Perceptions of hormone replacement therapy among African American women

Hormone replacement therapy (HRT) is commonly prescribed for women to relieve symptoms associated with menopause. The medical community does not uniformly recommend HRT, and ethnic and cultural differences may influence a woman's decision to request and adhere to it. Thirty-eight African American women were enrolled in a qualitative study to investigate beliefs, attitudes, and knowledge about HRT. Data collected from six focus groups were part of Ethnicity, Needs, and Decisions of Women (ENDOW), a multisite project investigating decision making and hysterectomy. Participants, age 30 to 65 years, were recruited from community agencies and public health clinics. The women were aware of the medical indications for HRT and its risks and benefits. Although a majority of participants were past or current users, they expressed reservations about the use of HRT and wanted a better dialogue with health care providers, including information about alternative treatments.     

Menopausal experiences and hormone replacement therapy use among women with physical impairments.

This study describes the menopausal experiences of women with physical disabilities and their knowledge and use of hormone replacement therapy (HRT). 166 women completed a mailed survey of demographic and disability characteristics, health history, menopausal information, and HRT knowledge. The typical respondent was a 52-year-old, Anglo, college-educated woman with a neuromuscular disorder. Half of the menopausal women were taking HRT, and 47% had a hysterectomy. HRT use was significantly associated with hysterectomy status, amount of HRT information received from providers, and regular gynecologic examinations. Effective interventions are needed to assist these women in making key health decisions during menopause.     

Managing menopause: a critical feminist engagement

Feminist critiques of menopause have been beneficial in opening up important public health debates around menopause. One of the most contentious public health issues concerns the use of Hormone Replacement Therapy (HRT) for the prevention of osteoporosis, heart disease and, more recently, Alzheimer's disease, in postmenopausal women. For preventive purposes, it is recommended that women should take HRT for 10-15 years and preferably remain on the therapy for the remainder of their lives. This is despite reported increased cancer risks associated with HRT, side effects and considerable cost of the therapy. Various studies have shown that up to 50% of women stop taking HRT after 9-12 months. These figures are used in the medical literature as an indication of women's non-compliance. Extending earlier feminist critiques around menopause and HRT, this paper discusses a critical feminist engagement around issues of women's perceived non-compliance with HRT.     

Rural Women and Osteoporosis: Awareness and Educational Needs

CONTEXT: Little is known about rural women's knowledge about osteoporosis. PURPOSE: To explore what women from high-prevalence rural communities know about osteoporosis and to assess their learning preferences. METHODS: We surveyed 437 women in rural Washington and Oregon. FINDINGS: The response rate was 93% (N = 406). The mean age of respondents was 63 years (range 16-95) and 74% (n = 301) of women were postmenopausal. While 27% over age 40 (n = 111) reported having a fracture as an adult, less than half of this group (42%, n = 47) considered themselves at risk for osteoporosis. Of the 42% (n = 171) who rated their knowledge of osteoporosis good or excellent, only 18% (n = 30) answered calcium and vitamin D questions correctly. About half (53%; n = 214) exercised 3 or more times per week. Reported sources of osteoporosis information included television, magazines, health care providers, and personal contacts. Over half of the women in this study wanted more information about osteoporosis, most wanted it before age 50, and health care providers were a preferred source. Less than half of participants reported having Internet access. CONCLUSIONS: While many participants underestimated their osteoporosis risk, most women wanted to learn more about osteoporosis and health care providers remain a preferred source of information.     

Women veterans and menopause: Knowledge and preferences

The increasing number and older age of women Veterans receiving care at Veterans Health Administration (VHA) requires health-care providers to adjust to their changing patient population. We explored women Veterans’ self-reported knowledge of menopause, current/preferred sources of menopausal health information, and perceptions/barriers regarding treatment of menopausal symptoms. Three focus groups were conducted at two South Florida VHA facilities in 2014, which included 30 women Veterans (aged 45–60 years) who visited VHA primary care clinics at least once in the past year. Participants reported using various sources to obtain general and menopausal health information, particularly family, friends, and the internet. Some women also had discussions with their health-care providers, but believed not all VHA providers were knowledgeable about menopause. Most preferred older female providers, thinking they were better informed about menopausal issues. Women favored complementary/alternative therapies and were against using hormone therapy (HT) for symptom relief, although they felt they were insufficiently informed about HT. Menopausal-age women are the fastest growing group at VHA. To provide better care and enhance their experiences, the VHA must educate all primary care providers about menopausal care and strive to address women Veterans’ menopausal concerns and preferences.     

Overview of women's decision making regarding elective hysterectomy, oophorectomy, and hormone replacement therapy

Over 600,000 hysterectomies are performed each year in the United States, the majority of which are to improve quality of life for perimenopausal women. Hysterectomy rates for common conditions differ between African American and white women, and African American women undergo surgery at a younger age for most diagnoses. Many hysterectomies are accompanied by elective oophorectomy, and hormone replacement therapy (HRT) is commonly used, especially among women experiencing surgical menopause, despite questions about its long-term benefits and risks. Despite the high rates of hysterectomy in the United States, little is known about how women make decisions regarding this surgery and, in particular, how ethnic and cultural factors may influence these decisions. This article provides a review of what is currently known about the epidemiology of hysterectomy, oophorectomy, and HRT use and identifies gaps in knowledge about women's decision making, with a special focus on ethnic variations and cultural influences, issues addressed by the Ethnicity, Needs, and Decisions of Women (ENDOW) project.     

