Determinants of the intention to adopt hormone replacement therapy among premenopausal women

Objective: To identify the psychosocial factors that influence the intention to adopt hormone replacement therapy (HRT) at menopause. Methods: Random Digit Dialing was used to recruit 644 premenopausal non-hysterectomized women aged 45–54. Data were collected using a telephone questionnaire previously developed according to the theory of planned behaviour. Variables measured were: intention to adopt HRT (INT); attitude towards HRT (Aact); perceived social norm (SN); perceived behavioural control (PBC); and personal normative belief (PNB). Socio-demographic data were also obtained. Results: Stepwise multiple regression of INT on the theoretical variables yielded an R² of 0.70. The determinants were Aact (β=0.39, P<0.001), PNB (β=0.25, P<0.001), PBC (β=0.23, P<0.001) and SN (β=0.12, P<0.001). Women with a strong intention to adopt HRT represented 25% of the sample. These women were more likely to believe that adopting HRT would have the following positive consequences: an improvement in general well-being, the prevention of health problems, an improvement in interpersonal relationships, an increase in productivity, the regulation of mood swings and a reduction of hot flashes. They were also more likely to believe in the following negative consequences: side-effects, an increased risk of cancer, the likelihood of weight gain, and interference in the natural course of menopause (all at P<0.001). Conclusion: Actions that target behaviourial beliefs regarding HRT and perceived barriers to its adoption are most likely to influence adoption of HRT.     

Compliance with hormone replacement therapy in Thai women

A retrospective study was performed to determine the compliance of hormone replacement therapy (HRT), the characteristics of women who continue to use HRT and the reasons for discontinuation. This study comprised of 821 postmenopausal women who attended the menopause clinic between January 1993 and December 1997. A total of 613 women (74.67%) were considered to be good compliant users. They had been on HRT for at least 1 year. Two hundred and eight women (25.33%) discontinued the treatment, with an average of 5.1 months duration of use. The younger age group at time of consultation and at menopause and those with previous hysterectomy were factors associated with higher degree of compliance. Its compliance decreased with age and the duration of menopause. The common reasons in the women's decision to discontinue HRT were bleeding episodes (23.08%), undesirable side effects (15.05%) and on physicians' advice (13.46%), respectively. Compliance with HRT appears to be similar to that reported in other specialist centres. Factors affecting compliance were age, age at menopause, duration of menopause, and hysterectomy. Irregular vaginal bleeding was the major reason for discontinuation.     

Prevalence of hormone replacement therapy in a sample of middle-aged women

A survey based on a postal questionnaire sent to a random sample of Danish women aged 40–59 yr living on the island of Fünen (n = 401, response RATE = 79%) revealed that the overall prevalence of the use of hormone replacement therapy (HRT) was 16%, the highest rate being in the 50–54 age group (21%). Among post-menopausal women the rate was 21% and it was highest of all (37%) in those who had undergone an artificial menopause. The median age at the start of treatment was 44.3 yr among the artificial menopause and 48.9 yr among the natural menopause subjects. About half of the women were treated with natural oestrogen alone and over a third with cyclic natural oestrogen in combination with progestogens.

Almost one-third of the women had consulted their doctor about climacteric complaints and two-thirds of these were current or past users of HRT. The women had ambiguous feelings towards HRT, approximately one third reporting a positive and one-third a negative attitude.     

Factors associated with endometrial bleeding in continuous hormone replacement therapy

OBJECTIVE: To identify clinical and laboratory parameters associated with the occurrence of endometrial bleeding within the first 6 months of treatment in postmenopausal women taking continuous hormone replacement therapy. DESIGN: We performed a prospective study of 55 postmenopausal women who had amenorrhea for at least 12 months before baseline screening and were taking 0.625 mg conjugated estrogen and 5 mg medroxyprogesterone acetate daily on a continuous basis. Postmenopausal duration was defined as the interval, in months, between the last menstruation and the commencement of treatment. All subjects were instructed to monitor bleeding episodes in a diary and were followed up monthly for at least 12 months. RESULTS: Thirty-four women (62%) experienced bleeding within the first 6 months of treatment. Using a multivariate approach, a woman with a postmenopausal duration of 24 months or less had a relative risk of 8.2 (95% confidence limits: 1.3, 53.1) of bleeding, as compared with those with a postmenopausal duration of more than 24 months. Furthermore, pretreatment endometrial thickness greater than 5 mm (p < 0.05) and serum estradiol levels greater than 25 pg/mL (p < 0.01) were noted to be significantly correlated with the occurrence of bleeding in women with a postmenopausal duration of more than 24 months. CONCLUSIONS: Women with a postmenopausal duration of 24 months or less, a pretreatment endometrial thickness greater than 5 mm, and serum estradiol level greater than 25 pg/mL are at risk to have endometrial bleeding within the first 6 months of continuous hormone replacement therapy.     

