopause and HRT and the potential subsequent impact on HRT use.
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Affiliation(s)
- S E Appling
- The Johns Hopkins University School of Nursing, Baltimore, Maryland 21205-2100, USA
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31
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Sambamoorthi U, Crystal S, Kumar R, Harman J. Estrogen replacement therapy among elderly women: results from the 1995 medicare current beneficiary survey. Womens Health Issues 1999. [DOI: 10.1016/s1049-3867(99)00019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Appling SE, Allen JK, Bellantoni M, Brager R, Hallerdin J, Olsen S, VanZandt S, Gaines J, Young KL. Factors associated with hormone replacement therapy use in low-income urban women. Womens Health Issues 1999. [DOI: 10.1016/s1049-3867(99)00025-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhang P, Tao G, Anderson LA. Prevalence of and factors associated with hormone replacement therapy counseling: results from the 1994 National Health Interview Survey. Am J Public Health 1999; 89:1575-7. [PMID: 10511844 PMCID: PMC1508785 DOI: 10.2105/ajph.89.10.1575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study estimated the prevalence of and the factors associated with hormone replacement therapy (HRT) counseling. METHODS We analyzed the responses of 3170 women, aged 40 to 60 years, from the 1994 National Health Interview Survey. RESULTS The prevalence of HRT counseling was 43.6%. Women were more likely to report having received HRT counseling if they were White, older, more educated, had had a hysterectomy, had experienced menopausal symptoms, and had a regular source of care. CONCLUSIONS More attention should be directed at counseling non-White women and women with less formal education. Reducing the barriers to having a regular source of care appears to increase the likelihood of receiving HRT counseling.
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Affiliation(s)
- P Zhang
- Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Ga., USA.
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Rolnick SJ, Kopher RA, Compo RB, Kelley ME, DeFor TA. Provider attitudes and self-reported behaviors related to hormone replacement therapy. Menopause 1999; 6:257-63. [PMID: 10486797 DOI: 10.1097/00042192-199906030-00013] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to survey providers within a large health maintenance organization regarding their attitudes and practice patterns related to counseling women about hormone replacement therapy (HRT). DESIGN A total of 260 providers from gynecology (n = 81), family practice (n = 96), and internal medicine (n = 83) from owned and contracted clinics were surveyed. Each was asked about prescribing philosophies, behaviors, and barriers to providing counseling regarding HRT. RESULTS Respondents reported HRT's greatest benefit to be in the prevention of osteoporosis (99%) and cardiovascular conditions (96%). Gynecologists were more likely to report the benefits of HRT for Alzheimer's than were clinicians in internal medicine or family practice (p < 0.05), and women providers were more likely than men to report this (p < 0.01). There was no statistical difference based on years in practice. Providers did not vary significantly by specialty or sex in their concerns of risk for breast cancer of endometrial cancer. However, those in family practice and internal medicine were significantly more likely to report concern about thromboembolism (p < 0.01). Only 42% of physicians claimed to initiate discussion with their patients more than 75% of the time. The two factors most often mentioned as barriers to counseling were time and lack of adequate knowledge. CONCLUSIONS Providers want to be an integral part of their patient's education regarding HRT; however, time constrains and a need for adequate information make this difficult. Now health systems must examine models of education for both providers and patients to ensure that women have access to current information with which to make informed decisions.
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Affiliation(s)
- S J Rolnick
- HealthPartners Research Foundation, Minneapolis, Minnesota, USA
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35
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Topo P, Luoto R, Hemminki E, Uutela A. Declining socioeconomic differences in the use of menopausal and postmenopausal hormone therapy in Finland. Maturitas 1999; 32:141-5. [PMID: 10515670 DOI: 10.1016/s0378-5122(99)00027-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Sales figures for the use of menopausal and postmenopausal hormone therapy in Finland show a rapid increase during the 1980s continued into the first half of the 1990s. Hormone therapy use became very common in Finland compared to many other Western countries. The aim of our study was to investigate the sociodemographic distribution of hormone therapy among Finnish women aged 45-64 years. METHODS The study is based on population-based surveys conducted in 1989 and 1996 (response rates 87% and 78%). RESULTS Between 1989 and 1996 the current use of hormone therapy increased from 22% to 27%; in 1989 it was most common in the age group 50-54 years, but in 1996 among 55-59-year-olds. In 1989 it was significantly more common among women with longer education than other women in every age group, but in 1996 this difference was significant only in those 55 years and older. In 1989 the use was more common in the capital area than elsewhere and this difference decreased but remained significant in 1996. CONCLUSION Our results suggest that hormone therapy has become a routine treatment during the menopause in all educational groups and throughout the country. The lack of socioeconomic differences indicates that among women under 55 year of age the saturation point in short-term hormone use was reached in 1996. However, the persistence of socioeconomic differences among older women suggests that the use of long-term postmenopausal hormone therapy will continue to increase for some time.