佛山市社区妇女围绝经期健康现状及需求的调查

目的:了解佛山市社区围绝经期妇女的健康状况及其保健需求,为构建新型社区卫生服务模式提供决策依据。方法:用整群随机抽样方法,选择佛山市社区308名45~60岁妇女为调查对象,以Greene症状量表和自编问卷形式进行调查。结果:佛山市社区妇女自然绝经年龄平均47.9岁,现患病前4位顺位分别是心血管疾病(20.10%)、骨关节疾病(12.70%)、高脂血症(8.10%)和子宫肌瘤(7.50%),围绝经期综合征的发生率为68.80%。最为痛苦的前4位症状是:烦躁54.20%(115/212),失眠52.36%(111/212),肌肉、骨关节疼痛48.10%(102/212),容易疲劳和乏力46.20%(98/212),有关"绝经的原因、绝经的远期影响、保健措施、骨质疏松的危险因素"等正确回答率均低于23.10%。结论:围绝经期综合征及相关疾病严重地影响围绝经期妇女的身心健康,应提供全方位的保健服务。     

Perceptions, attitudes, and self-management of natural menopausal symptoms in ghanaian women

The use of hormone replacement therapy (HRT) to alleviate menopausal symptoms is associated with risks of cardiovascular and thromboembolic diseases and breast cancer. In this qualitative study, we investigated how women in low-resource settings manage menopausal symptoms without HRT. We interviewed 34 menopausal Ghanaian women about their sources of information, perceptions, attitudes, and self-management methods for alleviating menopausal symptoms. The majority of the women used a combination of nonhormonal medications and complimentary and alternative medicine (CAM), including dietary modifications, exercise, and other lifestyle changes to effectively manage menopausal symptoms. Sources of information about menopause influenced participants' perceptions, attitudes, and self-management choices.     

酒泉市医务人员激素补充治疗的认知现状调查

目的调查酒泉市医务人员对围绝经期综合征的激素补充治疗(hormone replacement therapy,HRT)的认知和使用情况,为有针对性的开展中老年生殖健康服务提供依据。方法对酒泉市医院260名40~60岁医务人员通过调查表进行横断面调查。调查内容包括对HRT的认知、使用和需求等。结果接受调查的医务人员平均绝经年龄为(46.8±4.1)岁,16.92%的医务人员自认为了解HRT,64.62%的医务人员希望了解HRT;14.62%的医务人员推荐使用HRT,不推荐使用的原因中认为绝经是自然过程没必要治疗的占43.24%。曾使用过HRT的占11.54%,但使用HRT 9个月以上的仅占0.96%,担心不良反应是停止HRT的主要原因,占58.33%。结论酒泉市部分医务人员对HRT的知晓率、使用率、推荐率低,因此应加强对医务人员HRT知识的宣传教育。     

Postmenopausal hormone-replacement therapy discredited,except in healthy women shortly after menopause

Results from the Women's Health Initiative randomized trial in 16,608 healthy postmenopausal women have revealed more risks than benefits in terms of invasive breast cancer and cardiovascular disease rates in patients treated for more than 5 years with a combination of conjugated oestrogens and progestin compared with placebo. Hormone-replacement therapy (HRT) is more effective in healthy women (maintaining vascular health) than in older women with atherosclerosis (restoring endothelial dysfunction). The initiation of HRT in patients at risk of a cardiovascular event results in an increased rate of cardiovascular complications and has not been proven beneficial in the long term. The point at which HRT is started after menopause plays a crucial role in the effectiveness of hormones on the vascular system: it is uncertain whether HRT initiated shortly after menopause can delay clinical signs of atherosclerotic disease.     

Perceptions,Attitudes, and Self-Management of Natural Menopausal Symptoms in Ghanaian Women

The use of hormone replacement therapy (HRT) to alleviate menopausal symptoms is associated with risks of cardiovascular and thromboembolic diseases and breast cancer. In this qualitative study, we investigated how women in low-resource settings manage menopausal symptoms without HRT. We interviewed 34 menopausal Ghanaian women about their sources of information, perceptions, attitudes, and self-management methods for alleviating menopausal symptoms. The majority of the women used a combination of nonhormonal medications and complimentary and alternative medicine (CAM), including dietary modifications, exercise, and other lifestyle changes to effectively manage menopausal symptoms. Sources of information about menopause influenced participants’ perceptions, attitudes, and self-management choices.     