Determinants of hormone replacement therapy duration among postmenopausal women with intact uteri

OBJECTIVE: To investigate factors associated with hormone replacement therapy (HRT) duration among postmenopausal women with intact uteri. DESIGN: A Cox proportional hazard model on time to HRT discontinuation is estimated for 2,632 postmenopausal HRT users with intact uteri who began a new episode of treatment between January 1990 and December 1994 in Saskatchewan, Canada. RESULTS: Major contraindicating medical events were highly associated with HRT discontinuation among postmenopausal women. Women who were diagnosed with uterine cancer while taking HRT were almost four times as likely to discontinue HRT, and women who were diagnosed with breast cancer while taking HRT were nearly five times as likely to discontinue HRT. Other statistically significant factors associated with the duration of HRT episodes include administration mode and the ability to try different types and strengths of HRT. Women initiating HRT with a transdermal patch were 50% more likely to discontinue it. Women who were willing and able to experiment with different HRT reduced their likelihood of discontinuing by one-half to three-fourths. CONCLUSIONS: Although some of the factors associated with the hazard of HRT discontinuation among postmenopausal women who are taking the treatment for preventive benefits are immutable, clinicians may influence HRT continuation rates through initial drug choice or modifications in drug type or regimen over the course of therapy.     

Clinical and personal relationships between oral contraceptive and hormone replacement therapy use among US women physicians

OBJECTIVE: To examine relationships between a history of oral contraceptive (OC) use and current use of or intention to use hormone replacement therapy (HRT). DESIGN: The Women Physicians' Health Study examined a stratified random sample of US women MDs, aged 30 to 70 years (4,501 respondents; a 59% response rate). RESULTS: Among postmenopausal physicians who previously used OCs, current HRT use was significantly associated ( < 0.05) with being younger, living somewhere besides the East Coast, being sexually active, being an obstetrician/gynecologist, having no history of breast cancer, having a longer use of OCs, and being posthysterectomy. Among premenopausal physicians, intended future HRT use was significantly associated with being white, being an obstetrician/gynecologist, being in good health, living somewhere besides the East Coast, being a longer user of OCs, and having more extensive, recent continuing medical education. Among women who had taken both OCs and HRT, there were no significantly elevated rates in any of the 15 health conditions we examined (after controlling for family history). Postmenopausal physicians who took HRT (and premenopausal OC-using physicians intending to take HRT) were significantly more likely to counsel their patients on HRT use. Among post-OC HRT-users, 44% counseled their postmenopausal female patients on HRT at least yearly versus 22% of post-OC HRT-nonusers (74% v 45% among such primary care physicians). CONCLUSIONS: Physicians' personal OC/HRT use may strongly affect their patient counseling practices. HRT use after OC use was not associated with any obvious increases in examined diseases in this population.     

Attitudes to menopause and hormone replacement therapy among Asian and Caucasian women general practitioners

OBJECTIVE: To look for any differences in attitudes to menopause and hormone replacement therapy (HRT) between Asian and Caucasian women standardised for educational background, socio-economic status and access to medical information. METHOD: Self administered postal questionnaire sent to 144 women doctors (general practitioners) in defined geographical areas. RESULTS: The overall response rate was 61%. Both Asian and Caucasian women responded in a similar manner for most aspects. A high proportion of these women doctors (over 75%) would seek HRT at the climacteric. More Asian respondents reported a fear of breast cancer (P=0.001), and that a woman feels less of a woman after the menopause (P=0.02). More Caucasian respondents felt positively about the potential for HRT to enhance enjoyment of life (P=0.01). CONCLUSIONS: The lack of major differences between the ethnic groups in our sample suggests that variations reported elsewhere may be due to lack of knowledge and/or differences in socio-economic status.     

Hormone replacement therapy: knowledge,attitudes, and weil-being among middle-aged australian women

Use of hormone replacement therapy (HRT) is increasing, yet little is known of women's perceptions of HRT. A telephone survey examined relevant knowledge and attitudes, and psychological well-being, in 258 women aged 51 to 60 (111 HRT users, 47 previous users, and 100 never-users). Although HRT users were better informed than nonusers, knowledge was generally low. Half the HRT users could not name any hormone used in HRT, and one third could not give any reason for using HRT. Current users, however, had more positive attitudes to HRT. Groups defined by HRT usage did not differ on well-being or current symptomatology, although current and previous HRT users reported having previously experienced a higher level of symptomatology than never-users, suggesting that HRT may have provided symptom relief for those women who chose to use it. In contrast to previous research, women with a history of hysterectomy did not show more emotional distress than others. Results suggest that Australian women frequently make choices concerning HRT without adequate knowledge, and that HRT may reduce symptoms but may have little impact on psychological well-being. Optimal usage of HRT by middle-aged women will rely on a clearer understanding, both of its effects and of women's attitudes toward its use.     

