A third of all menopausal and post-menopausal women are undecided about hormone replacement therapy (HRT), according to new research. They may not be getting the information they need to make informed decisions that weigh the risks and benefits involved.
"When it comes to considering the balance of risks and benefits for individual women, one size does not fit all," says Andrea Z. LaCroix, PhD, Group Health Cooperative of Puget Sound, a large HMO headquartered in Seattle. "These decisions are highly complex because women's risk levels, values and preferences differ and because the scientific evidence of benefits and risks continues to evolve," said LaCroix, lead researcher in a study on information and decision making in menopausal women.
The Department of Health and Human Services' Healthy People 2000 has set a goal that 90 percent of perimenopausal women receive HRT counseling for osteoporosis prevention by the Year 2000. Studies have shown that HRT reduces the risk of osteoporosis and heart disease, but no definitive trials have been published. HRT also may lower the risk of Alzheimer's disease and colon cancer. However, it can increase the risk of uterine cancer and thrombosis, but its relation to breast cancer risk remains uncertain.
"Not much was known about the large group of menopausal women -- a full third -- who are undecided about use of HRT," according to Lori Bastian, MD, MPH, Durham Veterans Affairs Medical Center in North Carolina. Bastian is lead author of a study that investigated the attitudes and knowledge base of undecided menopausal women as a first step toward designing interventions to reach this group.
Identifying women who have not made a decision about HRT may help in designing interventions that lead to better personal decisions and greater satisfaction for this group, Bastian and her colleagues believe.
Both studies appear in the December issue of Women's Health Issues.
Using a sample of 318 menopausal women, Bastian and her colleagues found that the undecided women (33 percent) differed from those who decided for HRT (55 percent) and decided against (12 percent) in terms of income, stage of menopause, prior use of HRT, hysterectomy rates, attitudes about menopause, and knowledge about HRT. Women who were undecided about HRT were more likely to have lower incomes and to be less satisfied with information about menopause and HRT they had received from their health care providers than women who had made their decision for or against HRT. The majority of the undecided reported they had just begun menopause.
On the other hand, the surveys conducted at the Group Health Cooperative of Puget Sound with 1083 menopausal women and 366 health care providers found
- Half of all women agreed that taking hormone pills reduced risk of bone fractures, while 30 percent disagreed and 20 percent said they didn't know.
- Half of the surveyed women said they worried that taking hormone pills would increase their risk of breast cancer, 41 percent disagreed, and 9 percent said they didn't know.
- Providers agreed, with few exceptions, that HRT reduces risk of osteoporosis or heart disease.
- 28 percent of providers agreed that a strong scientific case has been made that HRT increases risk of breast cancer, 51 percent disagreed, and 21 percent neither agreed nor disagreed.
The Puget Sound group also developed a HRT workbook that can be incorporated in standard patient appointments for counseling at HMOs. The HMO conducted a pilot study using the workbook with 641 women to assess its impact. Although the results of the trial were described as "modest overall," the participants felt they had covered all their questions to a greater extent than did the comparison group.
The Puget Sound HMO study was supported by funding from the Centers for Disease Control and Prevention. Grant support for the North Carolina study at Duke University Medical Center was provided by the National Cancer Institute.
Duke University study contact:
Lori Bastian, MD, MPH
(919) 286-6936
lbastian@acpub.duke.edu .
Women's Health Issues (WHI) is the official publication of The Jacobs Institute of Women's Health and the only journal devoted to women's health issues at the medical/social interface. It is a journal for health professionals, social scientists, policy makers, and others concerned with the complex and diverse facets of health care delivery to women. WHI publishes peer-reviewed articles as well as position papers and reports from conferences and workshops sponsored by The Jacobs Institute of Women's Health. For information about the journal, contact Warren H. Pearse, MD, at (202) 863-2454.
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