Doppler ultrasonography of the ophthalmic artery in perimenopausal and postmenopausal women: a new approach.

BACKGROUND: The vascular endothelium has specific estrogen receptors and the impact of hormone therapy (HT) on circulation is associated with cardiovascular protection in perimenopause and postmenopause. Blood vessels can be assessed by ultrasound Doppler velocimetry, and more specifically the study of the ophthalmic artery (OA) can be used for brain vessel assessment; more recently, it is a possible method for cardiovascular risk assessment. METHODS: A cross-sectional study involved perimenopausal and postmenopausal women divided into three groups: 60 non-HT users (control group), 23 users of estrogen therapy (ET group), and 23 users of estrogen-progesterone therapy (EPT group). Doppler velocimetry of the OA was performed with analysis of the resistance index (RI), pulsatility index (PI), systolic peak velocity (P1), second systolic peak velocity (P2), peak velocity ratio (PVR), final diastolic velocity (FDV), and ratio between means of systolic and diastolic velocity (SDR). RESULTS: There was no significant difference between the groups in Doppler velocimetry indices of the OA: RI (p = 0.94), PI (p = 0.85), P1 (p = 0.81), P2 (p = 0.53), PVR (p = 0.41), FDV (p = 0.76), and SDR (p = 0.84). We observed a positive correlation of the SDR with age only in the control group (r = 0.34, p = 0.01). CONCLUSIONS: There is a positive correlation between the SDR and age in the control group. Therefore, this new index is a promising instrument in the non-invasive assessment of cardiovascular risk.

Prevalence of hormone therapy, factors associated with its use, and knowledge about menopause: a population-based household survey.

OBJECTIVE: The aim of the study was to assess the prevalence of hormone therapy (HT), the factors associated with its use, and the importance of knowledge about menopause and HT. METHODS: A cross-sectional population-based study with 749 Brazilian women aged 45 to 60 years living in the Campinas Metropolitan Region was carried out between September 2012 and June 2013. The dependent variable was current or previous HT use. The independent variables were sociodemographic data, health-related problems, and knowledge about menopause assessed using a score that was obtained with a questionnaire on various aspects of menopause. RESULTS: The mean age of the women was 52.5 (±4.4) years. With regard to the menopause status, 16% were premenopausal, 16% were perimenopausal, and 68% were postmenopausal. Among all the women included, 19.5% reported current or previous HT use. In multiple regression analysis, being postmenopausal (prevalence ratio [PR] 2.76; 95% CI, 1.74-4.38), receiving information about menopause from physicians and health service workers (PR 2.73; 95% CI, 1.91-3.89), having bilateral oophorectomy (PR 2.18; 95% CI, 1.49-3.17), experiencing work interruption due to hot flashes (PR 1.44; 95% CI, 1.03-2.01), and having extensive knowledge about menopause (PR 1.12; 95% CI, 1.05-1.19) were associated with a higher prevalence of HT use. CONCLUSIONS: The prevalence of HT use was 19.5%. Menopause status, information source, surgical menopause, work interruption due to hot flashes, and knowledge about menopause were associated with HT use. Education promoted by healthcare systems can increase HT use in women who have indications for treatment.

The American Cancer Society's Cancer Prevention Study 3 (CPS-3): Recruitment, study design, and baseline characteristics.

BACKGROUND: Prospective cohort studies contribute importantly to understanding the role of lifestyle, genetic, and other factors in chronic disease etiology. METHODS: The American Cancer Society (ACS) recruited a new prospective cohort study, Cancer Prevention Study 3 (CPS-3), between 2006 and 2013 from 35 states and Puerto Rico. Enrollment took place primarily at ACS community events and at community enrollment "drives." At enrollment sites, participants completed a brief survey that included an informed consent, identifying information necessary for follow-up, and key exposure information. They also provided a waist measure and a nonfasting blood sample. Most participants also completed a more comprehensive baseline survey at home that included extensive medical, lifestyle, and other information. Participants will be followed for incident cancers through linkage with state cancer registries and for cause-specific mortality through linkage with the National Death Index. RESULTS: In total, 303,682 participants were enrolled. Of these, 254,650 completed the baseline survey and are considered "fully" enrolled; they will be sent repeat surveys periodically for at least the next 20 years to update exposure information. The remaining participants (n = 49,032) will not be asked to update exposure information but will be followed for outcomes. Twenty-three percent of participants were men, 17.3% reported a race or ethnicity other than "white," and the median age at enrollment was 47 years. CONCLUSIONS: CPS-3 will be a valuable resource for studies of cancer and other outcomes because of its size; its diversity with respect to age, ethnicity, and geography; and the availability of blood samples and detailed questionnaire information collected over time. Cancer 2017;123:2014-2024. © 2017 American Cancer Society.

