Australian women's understanding of menopause and its consequences: a qualitative study.

BACKGROUND: This study was undertaken to determine women's knowledge of menopause and its consequences, and their menopause-related health-care experiences. METHODS: Participants were recruited to this cross-sectional qualitative study from a nationally, representative sample of Australian women. Recruitment was stratified by age to achieve groups of premenopausal (PRE), perimenopausal (PERI), early postmenopausal (E-POST), and late postmenopausal (L-POST) women. RESULTS: The 32 participants were aged 46-69 years: 10 PRE, three PERI, 11 E-POST and eight L-POST women. All understood that menopause meant the end of reproductive function and were aware of menopause-associated symptoms. Most PRE and E-POST women referred to lifestyle changes to optimize health, and self-help and complementary therapies to manage symptoms. E-POST and L-POST women were more likely to nominate seeing a doctor for overall health and symptom management. Menopausal hormone therapy (MHT) was viewed negatively, with shared perceptions of cancer risk and over-prescription. A strong theme was lack of knowledge of long-term menopause sequelae, with only four women nominating osteoporosis. CONCLUSIONS: Our in-depth qualitative study would suggest that, while Australian midlife women have a good understanding of the immediate effects of menopause, their lack of knowledge of the long-term consequences is concerning. Despite the effectiveness and safety of MHT, the overall attitude to MHT remains negative.

Does the menopausal status of female gynecologists affect their prescription of menopausal hormone therapy?

OBJECTIVE: To evaluate whether menopausal status and symptoms among female gynecologists would influence their clinical behavior related to menopausal hormone therapy (MHT). METHODS: Female gynecologists of 11 Latin American countries were requested to fill out the Menopause Rating Scale and a questionnaire containing personal information and that related to MHT use. RESULTS: A total of 818 gynecologists accepted to participate (86.4%). Overall, the mean age was 45.0 ± 10.7 years, 32.2% were postmenopausal, and 17.6% worked in an academic position; 81.8% reported that they would use MHT if they have symptoms, regardless of menopausal status. Academic gynecologists favor personal MHT use at a higher rate (p = 0.04) and have a higher MHT prescription rate as compared to non-academic ones (p = 0.0001). The same trend was observed among post- as compared to premenopausal ones (p = 0.01) and among those who had hysterectomy alone as compared to those experiencing natural menopause (p = 0.002). The presence of menopausal symptoms did not influence their MHT prescription. Current use of MHT and alternative therapy was higher among post- than premenopausal gynecologists (both, p = 0.0001) and among those who had undergone hysterectomy than those experiencing natural menopause. A 38.5% perceived breast cancer as the main risk related to MHT, and a high proportion prescribed non-hormonal drugs (86.4%) or alternative therapies (84.5%). CONCLUSION: Most female gynecologists in this survey would use MHT if menopausal symptoms were present. Postmenopausal physicians use MHT and prescribe it to their symptomatic patients at a higher rate than premenopausal physicians.

Factors determining the use of hormonal therapy and phytotherapy in Spanish postmenopausal women.

OBJECTIVE: To identify women's sociodemographic and variables related to health care with the prescription of hormonal therapy (HT) and phytotherapy (PT) in Spanish postmenopausal women. METHOD: The survey consisted of a multicenter, observational, cross-sectional, questionnaire-based investigation and was conducted among 3022 postmenopausal women. RESULTS: Of all the women, 31.8% reported the use of systemic HT or PT sometime in their lives. Hot flushes and information received about menopause were the most important variables that influence HT and PT use, although far more intense symptoms were observed in those who were inclined to use HT. The use of HT or PT was more frequently reported among women with high levels of education, who came from private clinics and lived in urban areas. Women who had primary ovarian insufficiency or surgical menopause were inclined to use HT. CONCLUSION: Hot flushes and information received about menopause are the most important variables that influence HT and PT use.

Bioidentical hormones, menopausal women, and the lure of the "natural" in U.S. anti-aging medicine.