Associations between attitudes toward hormone therapy and current use of it in middle-aged women

OBJECTIVES: To investigate the association between attitudes toward hormone therapy (HT) and use of it and explanatory factors for the association found. METHODS: All women in two primary healthcare districts aged 45, 50, 55 or 60 in 2000 or 2001 (n=771) received a questionnaire consisting of quality-of-life instruments and items concerning menopause, health, healthcare, symptoms, sociodemographic factors and attitudes toward HT. RESULTS: A total of 564 women (74%) responded to the questionnaire. In the women with a positive or a neutral attitude, rather than a negative one, the age- and menopause-adjusted odds ratios for current HT use were 18.55 (95% CI 8.55, 40.11) and 2.61 (1.15, 5.93), respectively. Health-related factors, factors concerning one's own person and psychosocial factors were the groups of factors found to contribute to explaining the association between attitudes and current HT use. Together, the three groups of factors explained 42 and 98%, respectively, of a positive and a neutral attitude's association with current use of HT. Individual factors of importance in these factor groups were a feeling of being appreciated outside the home, satisfaction with one's work, marital status, own climacteric period, visits to a physician and past use of hormonal contraceptives. In contrast, level of education and the occurrence of cold sweats/hot flushes was not found to contribute to the explanation. CONCLUSIONS: Factors concerned with women's everyday life, contentment with oneself and use of healthcare services were of importance in explaining the associations between attitudes toward HT and current use of it. Consideration at these factors in counselling women about HT is recommended.     

Factors associated with insensitivity to pyridostigmine therapy in Thai patients with ocular myasthenia gravis

The objective of this study was to determine factors associated with pyridostigmine therapy in patients with ocular myasthenia gravis (OMG). This retrospective study included eighty-five patients with OMG who have been treated with pyridostigmine. Patients were excluded if they were diagnosed as generalized myasthenia gravis within a month after diagnosis or were treated with other medications. Forty-two patients responded to pyridostigmine and 43 patients did not. There were no significant differences in gender, age, the duration of symptoms before treatment, the dosage of pyridostigmine, and the initial presentations of ptosis or diplopia between the two groups. However, an initial presentation of concurrent ptosis and diplopia and the presence of systemic involvement after follow up were significant factors associated with an insensitivity to pyridostigmine in patients with OMG (p = 0.001 and p = 0.01, respectively). Determining these factors could help predict the pyridostigmine response in patients with OMG.     

Motives for initiation,temporary discontinuation,and permanent discontinuation of hormone replacement therapy use among Norwegian women

Objective

The use of hormone replacement therapy (HRT) declined strongly in many countries after publication of the WHI-study. The purpose of the present study was to investigate HRT usage patterns and motives for initiation, temporary discontinuation, and permanent discontinuation of HRT use among Norwegian women.

Methods

A questionnaire study about use and attitudes towards HRT was carried out in 2005. Women 45–64 years old were invited to the study (n = 2325, response rate 47%).

Results

Women initiated HRT use mainly due to climacteric complaints (74%), while prophylactic motives were less frequently reported (27%). The most often reported benefits of HRT use were reduced climacterical symptoms, especially hot flushes/sweating (83%), and improved quality of life (59%). The major proportion of ever-users (57%) had at some point temporarily discontinued HRT use. The motive for temporary discontinuation of HRT use most frequently reported was to see if climacterical symptoms had ceased (58%). Permanent discontinuation of HRT use was most often motivated by anxiety to side effects (55%). In multivariable analyses, women using HRT prophylactically were less likely to temporarily discontinue use. Women with a positive attitude towards HRT were the most unlikely ones to permanently discontinue HRT use.

Conclusions

Temporary discontinuation of HRT use was common among Norwegian women. The majority of HRT users reported a reduction in climacteric complaints after initiation of HRT use but many women were afraid of side effects.     

