Attitudes towards the menopause and hormone therapy over the turn of the century

Objective

To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT).

Materials and methods

In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT.

Results

Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies.

Conclusions

Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women's attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women's actual use of HT. Probably women's and health care provider's apprehension of the risk-benefit balance of HT use is one such factor.     

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.     

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.     

Climacteric symptoms in a postmenopausal Czech population

Objectives: To assess the prevalence of climacteric symptoms and the use of hormone replacement therapy in a former eastern European country. All 55-, 57-, 59- and 61-year-old women in Kladno in the Czech Republic were asked to participate in the study. Method: In 1993, 1505 women in Kladno of the Czech Republic were sent a postal questionnaire concerning age at menopause and their climacteric symptoms. Results: Answers were received from 799 women (53%); 98% were postmenopausal. The median age at spontaneous menopause was 50 years, 49.5 years among women smoking at least 5 cigarettes/day and 51.0 years among non-smokers (P < 0.05). About every fifth woman smoked. Totally 22% of the women had undergone hysterectomy and/or oophorectomy and 3% had been treated for a gynaecological malignancy. The majority of the women (58%) reported ongoing vasomotor symptoms; half of them had moderate to severe vasomotor symptoms. In all, 79% of the women reported ever having vasomotor symptoms. Only 3% of the women had ever tried hormone replacement therapy (HRT) and one woman had curent treatment. Dysuria was reported by 22% and 4% had recurrent urinary tract infections; 70% of the women had a partner and 50% were sexually active. Reasons for not being sexually active were mostly lack of a partner, loss of sexual desire or partner's disease or impotence. Conclusion: Climacteric symptoms including vasomotor and urogenital symptoms had the same prevalence in the Czech Republic as previously reported in other Western Countries. Only a few women had tried HRT. Smokers had a slightly earlier menopause.     

Benefits and risks of long-term low-dose oral continuous combined hormone therapy

OBJECTIVES: Current recommendations for hormone therapy (HT) are mainly based on findings from studies using standard dose regimens in older women who had a different health profile from those who start HT soon after the onset of menopause. METHODS: We, therefore, reviewed controlled trials assessing the efficacy, safety and tolerability of low-dose oral continuous combined HT (cc-HT) started for treatment of climacteric symptoms. This review is limited to oral cc-HT regimens over sequential regimens as most postmenopausal women prefer not to have a return of uterine bleeding, and to studies of at least 2 years in duration. RESULTS: Low-dose cc-HT is effective in alleviating climacteric symptoms and in maintaining bone density over prolonged periods, although no data were available regarding fracture risk. No increased risk of coronary heart disease, venous thrombo-embolism or stroke during the use of low-dose cc-HT was reported in the long-term studies and no definitive evidence for an increased risk of breast cancer was found. Breakthrough bleeding during the first months of use is less common than with standard dose HT and amenorrhoea is achieved in most women over time. These regimens are safe for the endometrium and are well tolerated, with a low incidence of adverse events compared with standard doses. CONCLUSIONS: Current evidence from controlled trials indicates that low-dose oral cc-HT appears effective and safe. This makes it a good choice for the alleviation of climacteric symptoms, and for this purpose long-term administration of low-dose cc-HT does not seem to impose serious health risks. However, more long-term study data and direct head-to-head comparisons between various low-dose preparations are needed to support or rectify the safety aspects.     