A pilot study of women's knowledge of pregnancy health risks: implications for contraception

BackgroundThis study was performed to assess women's knowledge of the health risks of pregnancy and how their assessment of pregnancy risks compared to their estimates of the risks of oral contraceptives.Study DesignA survey, which asked both open-ended and specific questions about the health benefits and risks of pregnancy, was administered verbally on a one-on-one basis to nonpregnant, English-speaking, reproductive-age women.ResultsOf the 248 women who provided information for analysis, over one quarter of women could not correctly name any health risk associated with pregnancy. When shown a list of potential health risks, only 13.3% correctly identified all the health problems that increased in pregnancy. Only 49% knew that risks of venous thromboembolism (VTE), diabetes and hypertension increase in pregnancy; 30.6% did not know that VTE risk increases. Over 75% of respondents rated birth control pills as more hazardous to a woman's health than pregnancy. The greater the women's education, the more likely she was to believe that oral contraceptives are riskier than pregnancy.ConclusionThis pilot project clearly demonstrates a need to assess women's understanding of the health hazards of pregnancy on a national level. Underestimation of pregnancy risks can lead to contraceptive method discontinuation, can decrease motivation to seek preconceptional care and can lead to greater medicolegal liability for providers of obstetrical care.     

Women's control and choice regarding HRT.

The promotion and use of hormone replacement therapy (HRT) is the focus of much medical activity and a social phenomenon studied by sociology. The decision to prescribe HRT by a doctor may be a response to a woman's distress and is a decision involving uncertainty about risks and benefits. Sociological analysis has seen the promotion and use of HRT as medicalisation of the menopause. Through individual interviews and focus groups, this study hears from women how they approach the decision to take HRT or not, and what influences them. The interviews reveal how women who dislike medication in general may consider HRT, influenced by fear of ill health which may be enhanced by the experience of illness in the family and by medical advice. For the women the media and their social contacts were the major sources of information about HRT. In the focus groups the women explored the control they had over the choice to take HRT and what limited this control and they explored the uncertainties and complexities of the decision to take HRT or not. This study brings lay women's voices to the debate about the use and promotion of HRT. The results are also used to test the limits of the theory of medicalisation and to inform doctors of the issues women may bring to a consultation about HRT.     

Patients' understanding of risk: a qualitative study of decision-making about the menopause and hormone replacement therapy in general practice

OBJECTIVE: To explore women's understanding of the risks associated with the menopause and hormone replacement therapy (HRT). METHODS: Two general practices in Cambridge participated in this qualitative study using focus groups and semi-structured interviews. Forty women aged between 50 and 55 years, known to be current users, ex-users, or never-users of HRT were included in the study. RESULTS: Participants viewed risk as a danger: coping with risk required an assessment to facilitate an informed decision. To understand risk and make a personal interpretation, patients used their own knowledge, the presentation and context of that risk, together with their individual belief system particularly relating to representations of womanhood, lay beliefs and fatalism, control and choice. Experience, age and emotions often modified the salience of risk, and participants then used this meaning to weigh up the risks and benefits of a particular threat. CONCLUSION: Participants gained understanding of risk by an active risk assessment process involving individual and complex interplay between knowledge and core beliefs, allowing the assessment of risks and benefits to facilitate an informed decision about the menopause and HRT.     

Health information seeking in context: how women make decisions regarding hormone replacement therapy

This multimethod study explored women's information seeking behaviour and decision making regarding menopause, hormone replacement therapy (HRT), and use of complementary and alternative medicines (CAM) during menopause. This research was underway during the mass media release of the Women's Health Initiative (WHI) estrogen-progestin trial results, allowing an examination of the impact of this news on women's decisions. There were two studies: first, 20 women who currently were or previously had used HRT were interviewed about their experiences with menopause and HRT-related information seeking and decision making. Following this, 285 demographically representative Canadian women aged 45-65 who were current or former HRT users completed a questionnaire. Results indicate that women's information behaviour differed according to which decision they were making (starting versus stopping HRT, considering CAM), as did the sources they consulted. In general, there has been a paucity of good information to help women who are deciding to stop HRT. The types and sources of CAM information often are found to be less than credible and helpful. When information is lacking, women rely on informal sources, and on their own judgement, to make decisions. The results are discussed in the context of information behaviour and help-seeking theory.     

Health Information Seeking in Context: How Women Make Decisions Regarding Hormone Replacement Therapy

This multimethod study explored women's information seeking behaviour and decision making regarding menopause, hormone replacement therapy (HRT), and use of complementary and alternative medicines (CAM) during menopause. This research was underway during the mass media release of the Women's Health Initiative (WHI) estrogen–progestin trial results, allowing an examination of the impact of this news on women's decisions. There were two studies: first, 20 women who currently were or previously had used HRT were interviewed about their experiences with menopause and HRT-related information seeking and decision making. Following this, 285 demographically representative Canadian women aged 45–65 who were current or former HRT users completed a questionnaire. Results indicate that women's information behaviour differed according to which decision they were making (starting versus stopping HRT, considering CAM), as did the sources they consulted. In general, there has been a paucity of good information to help women who are deciding to stop HRT. The types and sources of CAM information often are found to be less than credible and helpful. When information is lacking, women rely on informal sources, and on their own judgement, to make decisions. The results are discussed in the context of information behaviour and help-seeking theory.