Factors associated with calcium, vitamin D supplements intake and use of hormonal replacement therapy in health workers postmenopausal women

OBJECTIVE: To know the frequency and factors associated with the intake of calcium (Ca), vitamin D supplements and use of hormone replacement therapy (HRT) among postmenopausal (PM) health professionals women. METHODS: During January to June 2004, health workers women of IMSS General Hospitals in Tijuana and Ensenada, Baja California, Mexico, were invited to participate. An interview and measurement of calcaneous bone mineral density (BMD) were performed. The following variables were assessed: sociodemographic, clinic and gynecologic features. We defined preventive osteoporosis (OP) treatment as the use of HRT, intake of Ca supplements (> or =1000 mg/ day) and supplements of vitamin D for a least six months. RESULTS: Among 739 women interviewed, 312 were PM, and 31%, 25% and 31% have been taking Ca supplements, vitamin D, and HRT respectively. Calcium, vitamin D supplements intake and use of HTR was similar during the menopause evolution. The variables significantly associated with the use of preventive OP treatment were older age, low weight, previous ooferectomy and use of corticosteroids. In the multivariate analysis, age and underweight were significantly associated with a low bone mass density, independently of the use of preventive OP treatment CONCLUSIONS: The frequency and length of time of Ca, vitamin D supplements intake and use of HRT was low, and 50% of PM health professional women are not under preventive OP therapy.     

Correlates of hormone replacement therapy use in Italian women, 1992-1996

OBJECTIVES: we analyzed the determinants of hormonal replacement therapy (HRT) use in Italy for the period 1992-1996, using data from a framework of case-control studies of colon and rectal neoplasm. METHODS: a total of 1574 women aged 45-74 years were considered. This group comprised women with acute, non neoplastic, non-hormone-related diseases admitted to a network of hospitals in six areas of Italy. RESULTS: a total of 146 women (8.5%) reported ever HRT use. The multivariate odds ratio (OR) of ever use was 1.6 (95% CI 1.0-2.6) for women with 12 years of education or more, compared with those with < 7 years. The frequency of use of HRT tended to decrease with increasing parity: the OR was 0.6 for women with four or more children as compared to nulliparae (chi2 trend 3.5, P = 0.06). Ever HRT users were more frequently smokers. HRT use was more frequent in women reporting surgical menopause (OR = 2.7) than those with natural menopause. Among post menopausal women, HRT use was related with early age at menopause (chi2 trend 4.6, P = 0.03). HRT use was more common among women reporting lower body mass index (BMI) both at interview and at age 30 years and the difference between current BMI and BMI at age 30 years, was not related with HRT use. CONCLUSIONS: women of higher socioeconomic status or education reported more frequent HRT use and nulliparae and smokers were also more likely to use HRT. Further HRT use was directly associated with early age at menopause and surgical menopause and inversely related with measures of body weight.     

Hormone replacement therapy and previous use of oral contraceptives among Swedish women

Objectives: To assess the current and previous use of hormone replacement therapy (HRT) and alternative remedies in a postmenopausal population and to relate HRT use to previous use of oral contraceptives. Material and methods: All 1323 women living in Linköping of 55 or 56 years old during 1995 were sent a questionnaire asking for data with relation to health and climacteric symptoms as well as to previous and current use of HRT, oral contraceptives and alternative remedies. Results: Current use of HRT was more common among women who previously used oral contraceptives (41.3 %) than among women who had never used oral contraceptives (23.1%). HRT users were also more often physically active, had undergone hysterectomy and had lighter occupation than non-users. Of all women 35% were current users of HRT, half of them for at least 2 years, whereas only 5% had tried HRT and abandoned therapy. Alternative remedies were used by 5% of the women as therapy for climacteric complaints, and about four times as many women had tried such therapy but abandoned it. The only characteristic about use of alternative medicines was that they were used less often by women who had been hysterectomized. No woman treated for breast cancer used HRT and only few of them used alternative remedies. Conclusions: The prevalence of HRT use, as well as compliance, was high. Previous use of oral contraceptives probably affected the attitude towards using HRT.     

Why menopausal women do not want to take hormone replacement therapy

OBJECTIVE: A survey was designed to determine why menopausal women do not take hormone replacement therapy (HRT). DESIGN: A sample of 3,600 women > 50 years old were randomly selected from six zip codes in northwest suburban Chicago. They received a maximum of three survey mailings. Those who did not respond were called and asked to respond over the phone. The data that were obtained included knowledge of, physician discussion about, use of, and reason for not currently taking HRT, menopausal status, last physician visit, and age grouping. RESULTS: A total of 1,966 (65%) women responded. Of these, 1,448 (74%) knew about HRT, 1,193 (61%) had discussed HRT with their physicians, and 815 (41%) had been treated with HRT in the past. A total of 552 women (28%) were currently being treated with HRT, of whom 419 (76%) had been treated for > 2 years. A total of 1,356 respondents were not being treated with HRT. Of these, 1,114 (82%) were menopausal, of whom 742 (67%) knew about HRT, 551 (50%) had discussed HRT with their physicians, 837 (75%) had seen their physician in the past year, and 236 (21%) had been treated with HRT in the past. Reasons for not taking HRT included the following: 49% no longer had menopausal symptoms, 45% did not want to take HRT, 33% were not offered it by their doctors, 28% were afraid to use it, and 27% were not menopausal. CONCLUSIONS: Seeing a physician in the past year did not ensure that these women understood the symptom course of menopause. Confirming women's knowledge about menopausal health or assisting physician education about menopausal health may offer opportunities both to assist women's decision making about HRT and to improve women's health care.     