In 2002, the Women's Health Initiative, a large-scale study of the safety of hormone replacement therapy (HRT) for women conducted in the United States, released results suggesting that use of postmenopausal HRT increased women's risks of stroke and breast cancer. In the years that followed, as rates of HRT prescription fell, another hormonal therapy rose in its wake: bioidentical hormone replacement therapy (BHRT). Anti-aging clinicians, the primary prescribers of BHRT, tout it as a safe and effective alternative to treat menopausal symptoms and, moreover, as a preventative therapy for age-related diseases and ailments. Through in-depth interviews with 31 U.S.-based anti-aging clinicians and 25 female anti-aging patients, we analyze attitudes towards BHRT. We illustrate how these attitudes reveal broader contemporary values, discourses, and discomforts with menopause, aging, and biomedicine. The attraction to and promise of BHRT is rooted in the idea that it is a "natural" therapy. BHRT is given both biomedical and embodied legitimacy by clinicians and patients because of its purported ability to become part of the body's "natural" processes. The normative assumption that "natural" is inherently "good" not only places BHRT beyond reproach, but transforms its use into a health benefit. The clinical approach of anti-aging providers also plays a role by validating patients' embodied experiences and offering a "holistic" solution to their symptoms, which anti-aging patients see as a striking contrast to their experiences with conventional biomedical health care. The perceived virtues of BHRT shed light on the rhetoric of anti-aging medicine and a deeply complicated relationship between conventional biomedicine, hormonal technologies, and women's bodies.

Health-related quality of life and healthcare resource utilization in Taiwanese women with menopausal symptoms: a nation-wide survey.

BACKGROUND: Menopausal experience differs among women with different cultural and ethnic backgrounds and may impact quality of life. Some women with severe menopausal symptoms seek medical help to alleviate menopause-related symptoms. PURPOSE: This study examined the demographic characteristics and health-related quality of life (HRQOL) of Taiwanese women experiencing menopausal symptoms and examined associations between menopausal symptoms and, respectively, poor HRQOL and healthcare resource utilization. METHODS: This cross-sectional study used data from the 2005 National Health Interview Survey in Taiwan, which used a multistaged stratified systematic sampling scheme. A total of 4,437 women aged 35-64 years were analyzed. We used multivariable logistic regression models to identify variables significantly and independently associated with the presence of menopausal symptoms. We also used the model to assess the odds of poor HRQOL and healthcare resource utilization in women with menopausal symptoms compared with those without. RESULTS: Eight hundred and forty-six women (19.1%) reported experiencing menopausal symptoms. Age, religion, smoking, exercise, and comorbidity were independently associated with the presence of such symptoms. The propensity score-adjusted odds ratio of poor physical HRQOL, poor mental HRQOL, use of outpatient, traditional Chinese medicine and emergency room services, and hospitalization for women with menopausal symptoms were 1.85 (95% CI [1.54, 2.21]), 1.66 (95% CI [1.40, 1.97]), 1.39 (95% CI [1.18, 1.63]), 1.73 (95% CI [1.37, 2.18]), 1.44 (95% CI [1.15, 1.81]), and 1.36 (95% CI [1.02, 1.81]), respectively, compared with those without symptoms. CONCLUSIONS: Nearly one fifth of women aged 35-64 years in Taiwan experience menopausal symptoms. The presence of menopausal symptoms increases the likelihood of poor HRQOL and healthcare resource utilization even after controlling for possible confounders.

Clinical update on hormone replacement therapy.

There has been much change concerning the menopause in clinical practice, research and prescribing since the 1990s, with conflicting information and uncertainties. The use of hormone replacement therapy (HRT) has declined and women have often stopped taking it with no discussion with healthcare professionals. The uncertainties have led to confusion for healthcare professionals and women alike, with some women being denied HRT when it would be appropriate for them to take it, and others taking alternative or complementary therapies when there is little or no information on their efficacy. This article aims to give an update on HRT, what it is, why women take it and alternatives to HRT, including lifestyle advice.

Physicians' and women's views on hormone therapy and breast cancer risk after the WHI: a qualitative study.

BACKGROUND: The use of menopausal hormone therapy (HT) has significantly declined since the release of the Women's Health Initiative findings, but to what extent physicians' and women's concerns about breast cancer contributed to this change is unknown. Our study explored physicians' and women's beliefs about hormone therapy and breast cancer risk. METHODS: We conducted qualitative in-depth interviews with 22 primary care physicians and 45 female patients at two large integrated health care delivery systems in Washington State and Massachusetts. RESULTS: Concerns about breast cancer risk weighed into the decision-making process for physicians and women in initiating and continuing hormone therapy. For women, control of menopausal symptoms was important and possibly outweighed their concerns about the potential risks of breast cancer. Though concerned about its association with increasing breast cancer risk, physicians were willing to consider hormone therapy to manage women's menopausal symptoms but were frustrated about the lack of available non-hormone therapy alternatives. Most physicians and some women were aware of the Women's Health Initiative, and its findings appeared to influence their beliefs about hormone therapy and breast cancer risk, though doubts remained among both groups about the study findings and implications. CONCLUSIONS: Our qualitative study suggests that after the Women's Health Initiative, concerns about breast cancer risk weighed into decisions to initiate and continue hormone therapy for both physicians and women, but menopausal symptoms often directed use.