Personal and professional use of menopausal hormone therapy among gynecologists: A multinational study (REDLINC VII).

BACKGROUND: Previously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. OBJECTIVE: To determine the use of MHT and perceived related risks among gynecologists. METHODS: A self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. RESULTS: A total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n = 1837). Mean age was 48.1 ± 11.4 years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p < 0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p < 0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. CONCLUSION: Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.

Compounded non-FDA-approved menopausal hormone therapy prescriptions have increased: results of a pharmacy survey.

OBJECTIVE: From a survey of compounding pharmacists, specific questions regarding compounded menopausal hormone therapy were used to estimate compounded hormone therapy (CHT) prescribing in the United States. METHODS: A national online survey was conducted by Rose Research--a market research company consisting of 12,250 US pharmacists from independent community pharmacies (ICPs) and compounding pharmacies (CPs). Pharmacists who completed the survey and met the prespecified criteria were eligible. Data from the survey were extrapolated to estimate overall CHT prescription volume and annual costs of CHT prescriptions for the United States based upon industry data from the National Community Pharmacists Association and IBISWorld. RESULTS: Surveys were completed by 483 pharmacies, including 365 ICPs and 118 CPs. On the basis of the survey responses and extrapolated industry data, an estimated 26 to 33 million CHT prescriptions were filled annually, with total sales estimated at $1.3 to $1.6 billion. CPs (vs ICPs) accounted for a higher proportion of CHT prescriptions. More than half of the ICPs (52%) and CPs (75%) expected continued compounding business growth, with most predicting 5% to 25% growth within 2 years, despite the potential effect of restrictive legislation regarding compounding. CONCLUSIONS: On the basis of extrapolated data from numbers of prescriptions reported by pharmacists participating in the survey, the volume of CHT seems to approach that of Food and Drug Administration (FDA)-approved menopausal hormone therapy, and growth in the CHT market is expected. Thus, physicians should educate themselves and the women consulting them about the differences between the FDA-approved and the less-tested CHT formulations. More research on the efficacy, safety, and consistency of non-FDA-approved CHT is needed.

Dyspareunia and lubrication in premature ovarian failure using hormonal therapy and vaginal health.

OBJECTIVE: To evaluate vaginal microbiological and functional aspects in women with and without premature ovarian failure (POF) and the relationship with sexual function. METHODS: A cross-sectional study of 36 women with POF under hormonal therapy who were age-matched with 36 women with normal gonadal function. The vaginal tropism was assessed through hormonal vaginal cytology, vaginal pH and vaginal health index (VHI). Vaginal flora were assessed by the amine test, bacterioscopy and culture for fungi. Sexual function was evaluated through the questionnaire Female Sexual Function Index (FSFI). RESULTS: Women in both groups were of similar age and showed similar marital status. The two groups presented vaginal tropic scores according to the VHI but the tropism was worse among women in the POF group. No difference was observed with respect to hormonal cytology and pH. Vaginal flora was similar in both groups. Women with POF showed worse sexual performance with more pain and poorer lubrication than women in the control group. The VHI, the only parameter evaluated showing statistical difference between the groups, did not correlate with the domains of pain and lubrication in the FSFI questionnaire. CONCLUSION: These findings suggest that the use of systemic estrogen among women with POF is not enough to improve complaints of lubrication and pain despite conferring similar tropism and vaginal flora. Other therapeutic options need to be evaluated.

Excess weight and abdominal obesity in postmenopausal Brazilian women: a population-based study.