Use of hormone replacement therapy among Chilean women: a comparison between socioeconomic levels

OBJECTIVE: To compare the use of hormone replacement therapy (HRT) among Chilean women according to their socioeconomic level. METHODS: A total of 540 women between 50 and 79 years of age were interviewed in Santiago, Chile. Women were allocated into two groups (H, high; L, low), according to their socioeconomic status. RESULTS: Each group consisted of 270 women. The mean age and percentage of menopausal women were similar in both groups. Of the interviewed women, 47% had taken HRT at some time; marked differences between the two groups were observed (L, 15%; H, 79%; < 0.0001). In group H, the percentage of women who had been advised about HRT was close to 88%, whereas, in group L, the percentage was only 24%. Among the women who were informed about HRT, 83% ( = 253) had used it at some time. The percentage of women who used HRT for >2 years was similar in both groups. The main reason for not taking HRT in group H was fear of adverse effects, whereas the main reason for not taking it in group L was the lack of medical advice. CONCLUSIONS: The percentage of women in the low socioeconomic group who use HRT is low. Medical advice is fundamental to increasing HRT use in this group.     

Progestogen intolerance and compliance with hormone replacement therapy in menopausal women

It is vital that we maximize compliance if patients are to receivethe full benefits from hormone replacement therapy (HRT). Oneof the main factors for reduced compliance is that of progestogenintolerance. Progestogens have a variety of effects apart fromthe one for which their use was intended, that of secretorytransformation of the endometrium. Endometrial effects varybetween individuals and between different progestogens, leadingto bleeding problems. Symptoms of fluid retention are producedby the sodium-retaining effect on the renin-aldosterone system.The nor-testosterone-derived progestogens can have adverse effectson skin, lipids, vasculature and insulin resistance. Negativemood effects are produced by most progestogens due to the effecton neurotransmitters via central nervous system progesteronereceptors. Manipulation of the dosage and duration of progestogen,continuous administration of a low dose of progestogen and areduction in the number of progestogenic episodes can be usedto improve compliance. The progestogen and progesterone releasingcoils and vaginal progesterone gel minimize systemic side effectsand bleeding. Adverse effects can also be avoided by makinguse of the progesterone receptor-specific progestogens suchas the pregnanes (e.g. cyproterone), nor-pregnanes (e.g. nomegestrol)and progesterone itself. Hysterectomy remains an option forthe severely progestogen-intolerant woman. In the future, progestogenintolerance may not be an issue if selective oestrogen receptormodulators provide a complete alternative to HRT.     

Ascorbic acid status in postmenopausal women with hormone replacement therapy.

OBJECTIVES: Hormone oral contraceptives affected ascorbic acid status adversely in young women. In vitro, estrogens and progesterone inhibited ascorbic acid accumulation in intestinal cells. This is a pilot study to examine the relation between hormone replacement therapy (HRT) and plasma ascorbic acid levels among a group of healthy non-smoking postmenopausal women. METHODS: Healthy non-smoking postmenopausal women aged 48-72 years, 34 with HRT and 21 without HRT, were recruited in summer, 1997. Their fasting plasma ascorbic acid levels were measured and information on ascorbic acid intakes (diet and supplements) was collected through questionnaires. RESULTS: Women taking HRT in this study did not have significantly lower plasma ascorbic acid levels compared with non-HRT users. When subjects were further divided into groups based on ascorbic acid supplementation, HRT users without supplement had a lower mean plasma ascorbic acid level (54+/-16 microM, n=10) compared with non-HRT users (66+/-14 microM, n=12) (P=0.08 for the effect of therapy). HRT users and non-users taking ascorbic acid supplement had similar plasma levels (66+/-10 microM, n=24; 66+/-12 microM, n=9, respectively). CONCLUSION: HRT does not affect ascorbic acid status of healthy well-nourished non-smoking postmenopausal women that are using ascorbic acid supplement. Future larger case-control or supplement intervention study is needed.