A survey of views on hormone replacement therapy

Abstract

Objective To investigate the attitude of consultant gynaecologists and general practitioners to various aspects of hormone replacement therapy and to compare the findings in these two groups.Design Anonymous postal survey of 589 general practitioners and 998 consultant gynaecologists; 373 (63 %) and 655 (66 %) valid replies, respectively, were received. Main outcome measuresViews on universal treatment of eligible women, indications for hormone replacement therapy, prescribing practice, pretreatment investigation, monitoring, and contraindications to treatment. ResultsMore consultants (64 %) than general practitioners (56 %) thought hormone replacement therapy should be offered to all eligible women, with a significant trend against treatment amongst more senior consultants. Most practitioners were prepared to offer treatment before the cessation of menstruation, but only 27 % of consultants and 11 % of general practitioners recommended indefinite treatment. Most limited treatment to less than 10 years. Menopausal symptoms, premature natural and surgical menopause, and a family history of osteoporosis were regarded as indications for treatment, but less than half felt established osteoporosis an indication. Hormone replacement therapy was judged to reduce the risk of ischaemic heart disease and osteoporosis by both groups but there was less consensus on the prevention of cerebrovascular accident. In general, consultants had more faith in hormone replacement therapy as prophylaxis. One-quarter of consultants said that hormone replacement therapy should be initiated by consultants. Only 4 % of general practitioners shared this view. About 30 70 of both groups required mammography, but less than 10 % required sophisticated tests. A range of common cardiovascular conditions were regarded as contraindications, although general practitioners were more likely to regard thrombosis and cerebrovascular accident as contraindications. Breast cancer and a family history of breast cancer were regarded with suspicion by both groups.Conclusions Practitioners were positively inclined to hormone replacement therapy, but many were unconvinced of its chronic use and use in those with cardiovascular conditions. There were differences in views as to who should initiate therapy.38, 398-401. 5 I 9-522. 822-824.

Prevalence and characteristics associated with use of hormone replacement therapy in Britain

“…Certainly, there was no firm evidence that women with a history of vascular or fracture problems were more likely to be offered these treatments, even though HRT is often advocated for the prevention of cardiovascular and skeletal disease. This probably reflects continuing uncertainty among the medical profession, particularly among general practitioners, about the balance of risks and benefits associated with these preparations 25,26 .…”

Attitude, subjective norm and perceived behavioural control as predictors of women's intentions to take hormone replacement therapy

“…Many general practitioners are equivocal about HRT. A study of GPs in Middlesex (Wilkes & Meade, 1991) concludes that 'there is considerable uncertainty among general practitioners as to the balance of beneficial and harmful effects of hormone replacement therapy in the long term, particularly to its use for prevention of osteoporosis' (p. 1317), and a more recent survey of general practitioners and gynaecologists (Norman & Studd, 1994) showed little agreement on prescription of HRT. Sixty-four per cent of consultants and 56 per cent of GPs thought it should be offered to all eligible women.…”

Towards understanding women's decisions to cease HRT

“…They could not explain it nor did they understand it and this mirrors a major problem in the literature, namely the lack of consistent and readily available information on this key topic. Secondly, reflecting the current state of scientific knowledge and the idiosyncratic behaviour of physicians ( Norman & Studd 1994), HRT was frequently prescribed on an open‐ended basis with uncertainty on the part of doctors and women about how long it could and should be taken for symptom relief and/or prophylactic purposes. Both these points emerged in Tess's account.…”