BACKGROUND: The menopause is associated with a tendency to gain weight. Several alterations in fat deposits occur, leading to changes in the distribution of body fat. There are strong indications that, in middle age, obesity is associated with increased mortality. This study set out to determine the factors associated with the prevalence of overweight and abdominal obesity in postmenopausal women in a population-based study in Brazil. METHODS: The sample included 456 women, aged 45-69 years, residing in the urban area of Maringa, Parana. Systematic sampling, with a probability proportional to the size of the census sector, was performed. Behavioral, economic, and sociodemographic data were collected, and body mass index (BMI) and waist circumference (WC) were determined. RESULTS: According to BMI criteria (≥25.0 kg/m2), 72.6% of the women were overweight, and according to WC (≥88 cm), 63.6% had abdominal obesity. Based on logistic regression analysis, the factors that were most closely associated with overweight were: having three or more children (odds ratio (OR): 1.78; 95% confidence interval (CI): 1.06-3.00); and not taking hormone replacement therapy (OR: 1.69; 95% CI: 1.06-2.63). The prevalence of abdominal obesity was positively associated with greater parity (OR: 1.34, 95% CI: 1.05-1.72) and age older than 65 years (OR: 1.50; 95% CI: 1.03-2.19). CONCLUSIONS: This study found that the prevalences of overweight and abdominal obesity were higher for postmenopausal women who had three or more children. Age over 65 years was also a risk factor for abdominal obesity and no use of hormonal replacement therapy was a risk factor for overweight.

Assessment of sleep quality and correlates in a large cohort of Colombian women around menopause.

OBJECTIVE: The aim of this study was to determine the relationship between self-reported sleep quality, menopausal symptom intensity, and correlates (including ethnicity) among middle-aged women. METHODS: The present cross-sectional study involved 1,078 Colombian women aged 40 to 59 years who completed the Pittsburgh Sleep Quality Index (PSQI), the Menopause Rating Scale (MRS), and a general questionnaire exploring sociodemographic data. RESULTS: The median [interquartile range] age of the whole sample was 49.0 [9.0] years. Among the participants, 45.4% were postmenopausal, 57.2% had increased body mass index values, 13.9% were black, 20.7% had hypertension, 74.1% had a stable partner, and 3.8% used hormone therapy. The prevalence of poor sleep quality was 57.1% (PSQI global score ≥5). Significant correlations between PSQI global scores and MRS total and subscale scores were found. Multiple linear regression analysis found that higher PSQI scores (poorer quality of sleep) correlated with higher MRS psychological and somatic subscale scores (more severe symptoms), smoking habit, and hypertension. Menopause status and black ethnicity were excluded from the final regression model. CONCLUSIONS: Despite study limitations, poor sleep quality is highly prevalent in this large middle-aged Colombian female sample and is related to menopausal symptom severity, tobacco use, and presence of hypertension.

[Frequency of metabolic syndrome in Mexican postmenopausal women and its relation with the hormonal therapy]. / Frecuencia del síndrome metabólico en mujeres posmenopáusicas mexicanas y su relación con la terapia hormonal.

INTRODUCTION: Metabolic syndrome is related with a significant increase in some chronic-degenerative diseases. In the same manner in the postmenopause exist several and metabolic changes. OBJECTIVE: To determine the frequency of metabolic syndrome in Mexican postmenopausal women that receive or not hormone therapy. MATERIAL AND METHODS: 33 postmenopausal women divided in two groups one without hormone therapy and the other received conjugated equine estrogens plus medroxyprogesterone acetate 0.625/2.5 mg/day. Age was documented; weight, height, waist and hip perimeters as well as blood pressure were analyzed. Body mass index and waist-hip ratio were calculated. Glucose and lipid levels were measured. Statistical analysis was done with Student's test for independent samples for comparison among the groups. RESULTS: Thirty-three patients were studied, 17 were in the group without hormone therapy and 16 in the group with hormone therapy with conjugated equine estrogens and medroxyprogesterone acetate 0.625/2.5 mg/day were studied. When the groups were compared, the waist perimeter was significantly greater in the group without hormone therapy (98.7 +/- 7.8 cm vs. 92.9 +/- 9.1 cm, respectively, p < 0.05). No significant differences were found between the groups in blood pressure, glucose, total cholesterol, high-density lipoprotein cholesterol and triglycerides. Metabolic syndrome diagnostic criteria were completed in 12 patients of group 1 (70.6%) and 8 in group 2 (50%), without statistically significant difference between them. CONCLUSION: Hormone therapy group was associated to a lower abdominal perimeter and a lower waist-hip ratio. This let's suppose that hormone therapy has a beneficial effect on the prevention of metabolic syndrome.