Complementary and alternative medicine use for vasomotor symptoms among women who have discontinued hormone therapy.

OBJECTIVES: To explore the use and perceived usefulness of complementary and alternative medicine therapies and nonhormonal conventional medicine alternatives to treat vasomotor symptoms occurring after withdrawal from hormone therapy. DESIGN: Retrospective, single cross sectional descriptive study. SETTING: Study volunteers were recruited via a direct mailed questionnaire sent to a sample of women throughout the United States. Additional respondents were recruited through flyers and postcards advertising the study placed with permission at several health care provider offices and other locations. PARTICIPANTS: A sample of 563 menopausal women who had discontinued the use of hormone therapy completed a questionnaire describing their experiences with the use of complementary and alternative medicine. MAIN OUTCOME MEASURES: Responses to an investigator developed survey. RESULTS: Nearly half of the women surveyed used complementary and alternative medicine. The most common choices of complementary and alternative medicine were (a) multivitamins and calcium, (b) black cohosh, (c) soy supplements and food, (d) antidepressants, (e) meditation and relaxation, (f) evening primrose oil, (g) antihypertensives, and (h) homeopathy. Of the alternative therapies that were used by at least 5% of the sample, antidepressants were perceived as the most useful. CONCLUSIONS: With the increased adoption of complementary and alternative medicine, it is important for health care providers to be familiar with the various methods so they are comfortable discussing the benefits and risks with their patients to assist them in making informed decisions.

The dilemma of menopause and hormone replacement--a challenge for women and health-care providers: knowledge of menopause and hormone therapy in Spanish menopausal women.

BACKGROUND: An important goal in menopause research is to develop knowledge and identify interventions that strive to promote, maintain and enhance well-being for women. OBJECTIVE: To evaluate the knowledge of postmenopausal Spanish women about menopause and their knowledge of and trust in hormone replacement therapy (HRT) and to identify their sources of information and how those data are related to compliance with their prescription. STUDY DESIGN: A total of 270 symptomatic postmenopausal women were personally interviewed using a structured questionnaire, which was designed to collect information on their familiarity with medical menopause studies, the menopause and the effects of HRT, their knowledge of alternative therapies, and to identify their sources of information. RESULTS: The most well-known menopausal complaints were hot flushes, sweats, irregular menstruation, cessation of menstruation, irritability and mood changes. Following suggestions of other symptoms by the interviewer, other complaints such as vaginal dryness, insomnia and depression/anxiety were also mentioned. HRT and phytoestrogens were recognized as treatments for the climacteric by most of the women. A woman's decision to seek treatment was initiated in 77% of cases by the gynecologist, in 12% by the general practitioner, in 3% by friends/family and in 3% by books/magazines. The most frequent responses of women to the onset of menopausal symptoms were to talk with their partner (39%), to discuss it with their gynecologist (33%) or with their general practitioner (14%) and to talk with their friends/family or to read books/magazines (10%). CONCLUSIONS: Vasomotor symptoms are recognized as the main complaint during the climacteric and HRT and phytoestrogens as the main therapies. Gynecologists play an important role in assuring compliance with therapies related to the menopause.

Hormone use and patient concerns after the findings of the Women's Health Initiative.

OBJECTIVE: To assess behaviors and concerns related to hormone therapy after the findings of the Women's Health Initiative (WHI). DESIGN: A survey was mailed to a random sample of 1,200 women identified through the pharmacy database as taking one of two estrogen + progestogen therapies (EPT) during the 6-month period before the publication of WHI findings. Questions included hormone use history, changes in usage, an assessment of symptoms, symptom changes, health behavior changes, use of alternative therapies, and demographics. RESULTS: The response rate was 70%, with women in their 60s and those receiving hormone therapy for 5 or more years were more likely to respond (P < 0.05). The majority had started hormones for symptom relief (69%) and expected to continue use. Many reported discontinuation (63%) or modifying their medication (18%). Half of these women stopped then restarted, the other half changed products. Women in their 50s were more likely to remain on hormones than older women (P < 0.01), and those taking ethinyl estradiol and norethindrone acetate were more likely to remain on their medication than those on conjugated estrogens (43% vs 29%, P < 0.01). Little change was reported in exercise and 19% increased their calcium intake. Patient concerns fell into five major categories: long-term effects, symptom control, breast cancer risk, bone health, and cognitive function. CONCLUSIONS: Women seem to be heeding the warnings about hormones but remain concerned about the potential long-term sequelae and symptom control. More research is needed to identify safer approaches to symptom relief and to address the concerns expressed.