Discussing menopause in general practice

The dual objective is, first, to determine if menopausal women discuss the menopause with a doctor, and if so to which extent; second, to ascertain potential differences between those who do and those who do not. METHODS: A postal questionnaire was sent to 1251 Danish women randomly selected among all 51-year-old women born and living in Denmark. Completed questionnaires were returned by 972 (77%) women. RESULTS AND CONCLUSIONS: More than two thirds (71.8%) of the peri and postmenopausal women had discussed the menopause with a doctor; either with the general practitioner (GP) or with another doctor. There were significant differences between women who had discussed the menopause with a doctor and those who had not. The more problematic the symptoms the greater the likelihood that the woman would have discussed the menopause. Women who had not discussed the menopause with a doctor, had fewer symptoms and were more critical of hormone replacement therapy (HRT). Menopausal symptoms do not necessarily create problems for women in their daily lives. For example almost all women reported hot flushes (87.2%), but few felt very bothered by this symptom (13.8%). Doctors most often listen to menopausal women with severe symptoms. This "bias" may direct the focus upon the negative aspects of menopause. It is suggested that active intervention among women who have not consulted a doctor about menopause is inappropriate, partly because they apparently have chosen non-medical solutions and partly because they have so few symptoms that the use of resources in this way could be considered wasteful.     

Menopause and perceived health status among the women of the french GAZEL cohort

The aim of this study was to evaluate the effect of menopause on women's quality of life. Women (1171) aged from 45–52 years who work for the French national gas and electricity company volunteered for this study (response rate 75%). They completed a self-administered questionnaire pertaining to general health. Quality of life was measured by the Nottingham Health Profile (NHP). Within this group 289 women were postmenopausal. After controlling for age, those women were more likely to show a lower quality of life than women still menstruating for 4 of the 6 sections of the NHP: social isolation (odds ratio 1.4; 95% confidence interval 1.1–1.9), pain, sleep and energy (odds ratios 1.5; 95% confidence intervals I. 1–2.0). Those alterations of quality of life are explained by the climacteric complaints the women report. Those findings suggest that the treatment of menopausal symptoms with medication of proven efficacy may prevent lowering of quality of life due to menopause.     

The climacteric of Chinese factory workers

Chinese factory workers (427) mainly of Fujian origin were found to have few climacteric symptoms. Of these, 65% and 50% reported having no circulatory and nervosity symptoms, respectively. Only 18% of women experienced hot flushes. The climacteric symptoms were more pronounced at the perimenopausal period (P < 0.001) when these women experienced more irregular menstruation. Low socio-economic status and educational level did not have adverse effects on the symptom reporting. High parity and employment may be positive factors in this period of change of life. A majority of women (74%) felt that the climacteric and menopause is a natural process which caused them no concern. Of those who were still menstruating 80% did not anticipate that they would have problems with the climacteric and menopause. These women's different climacteric pattern could be related to their introspective abilities to cope adequately or in an impersonal manner.     

Symptoms of multiple sclerosis in women in relation to sex steroid exposure

ObjectiveTo investigate if women with multiple sclerosis (MS) experience changes in MS symptoms related to pregnancy, the postpartum period, menopause or use of oral contraception (OC) or postmenopausal hormone therapy (HT).MethodsWomen with diagnosed MS were recruited from registers of all MS patients known in two counties of Sweden, respectively. Ninety-four women were recruited in Linköping and 52 in Sundsvall. The women answered a questionnaire with categorized alternatives regarding their MS symptoms related to menstruation, pregnancy, delivery, menopause and use of OC or HT.ResultsForty percent of the women reported worsening of MS symptoms related to menopause, whereas 56% reported no change of symptoms and 5% reported decreased symptoms. More than a fourth of the women reported decreased symptoms during pregnancy, 64% reported unchanged symptoms and 10% reported increased symptoms. Every third woman reported increased symptoms after delivery, 59% reported no change and 5% reported decreased symptoms. Few women reported changes in MS symptoms in relation to use of HT or OC.ConclusionThe presented data indicate a relationship between high-oestrogen states and ameliorated symptoms whereas low-oestrogen states seem to relate to a worsening of the disease. A majority of women, however, reported no changes in MS symptoms in relation to the different oestrogen states.     

Hormone replacement therapy and symptom reporting in menopausal women: a population-based study of 35-65-year-old women in mid-Sweden.