Hormone therapy for the management of the menopause in Ecuador: perception, use and knowledge among middle-aged women.

BACKGROUND: There is scant data on social and personal aspects related to the use of menopausal hormone therapy (HT) in Latin America. OBJECTIVES: To obtain information regarding menopausal HT, i.e. use, perception, level and sources of knowledge, and to determine factors affecting several of these issues among middle-aged women of Guayaquil, Ecuador. DESIGN: A total of 349 women (nursing staff), aged 40 years or more, were included in the present cross-sectional study. Participants completed a structured questionnaire including details related to HT and the reasons for not using it, as well as demographic and psychosocial data. RESULTS: Only 50.1% of women considered HT beneficial. Current and former HT use was low (1.7% and 14.3%, respectively) and mean HT duration among former users was short (mean +/- standard deviation: 1.0 +/- 1.4 years). Women responded that the main reasons for not using HT were being asymptomatic (49.0%), non-established menopause (30.4%) and physician's advice (27.2%). Only 28.9% of women considered having enough information regarding HT, whereas a high percentage (93.1%) indicated willingness to participate in educational sessions addressing this issue. For most of the women the main sources of information were physicians, educational sessions and television. Logistic regression analysis determined that women with lower income and HT information did not consider HT beneficial at a higher rate than their counterparts. Premenopausal women and those with lower income were more prone to never HT use. Age and professional level were found to be confounding factors. CONCLUSIONS: HT use in this population was low; hormonal status, economic income and level of HT information determined its use and benefit awareness.

The attitude of gynecologists in São Paulo, Brazil 3 years after the Women's Health Initiative study.

OBJECTIVE: The objective of this study was to evaluate gynecologists' knowledge of the WHI study, and its repercussions on their attitudes and practice 3 years after publication. DESIGN: A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the São Paulo Society of Obstetrics and Gynecology. RESULTS: The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of the respondents were aware of the WHI study, only 24.4% knew of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p<0.0001). The principal reason for physicians to discontinue HT in a patient was increased risk of breast cancer (62.3%), whereas, according to the physicians, the most important factor for the patients was fear of HT (80.3%). CONCLUSION: A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose.

Clinical guidelines for improving compliance with hormone therapy in Latin American women during the menopausal transition and thereafter.

OBJECTIVE: To provide uniform, objective guidance for physicians and other health care workers in Latin America to enhance compliance with hormone therapy (HT), and to provide a tool for continued medical education and a source for answering clinical questions. METHOD: Literature search using MEDLINE; identification of key relevant publications by a five-member expert committee; creation and validation of a 60-item questionnaire used to survey the opinion of 72 physicians participating in a Latin American symposium, "The Faces of Menopause". RESULTS: On the basis of the validated responses, major points were identified to enhance compliance with HT with specific reference to Latin America, and two algorithms were created to provide practical guidance. CONCLUSION: The present guidelines will facilitate optimal compliance with therapy in Latin American postmenopausal women who opt for HT and for whom HT is indicated.

[Estrogen treatment in climacteric and postmenopause after 2002. Can it still be prescribed?]. / Tratamiento con estrógenos en el climaterio y la posmenopausia después de 2002. Aún puede prescribirse?

Preliminary results of the American study called Women's Health Initiative starting in July 2002, showed an increase in some health risks, such as coronary disease, stroke, invasive breast cancer and dementia in 2003, in postmenopausal users of replacement hormonal therapy (HRT) with conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA). These results were opposed to those found in many observational studies in previous years. Although some benefits like significant reduction in number of osteoporotic fractures were demonstrated too, these results caused an enormous change in medical criteria for prescription and time of usage of HRT during the climacteric and postmenopausal periods in the whole world. The publication of complementary information in subsequent years to date, related to other sections or branches of Women's Health Initiative, such as only-estrogens users, which showed no increase of the above mentioned results, confirm the importance of continuing analysis of Women's Health Initiative results, as well as the need to do more research about HRT, with the purpose to get a better understanding about risks and benefits. This paper is a review of the most important results of Women's Health Initiative published to date, with comments about the hypothesis and possibilities to explain them, with the purpose of spreading in a realistic way the state of knowledge in the usage of HRT and increase the information of family physicians in Instituto Mexicano del Seguro Social, who are the first contact for medical care in these periods of their lives and help them to take clinical decisions.