Menopause in Croatia. Socio-demographic characteristics, women's attitudes and source of information, compliance with HRT.

OBJECTIVES: Hormone replacement therapy (HRT) in Croatian postmenopausal women, attitudes towards it and factors influencing this decision. METHODS: A total of 1100 women were interviewed in Ob/Gyn offices using self-response questionnaire of 56 items, dealing with demographic data, personal and family medical history, surgeries, menstrual and menopausal status, body mass index (BMI), sexuality, knowledge and attitudes towards the menopause and HRT. RESULTS: The adherence to HRT in Croatia was found to be very short, averaging only 3 months. Despite the differences between the users, non-users and past users, all groups give more reasons to take HRT, then reasons against it. Among the many demographic and patient history characteristics considered, the differences were only found regarding breastfeeding duration, menopausal age, use of oral contraceptives and IUDs. No differences were found in age, menarche, number of family members, number of deliveries, number of abortions, BMI, marital and employment status or level of education. Regarding personal and family medical history, an increased frequency was found in gallbladder and hepatic disorders for HRT users. The differences in current/past users ratio for different prescribers show that compliance with HRT is highest for university polyclinics and private gynaecological practices, and lowest for GPs and endocrinologists. CONCLUSION: The compliance with HRT in Croatia is very low, recommendations are mostly restricted to gynaecological practices and decision to take HRT is influenced mostly by psychological factors.

Health beliefs and women's use of hormone replacement therapy.

This research, part of an Internet-based study, examined whether beliefs about menopause and the Health Belief Model (HBM) variables explained women's use of hormone replacement therapy (HRT). Data were collected via a Web site and 208 women, ages 40 to 60, enrolled in the study over an eight-week period. Logistic regression analysis revealed perceived barriers and confidence as significant in predicting which women used HRT. The project was conducted prior to findings from the Women's Health Initiative (WHI). Despite a reduced risk of osteoporotic fractures in women receiving combined HRT, the WHI reports the risks of HRT outweigh the benefits.

Women's decision-making about their health care: views over the life cycle.

This paper describes a compilation and further analysis of three qualitative studies, conducted independently, on women's health care decisions. Key areas regarding women's health, which span the life cycle, were examined including prenatal genetic screening, hormone replacement therapy and the use of complementary/alternative medicine in the treatment of breast cancer. Common themes were evident across all the focus groups in each of the three studies including: women's information seeking behavior; reliance on trusted information sources; the desire for information sharing; active involvement in the decision-making process; and accepting the consequences of the final decision. The findings have important implications for health care professionals as they engage women in the decision-making process about health concerns.

Menopausal treatment dilemma: a challenge for women and nurses.

An important goal of nursing research in women's health is to develop knowledge and identify interventions that strive to promote, maintain, and enhance well-beingfor women. A new emphasis on the quality of life, health promotion, and cost-effective delivery modes has opened the door to nontraditional approachesfor a myriad of disease conditions. As women look to their healthcare providers for information regarding treatments for uncomfortable menopausal symptomatology, inconclusive and contradictory information has added to the confusion concerning hormone replacement therapy (HRT). A woman who has declined traditional treatments for menopausal symptomatology may resort to alternative therapies to meet her healthcare needs. As alternative therapies can be wide-ranging, the woman may seek information from healthcare providers regarding these therapies. Sensitivity to the woman's expressed concerns and knowledge of various traditional and alternative treatment modalities is essential in providing individualized wholistic care. This article reviews the literature and concludes care of perimenopausal/menopausal women who decline, traditional hormone replacement therapy for uncomfortable menopausal symptomatology and seek alternative treatments has received insufficient attention by the medical and nursing profession.

Postmenopausal hormone replacement: historical perspectives and current concerns.