OBJECTIVE: To measure the prevalence rate of hormone replacement therapy (HRT) in the general population and to see whether HRT users report less symptoms, better general health and less use of other palliative than non-users and previous users. METHODS: The study was performed in 1995 as a cross-sectional postal questionnaire study in seven counties in mid-Sweden. The questionnaire was sent to a random sample of 4200 35-64-year-old women of whom 2991 responded. The age distribution of responders and non-responders was similar 49.6+/-8.5 and 49.8+/-8.7 years, respectively. The main outcome measures were vasomotor and general symptoms in relation to menstrual status and HRT. RESULTS: Fifteen percent were on HRT and 2.3% had stopped treatment during the past year. Thirteen percent used other palliatives. Twenty-five percent of premenopausal women experienced any vasomotor symptoms, as compared with 51% of menopausal and 40% of postmenopausal women. Those on HRT reported higher frequencies than non-users of all symptoms except for sweating during the daytime. In addition, menopausal women experienced more of other symptoms, usually not associated with the menopause, than premenopausal and postmenopausal women. HRT users reported a significantly worse perceived health and they took other palliatives drugs to a larger extent than HRT non-users. CONCLUSION: HRT seemed to be effective in relieving some vasomotor symptoms but did not affect the prevalence of other symptoms or perceived health, in spite of the fact that women on HRT supplemented their therapy with palliative drugs to a larger extent than other women.     

Perceptions and attitudes toward the menopause among middle aged women from Guayaquil, Ecuador

BACKGROUND: Studies reporting the perspective of Latin American women, Ecuador, included, regarding the menopausal phenomena are scarce or lacking. OBJECTIVES: Obtain information regarding the perception and attitudes toward the menopause among middle aged women of Guayaquil, Ecuador. METHODS: Women aged 40 or more, nursing staff members of two major associated teaching hospitals of the Universidad Católica de Santiago de Guayaquil, Ecuador, were surveyed with a structured questionnaire containing items intended to assess women's perception and attitudes toward the menopause. Secondarily level of information related to the menopause was explored. RESULTS: During the study period, 349 women were surveyed of which mean age was 48+/-6.8 years. A 41.3% were postmenopausal, 55% premenopausal and 3.7% had a history of hysterectomy with conserved ovaries. Women more frequently perceived the menopause as a positive event as they agreed that it is a normal (93.7%) and important event (73.6%), that it gives more confidence and maturity (78.8%), that they may fully enjoy sexual relations (74.8%), that there is a relief as the risk of becoming pregnant is null (65.3%) and that life becomes easier and calmer (60.7%). A relatively high rate demonstrated a preoccupying attitude toward the menopause as 79.4% responded to be concerned about it indicating that seeking medical attention was important, moreover, 77.9% responded that health during this phase be taken care of and life styles changed. Less than 50% of surveyed women considered having enough information regarding the menopause whereas a high rate indicated wanting to receive educational sessions related to the menopause. Married and lower educated women were not concerned about the menopause in a higher rate than their counterparts. CONCLUSIONS: Despite the fact that women perceived the menopause as a positive event, displaying a concerned attitude toward it, their related knowledge was low.     

Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study

OBJECTIVE: To investigate knowledge of hormone therapy (HT), reproductive physiology, and menopause in a population of 53- to 54-year-old women. Further aims were to determine whether the knowledge differed between users and nonusers of HT and between groups with different levels of education. DESIGN: In 2003, all 53- and 54-year-old women (N = 1,733) in Link?ping, Sweden, were sent a questionnaire containing questions about reproductive physiology related to menopause and HT. Answers from 73% of the women were analyzed. RESULTS: Swedish women had limited knowledge of HT, reproductive physiology, and menopause irrespective of HT use or educational level. Most of the women knew that hot flashes are common around menopause and decreasing estrogen production causes the menopause. They knew little about the effects of progestagens and the effects of HT on fertility. Women with low educational level were more likely to answer the questions by stating that they were unsure than did women with high educational level. Ever-users of HT knew more than never-users about risks and benefits of HT in relation to breast cancer and osteoporosis, and ever-users thought that the risks of thrombosis and myocardial infarction were lower than did never-users. CONCLUSIONS: Women need improved knowledge of the risks and benefits of HT as well as education about the reproductive system around menopause. This would probably better support and empower women to manage an important period of their lives.     