Familial Alzheimer disease in Latinos: interaction between APOE, stroke, and estrogen replacement.

BACKGROUND: Factors that modify risk related to APOE variants have been examined primarily in unrelated patients and controls, but seldom in family-based studies. Stroke, vascular risk factors, estrogen replacement therapy (ERT), head injury (HI), and smoking have been reported to influence risk of sporadic but not familial Alzheimer disease (AD). OBJECTIVES: To examine the potential relationship between these risk factors and APOE, the authors used a family study design in a population in which the APOE-epsilon4 variant is strongly associated with risk of AD. METHODS: Latino families primarily from the Caribbean Islands in which two or more living relatives had dementia were identified in the New York City metropolitan area, the Dominican Republic, and Puerto Rico. A total of 1,498 participants from 350 families underwent a clinical interview, medical and neurologic examinations, neuropsychological testing, and APOE genotyping. Diagnosis was made by consensus using research criteria for AD. RESULTS: APOE-epsilon4 was associated with a nearly twofold increased risk of AD. A history of stroke was also associated with a fourfold increased risk. A statistical interaction between APOE-epsilon4 and stroke was observed. Women with an APOE-epsilon4 who took ERT did not have an increased risk of AD, but in women with a history of stroke ERT was a deleterious effect modifier. CONCLUSIONS: APOE-epsilon4 and stroke independently increase risk of familial Alzheimer disease (AD) among Latinos, and may interact to further increase AD risk. Among women, the risk of AD associated with APOE-epsilon4 may be attenuated by a history of ERT.

Influência da terapia hormonal sobre o filme lacrimal em mulheres na pós-menopausa / The influence of the hormone therapy on the lacrimal film in postmenopausal women

Objetivo: Avaliar se a terapia hormonal (TH) administrada para mulheres na pós-menopausa, exerce algum efeito sobre os sintomas do "olho seco". Métodos: Foram avaliadas 14 pacientes na pós-menopausa, antes e 3 meses após introdução da terapia hormonal. Os parâmetros avaliados foram: idade, tempo de menopausa, presença de doenças e uso de medicações associadas, sinais e sintomas oculares e fatores de exposição ambiental. O exame oftalmológico incluiu topografia corneana, Teste de Schirmer I, tempo de quebra do filme lacrimal (break up time) e exame biomicroscópico completo. Os dados obtidos foram submetidos à análise estatística. Resultados: A média de idade das pacientes foi de 53,8. As principais queixas encontradas foram sensação de corpo estranho (35,7 por cento) e lacrimejamento (28,5 por cento), tanto antes, quanto depois da terapia hormonal. As topografias corneanas mostraram alterações inespecíficas, e os testes de Shirmer I e quebra do filme lacrimal não apresentaram diferença estatisticamente significativa, antes e depois da introdução da medicação. Conclusão: Usando a metodologia proposta, não se observou influência da terapia hormonal, usada durante 3 meses, sobre o filme lacrimal em mulheres na pós-menopausa.

[Hormonal replacement therapy and breast cancer. A case-control study]. / Terapia de reemplazo hormonal y cáncer de mama. Estudio de casos y controles.

AIMS: Breast cancer is the second more frequently neoplasia in the woman and the first cause of mortality after 35 years old. It is considered a multifactorial illness, since is influenced for genetic, dietary and endocrine factors. Among these, hormonal replacement therapy (HRT) have been assigned benefits effect, as well as risks to increase the breast cancer incidence, because presence of estrogens receptor in the neoplasia cells makes think that the estrogens and other sexual hormones constitute a factor promoter of this cancer. OBJECTIVE: The objective of this study was to determine the association of HRT as risk factor in the incidence of breast cancer, in women from oncology-gynecological service. PATIENTS AND METHOD: Was carried out this descriptive study in patients that used HRT, considering as cases patients with breast cancer confirmed by hystophatological study and controls the patients without breast cancer. To statistical analysis took mean occurrence using the momios reason (MM), with confidence interval of 95% (CI), and chi2 test of Mantel-Haenszel, for a significant value of p < 0.05. RESULTS: Were included successively 250 patients, in 100 of these were confirmed diagnosis of breast cancer, 60 patients (37.5%) used HRT with mean of 3 years and 40 patients (44.4%) did not use HRT (Cases), the other 150 patients did not have breast cancer, 100 of these used HRT and 50 patients did not use HRT (Control). The statistical analysis showed that the HRT had a MM 0.75 (IC 95% 0.62-1.15) p=0.28, the maternal nursing with MM 0.68 (IC 95% 0.59-1.08) p=0.05, the multiparity with MM 0.42 (IC 95% 0.16-1.87) p=0.26, obesity MM 1.67 (IC 95% 0.99-1.54) p=0.05, familial history with MM 1.23 (IC 95% 0.83-1.54) p=0.05. CONCLUSIONS: These results show that does not exist a direct association between HRT and breast cancer. Therefore, whenever takes the decision to use the HRT should be considered the possible risks and benefits individualizing the patient, also the mammography should be present in mind, same that frequent physical examination, autoexploration and the use of HRT smaller to 5 years.