Despite continuing evidence of its value, hormone replacement (HR) therapy is used by only a minority of postmenopausal women. Some of this reluctance may stem from concerns about the medicalization of menopause and the labeling of menopause as a state of failure or disease that needs to be treated. These concerns are understandable given the impact of previous efforts to apply erroneous biological models to women's physiology, often to their detriment. Some may assert that current attempts to describe menopause as a state of estrogen deficiency are as wrong as previous explanations that the backing up of menstrual blood required purging and bleeding. However, there is an abundance of research attesting to the value of HR in decreasing such menopausal symptoms as hot flashes and insomnia and in preventing chronic problems, including urogenital atrophy and osteoporosis. In addition, recent research suggests that estrogen may have positive effects on cognition. Questions about HR and breast cancer remain, and several studies have found a small increase in breast cancer among long-term estrogen users. The recent introduction of selective estrogen response modifiers may further increase the safety of HR therapy. Many women worried about breast cancer and other possible estrogenic effects of HR are seeking approaches they consider more natural to managing menopause, turning to such untested remedies as soy supplements and herbs. While awaiting rigorous trials, clinicians can help patients understand the consequences of relying on therapies that have unknown long-term safety and effectiveness.

The need for continuing education of the prescriber.

The Millennium will be seen as an important time of change in the doctor-patient relationship. Until very recently, many patients, male and female, expected not only advice from their doctor, but also to be told which treatment would be best for them. This paternalistic approach, however, is rapidly disappearing. Nowadays, early post-menopausal women expect to make decisions about their treatment, after being fully informed of all the possible benefits and risks. Provision for this requires the doctor to keep abreast of the literature. Occasionally, new data are released that challenge established beliefs. It was thought, for example, that hormone replacement therapy (HRT) would reduce the risk of coronary heart disease. This still applies to apparently fit and healthy women but data from the Heart and Estrogen/progestin Replacement Study (HERS) have shown that the use of HRT in women with established risk factors for coronary heart disease increases mortality in the short term. A protective effect of HRT on the risk of coronary heart disease was not observed until after 2-3 years of treatment. Patient access to medical information has been revolutionized during the last decade. The availability of books, magazines and newspaper articles, which have always been an important source of patient information, has greatly increased. In addition, the Internet has transformed patient knowledge. According to surveys, these forms of communication provide the major source of information for 50% of women seeking advice about HRT. Indeed, the patient is often aware of the latest medical information before her doctor, possibly because she has more time. With such a large readership, these forms of communication have to report accurately. Unfortunately, they frequently do not and errors in reporting change the emphasis of a piece of medical research. The result is women are frightened and continuance suffers. It is worth remembering that 'bad news', suitably publicized, sells more newspapers and magazines than 'good news'. Competition is growing for 'alternative' products. 'Natural' treatments are 'in'. These treatments are widely claimed to reduce menopausal complaints in older patients and patients are keen to take them. But where is the evidence of efficacy and safety from robust and rigorous studies? All too often it is lacking. The doctor therefore has to advise the patient accurately about products for their treatment, and may also have to provide an opinion on 'alternative' remedies. Knowledge of alternative medical literature is therefore becoming essential. If doctors wish to continue to be respected by patients, they must remain knowledgeable and communicate their knowledge in an unbiased manner. They must emphasize the benefits and risks of different treatments according to the concerns of the patient. Failure of the doctor to provide this service will result not only in loss of respect, but alas, too often, in medico-legal consequences.

Women's decisions about hormone replacement therapy after education and bone densitometry.

BACKGROUND: The decisions that postmenopausal women make about whether to start hormone replacement therapy may depend on the potential risks and benefits of such therapy as well as their risk for osteoporosis-related fractures. This study examined the decisions made by women at risk for osteoporosis-related fractures who were educated about hormone replacement therapy and who were given information about their bone mineral density. METHODS: The study employed a prospective cohort design. Thirty-seven post--menopausal women with risk factors for osteoporosis-related fractures were recruited from an orthopedic clinic at a teaching hospital in Hamilton, Ont. The women were given an education kit (consisting of an audio tape and a work-book) to clarify the benefits and risks of hormone replacement therapy. Two to 4 weeks later, densitometry of the hip and the lumbar spine was performed. A summary of the risks, the densitometry findings and decisions about hormone replacement therapy were given to the women's family physicians for follow-up. Outcome measures included decisions about hormone replacement therapy, as well as use of such therapy and other medications at 12 months. RESULTS: After the education component alone, 10 (27%) of the women requested hormone replacement therapy. After densitometry testing, 4 more requested hormone replacement therapy (for a total of 14 women [38%]). At 12 months, 2 (5%) of the women had been lost to follow-up. Of the remaining 35, 6 (17%) were receiving hormone replacement therapy, 7 (20%) were using bisphosphonates, and 24 (68%) were taking calcium supplements. INTERPRETATION: These preliminary findings suggest that the combination of education about hormone therapy and feedback about bone density is associated with an increase in the use of hormone replacement therapy and other preventive medications by women at risk for osteoporosis-related fractures. However, the observed increase was small and so the clinical significance must be confirmed and clarified.