Dietary supplement use among menopausal women attending a San Francisco health conference.

OBJECTIVE: This study examined the usage patterns of dietary supplements during menopause, providing information about type, prevalence, and rationale for use. METHODS: A survey instrument was distributed to self-identified peri- or postmenopausal women at a San Francisco women's health conference in March 2000. RESULTS: Of the 100 eligible women, 29% used hormone replacement therapy (HRT) alone, 16% used HRT with dietary supplements (Combo group), 32% used dietary supplements alone, and 13% used no product or used supplements excluded in this survey. The most common dietary supplements were soy (29%), ginkgo biloba (16%), and black cohosh (10%). Only 54% of women using dietary supplements reported such usage to their primary care providers. Women using HRT alone reported relief of hot flashes significantly more often than those using dietary supplements alone (63% vs. 30%; p = 0.016). Women using combination therapy reported enhanced improvement in vaginal dryness, libido, and mood compared with those using HRT alone. Perceived quality of life and overall control of menopausal symptoms were highest among women using dietary supplements alone and women using combination therapy, respectively. Satisfaction with menopausal counseling from a primary care provider was significantly greater in women receiving HRT alone ( p = 0.02) and combination therapy ( p = 0.006) compared with women receiving dietary supplements alone. CONCLUSIONS: Dietary supplements were frequently used during menopause. Combined use of dietary supplements and HRT seemed to be associated with enhanced relief of certain menopausal symptoms. Women using dietary supplements alone seemed particularly dissatisfied with the menopausal counseling provided by a primary care provider.     

Factors associated with treatment options among menopausal women in Taiwan

OBJECTIVES: Taiwan has a two-tiered medical system that includes modern medicine and traditional Chinese medicine (TCM). The objectives of this study were to compare the characteristics of menopausal women who did not use any treatment, who used hormone replacement therapy (HRT), and who used TCM to treat their climacteric symptoms. METHODS: The study subjects were 182 women aged 46-55 years (non-treatment: 61, HRT: 60, TCM: 61). Variables used included socio-demographics, climacteric symptoms, other physical symptoms, experiences with the treatment, and attitude toward menopause. Multivariate analyses were performed using multinomial logistic regression. RESULTS: Compared with women in the non-treatment group, employed women were more likely to have received HRT or TCM. Women in the TCM group were more likely to have comorbid non-climacteric physical symptoms and were less likely to have family support for the use of HRT. Women in the TCM group were more likely to have an attitude regarding menopause as a natural phenomenon and as having little impact on attractiveness and sexual life. Severity of current climacteric symptoms was lower in the HRT group, while it was higher in the TCM group. These factors accounted for 66.1% of the model variances. CONCLUSIONS: Women in different treatment groups had different characteristics. Health professionals should be aware of the differences and provide information on treatment options in order to help and support women in making treatment decisions.     

The climacteric,osteoporosis and hormone replacement; views of women aged 45–49

We report climacteric symptoms among women aged 45–49, and their attitudes towards HRT and osteoporosis prevention. Semi-structured questionnaires were administered to 481 women attending for bone density screening after random invitation. We recorded social class, menopausal status, history of HRT exposure and climacteric symptoms, awareness of HRT and osteoporosis, and potential willingness to consider HRT before and after bone densitometry. In total, 294 (61%) were from non-manual social classes; 338 (70%) were premenopausal, 68 (14%) postmenopausal and 75 (16%) uncertain; 101 (21%) were current/previous HRT users. Three or more climacteric symptoms were experienced by 189 (56%) of premenopausal women, compared to 64 (94%) of postmenopausal women. Most women had heard of HRT (96%) and osteoporosis (84%), usually from women's magazines or friends. HRT was usually prescribed for climacteric symptoms and, in one case, for osteoporosis prevention. Side effects were reported with most HRT preparations and affected 38% of all users. Of the 380 (79%) women who had never taken HRT, half had concerns about such treatment, and few wanted it at the menopause. However, 364 (96%) said they would consider HRT if their bone scan suggested increased osteoporosis risk. In conclusion, women around the menopause experience considerable climacteric morbidity, but are often anxious about HRT use. Better health education might improve HRT uptake, while long-term compliance might be enhanced by disclosure of fracture risk.     