Patients' and clinicians' attitudes after the Women's Health Initiative study.

OBJECTIVE: To assess the effect of the publication of the Women's Health Initiative (WHI) study on patients' and physicians' attitudes in relation to hormone therapy (HT). DESIGN: A survey focused on the degree of knowledge and on the reactions to the WHI study was administered to 600 women allocated in two groups according to their socioeconomic status, high (HSES) or low (LSES). Additionally, 283 physicians were surveyed to determine their attitudes regarding HT after the publication of the WHI study. The rates of HT prescription before and after publication of the study were compared. RESULTS: Among patients, HT use and knowledge of the WHI study were less common among women of lower socioeconomic status (LSES 16.7% v HSES 47.3%, and LSES 15.7% v HSES 67.3%; P < 0.0001). Of the women in the LSES group who were HT users and had knowledge on the subject of the WHI study (n = 30), 56.7% contacted their physicians and 6.6% abandoned HT. These rates were similar for women in the HSES group. Among physicians, 97.2% of physicians referred to being aware of the WHI study, and 64.7% modified their clinical approach. The main changes were that 21.5% applied more rigorous risk/benefit assessment, 20.1% lowered hormone dosage, 18.8% decreased continuous-combined therapy use, 12.1% shortened the duration of HT, 7.7% abandoned medroxyprogesterone or conjugated estrogen use, and 5.0% increased the use of transdermal estrogens, tibolone, or other alternatives. As for prescriptions, after the publication of the WHI study, there was an 8.6% drop in the rate of HT prescriptions. This decrease was more pronounced for prescriptions based on conjugated equine estrogen and medroxyprogesterone acetate. In contrast, prescription of transdermal estrogens and tibolone increased 5.2% and 16%, respectively. CONCLUSIONS: There was a significant change in physicians' and patients' attitudes toward HT after publication of the WHI study.

Sources of information and HRT prescribing practices among gynecologists in Puebla, Mexico.

OBJECTIVE: The purpose of this study was to determine the sources of information and hormone replacement therapy (HRT) prescribing practices of gynecologists in the capital city of Puebla, Mexico. METHODS: Practicing gynecologists (n=44) in 29 colonias (neighborhoods) in the city of Puebla completed a self-administered standardized questionnaire. Survey topics included primary sources of information about HRT, discussion of patient health practices, awareness of alternative medicines, and HRT prescribing practices. RESULTS: Medical journals, hospital presentations, and textbook manuals were rated as the primary sources of information about HRT by 69-73% of physicians. Patients were rated as a primary source of information by 25% of physicians, and pharmaceutical representatives by 16% of physicians. Almost all physicians reported a willingness to discuss diet, smoking habits and other health issues with their patients. Natural and herbal medications were recommended by 25% of physicians. Contrary to studies in the US, more male than female physicians reported recommending hormones to 90-100% of their menopausal patients (60 vs. 33%, n.s.). CONCLUSIONS: This study revealed that physicians utilize a wide range of information about HRT, including patients and pharmaceutical representatives. Physicians' willingness to list patients as a source of information about HRT indicates the degree to which patients are involved in the medicalization of menopause. Reasons given for prescribing HRT (e.g. prevention of osteoporosis) were similar to those identified in studies in the US and Canada. Some variation in physician attitudes and practices related to HRT was apparent within the city of Puebla, Mexico.