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Affiliation(s)
- P Topo
- National Research and Development Centre for Welfare and Health, Helsinki, Finland
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36
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MacLennan AH, Wilson DH, Taylor AW. Hormone replacement therapies in women at risk of cardiovascular disease and osteoporosis in South Australia in 1997. Med J Aust 1999. [DOI: 10.5694/j.1326-5377.1999.tb127876.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - David H Wilson
- Centre for Population Studies in Epidemiology, South Australian Health CommissionAdelaideSA
| | - Anne W Taylor
- Centre for Population Studies in Epidemiology, South Australian Health CommissionAdelaideSA
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Abstract
Menopause is beginning to be recognized as a survivorship issue for women with a diagnosis of breast cancer. This article presents an outline of the literature relating to natural menopause and its symptoms, moves on to discuss general management of menopausal symptoms, then reflects on the particular implications of breast cancer diagnosis and treatment. Finally, the role of nursing in restoring a holistic perspective to the subject of menopause generally, and to women with breast cancer specifically, is considered.
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Affiliation(s)
- G McPhail
- University of Glasgow, United Kingdom
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38
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McGlynn EA. Quality of care for women: where are we now and where are we headed? Womens Health Issues 1999; 9:65-80; discussion 93-106. [PMID: 10189819 DOI: 10.1016/s1049-3867(98)00051-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E A McGlynn
- Center for Research on Quality in Health Care, RAND, Santa Monica, California, USA
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Steffen AM, Thompson LW, Gallagher-Thompson D, Koin D. Physical and psychosocial correlates of hormone replacement therapy with chronically stressed postmenopausal women. J Aging Health 1999; 11:3-26. [PMID: 10848139 DOI: 10.1177/089826439901100101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study investigated the relationship between hormone replacement therapy (HRT) use and physical and psychosocial functioning in a sample of chronically stressed older women. METHODS Participants (N = 94) were postmenopausal women caring for a parent or spouse with dementia. Caregivers were evaluated using both psychological and physical health indices. RESULTS Caregivers receiving HRT reported lower levels of hostility and were less likely to report unpleasant interactions with members of their support network; these findings were unrelated to demographic variables, caregiving-related indices, or health behaviors. HRT recipients had lower 10-year risk scores for cardiovascular disease, but there were no group differences in stroke risk. The largest effects on hostility, depression, heart and stroke risk were observed in caregivers receiving a combination of estradiol and progesterone. DISCUSSION HRT for postmenopausal women may promote positive outcomes for some, but not for all, affective states and cardiovascular variables vulnerable to chronic life stressors.
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Exline JL, Siegler IC, Bastian LA. Differences in providers' beliefs about benefits and risks of hormone replacement therapy in managed care. J Womens Health (Larchmt) 1998; 7:879-84. [PMID: 9785314 DOI: 10.1089/jwh.1998.7.879] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Our objective was to determine if physician beliefs about the benefits and risks of hormone replacement therapy (HRT) differ by physician gender or specialty in a managed care setting. In a cross-sectional survey of providers in a health maintenance organization in North Carolina, 105 gynecologists, internists, and family physicians and physician assistants were surveyed, and 74 providers completed and returned the survey (70.5% response rate). Providers' beliefs about the benefits and risks of HRT differed by specialty and gender of physician. Gynecologists are significantly less concerned about the potential risks of HRT on breast cancer (p = 0.004) and thromboembolic events (p = 0.005) compared with family physicians and internists. Female providers across the three specialty categories were significantly different from their male colleagues in their beliefs about the benefits of HRT with regard to the reduction in risk of heart disease (79% versus 64%, p = 0.001), osteoporosis (83% versus 75%, p = 0.045), and Alzheimer's disease (45% versus 26%, p = 0.026). There was a trend toward female physicians being more convinced about the risks of breast cancer than their male colleagues (p = 0.08). Our results suggest that providers in a managed care setting vary in their beliefs about the benefits and risks of HRT, and this may affect provider-patient discussions about HRT.
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Affiliation(s)
- J L Exline
- Department of Health Policy and Administration, University of Southern Mississippi, Hattiesburg, USA
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Women's health LiteratureWatch & commentary. J Womens Health (Larchmt) 1997; 6:683-99. [PMID: 9437646 DOI: 10.1089/jwh.1997.6.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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