The majority of Ontario doctors agree on the risks and benefits of hormone replacement therapy (HRT) for women and are consistent in their reasons for prescribing it, says a recent University of Toronto study.
There is some controversy in the medical community about the safety and effectiveness of HRT and a lack of explicit guidelines regarding its use. "Until now we didn't know how physicians practised in a climate of uncertainty with few clear recommendations regarding HRT, but this study indicates they have similar motivations and approaches in prescribing, based on the available medical literature," says study co-author Dr. Marsha Cohen of the department of health administration and the Centre for Research in Women's Health.
More than 98 per cent of the respondents in the study's survey of 327 Ontario family physicians and gynecologists said the prevention of osteoporosis is an important reason for prescribing HRT; almost 90 per cent said the prevention of coronary artery disease is also a consideration. (A more recent study indicates HRT may not protect against heart disease as it was thought to before, but this information was not available to physicians at the time of the survey.) The physicians cited breast cancer and a strong family history of breast cancer as the most significant reasons not to put women on HRT.
Other reasons cited for prescribing HRT include artificial or early menopause, hot flushes, mood changes and patient requests. Cohen's co-authors were Lynn Elinson, whose Ph.D. thesis was the basis for the paper, and Dr. Tom Elmslie of the department of family medicine at the University of Ottawa. The study, published in the Sept. 21 issue of the Canadian Medical Association Journal, was supported in part by a fellowship from the National Health Research Program.
Journal
Canadian Medical Association Journal