Consciousness about climacteric and menopausal symptoms affects the mental health of middle-aged women

Consciousness about climacteric and menopausal symptoms in relationship to menopausal stage and mental health was investigated. Midlife women (N = 407, 40-60 years old) were asked about their menstrual status, consciousness of climacteric and menopausal symptoms, self-esteem and depression. Based on their menstrual status, 222 participants were divided into three groups (pre-menopause, peri-menopause, and post-menopause). The main results are as follows. Women who were pre-menopausal had a negative consciousness about menopause, which contributed negatively to their self-esteem. Women who were perimenopausal or post-menopausal had more symptoms, which contributed negatively to their mental health. These results indicate that middle-aged women should be provided with interventions focusing on their menopausal status.     

Health behaviors and other characteristics of women on hormone therapy: results from the Third National Health and Nutrition Examination Survey, 1988-1994

OBJECTIVE: To examine the prevalence of hormone therapy (HT) use and compare demographic characteristics, health behaviors, and health indicators between current HT users and never-users in a nationally representative sample of postmenopausal women. DESIGN: The Third National Health and Nutrition Examination Survey was a cross-sectional survey conducted between 1988 and 1994, including 3,673 postmenopausal women aged 40 years and older. RESULTS: Overall, 419 (11.4%) of the women reported current HT use, 857 (23.3%) reported past use, and 2,397 (65.3%) were never-users. Non-Hispanic black women and women aged 70 years or older were less likely to be current users. Higher socioeconomic status (education and income) and surgical menopause were associated with increased odds of current hormone use. After adjusting for the above variables, women who reported being inactive during leisure time and obese women (body mass index >or= 30) were less likely to be current users. Women who had 5 to 29 alcoholic drinks per month, perceived their health status as "good," took a multiple vitamin, were aware of having high blood cholesterol, and had a clinic for regular medical care were more likely to be current users. Smoking habits were not significantly different between the groups. CONCLUSIONS: Current HT users have different demographic profiles and may lead healthier lives than never-users. This is important to take into account when studying the effects of HT, and it may partly explain differences in findings regarding the health effects of HT use in observational studies compared with randomized clinical trials.     

Women at mid-life: symptoms, attitudes, and choices, an internet based survey

OBJECTIVES: This Internet-based survey questioned middle-aged women (age 35-69) regarding their current attitudes, beliefs, symptoms, and treatment choices surrounding the climacteric. METHODS: 448 respondents completed the 189 item, WEB-based survey that included measures of quality of life, lifestyle habits, anxiety symptoms, and questions regarding attitude toward and sources of information about menopause. RESULTS: Three relationships were hypothesized and supported: frequency of self-reported menopause symptoms would be: (1) negatively associated with healthy behaviors; (2) positively associated with anxiety; (3) positively associated with stress. All measures were self-report. Fatigue, muscle and joint aches, and impatience were the most commonly reported symptoms. No particular symptom was strongly correlated (r > 0.4) to lifestyle behaviors. Questions regarding information exchange reveal that many women are not consulting with their healthcare providers about HRT or frequently discussing alternatives. Many receive health information from lay sources. CONCLUSIONS: There is a need for improved information exchange on this subject. Our results are similar to those found using large randomized telephone survey methods, which supports the use of the Internet as a reliable and convenient venue for gathering data regarding health issues. It is important to consider healthy lifestyle behaviors toward the regulation of the climacteric syndrome.