Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy

Ettinger, Bruce; Grady, Deborah; Tosteson, Anna N.A.; Pressman, Alice; Macer, Judith L.

doi:10.1016/j.obstetgynecol.2003.08.007

Cited by 151 publications

(104 citation statements)

References 8 publications

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“…In a telephone survey of 670 women who participated in a large HMO organization, the investigators assessed the level of knowledge of the results and whether the results influenced the decision to remain on HT or discontinue therapy (32). The average age range was from 50-69 years and women had been on estrogen for at least 1 year.…”

Section: Results From the Women's Health Initiative (Whi)mentioning

confidence: 99%

Estrogen therapy for postmenopausal osteoporosis

Fitzpatrick

2006

Arq Bras Endocrinol Metab

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Osteoporosis is a worldwide problem that results in fractures that lead to disability and high costs to society. Estrogen therapy is frequently utilized for postmenopausal symptoms, but also has proven protective effects on the skeleton. The main action of estrogen at the cellular level is to inhibit the osteoclast by increasing levels of osteoprotegerin (OPG). OPG binds to the receptor activator of NFkB and prevents osteoclast differentiation, activity and survival. Numerous trials have demonstrated the positive effect estrogen has on the improvement of bone mineral density, and lower doses have also proven efficacious with fewer side effects. Both observational and randomized clinical trials have demonstrated the ability of estrogen treatment to prevent fractures. Topics that remain controversial include the appropriate length of estrogen treatment for postmenopausal women and the appropriate follow-up after treatment discontinuation. RESUMO Terapia Estrogênica Para Osteoporose na Pós-Menopausa.Osteoporose é um problema universal que resulta em fraturas e leva a incapacidade e alto custo para a sociedade. A terapia estrogênica é freqüentemente utilizada nos sintomas da pós-menopausa, mas também tem comprovado efeito protetor no esqueleto. A principal ação a nível celular é inibir os osteoclastos por causa do aumento dos níveis de osteoprotegerina (OPG). A OPG liga-se ao receptor ativador do NFkB e impede a diferenciação, atividade e sobrevida dos osteoclastos. Numerosos estudos demonstraram o efeito positivo do estrogênio na melhora da densidade mineral óssea e doses mais baixas apresentam comprovada eficácia com menos efeitos colaterais. Tanto os estudos observacionais como os clínicos demonstraram a capacidade da terapia estrogênica na prevenção de fraturas. Alguns tópicos permanecem em controvérsia, como a terapia prolongada e um seguimento adequado após a descontinuação do tratamento.

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Section: Results From the Women's Health Initiative (Whi)mentioning

confidence: 99%

Estrogen therapy for postmenopausal osteoporosis

Fitzpatrick

2006

Arq Bras Endocrinol Metab

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“…Given that insomnia affects one-third of the population at any one time (Bartlett et al 2008), we expected a dramatic decline in the use of zolpidem akin to the discontinuation of hormone-replacement therapy after the findings from the Women's Health Initiative trial became widely publicised by the media (Ettinger et al 2003;Lawton et al 2003). One possible reason for the subdued response toward zolpidem might be that patients who had not experienced the adverse effects reported in the media were more strongly influenced by the therapeutic benefits that they derived from using zolpidem.…”

Section: Discussionmentioning

confidence: 99%

Primary health care practitioner perspectives on the management of insomnia: a pilot study

Cheung

Atternäs

Melchior

et al. 2014

Aust. J. Prim. Health

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Abstract. This paper reports a qualitative pilot study exploring primary care health practitioners' perspectives on the management of insomnia following the extensive media coverage on the adverse effects of zolpidem in 2007-08. General practitioners and community pharmacists were recruited throughout metropolitan Sydney, New South Wales using a convenience sampling and snowballing technique. Demographic information was collected from each participant followed by a semistructured interview. In total 22 participants were interviewed, including eight general practitioners and 14 community pharmacists. Interview transcripts were analysed using 'framework analysis'. Participants' responses illuminated some of the key issues facing primary care practitioners in the management of insomnia. Practitioners perceived there to be an overreliance on pharmacotherapy among insomnia patients and inadequate support for directing patients to alternative treatment pathways if they require or prefer non-pharmacological management. Current prescribing trends appear to favour older benzodiazepines in new cases of insomnia whereas some successful sporadic users of zolpidem have continued to use zolpidem after the media coverage in 2007-08. The findings of this pilot study suggest the need to address the limitations in the management of insomnia within the current health care system, to revise and disseminate updated insomnia guidelines and to provide educational opportunities and resources to primary care practitioners concerning management options.

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“…The actual duration of use within a duration category will tend to be longer in current than in past users (Ettinger et al, 2003), and, in cohort studies, duration of use is underestimated in current users since exposure is only assessed at baseline. Nondifferential misclassification of duration of use is also likely to be higher with past use, leading to a greater underestimate of the risk associated with past use.…”

Section: Discussionmentioning

confidence: 99%

An overview of menopausal oestrogen–progestin hormone therapy and breast cancer risk

2005

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Results from the Women's Health Initiative (WHI) trial support findings from observational studies that oestrogen -progestin therapy (EPT) use is associated with an increase in breast cancer risk. We conducted a meta-analysis using EPT-specific results from the Collaborative Group on Hormonal Factors in Breast Cancer (CGHFBC) pooled analysis and studies published since that report to obtain an overview of EPT use and breast cancer risk. We also assessed risk by histologic subtype of breast cancer, by schedule of the progestin component of EPT, and by recency of use. We estimate that overall, EPT results in a 7.6% increase in breast cancer risk per year of use. The risk was statistically significantly lower in US studies than in European studies -5.2 vs 7.9%. There was a significantly higher risk for continuous-combined than for sequential EPT use in Scandinavian studies where much higher total doses of progestin were used in continuous-combined than in sequential EPT. We observed no overall difference in risk for lobular vs ductal carcinoma but did observe a slightly higher risk for current vs past EPT use. The Collaborative Group on Hormonal Factors in Breast Cancer (CGHFBC) (1997) pooled data from 51 epidemiologic studies to obtain an overall estimate of breast cancer risk associated with menopausal hormone therapy (HT) use. The risk estimate for oestrogen therapy (ET) use was based on large numbers of cases and controls, but the oestrogen -progestin therapy (EPT) result was not. Since then, a number of statistically powerful studies have evaluated EPT in relation to breast cancer risk. Some of these further evaluated differences in risk by schedule of progestin administration, that is, sequential vs continuous-combined use (Magnusson et al, 1999;Ross et al, 2000;Schairer et al, 2000;Newcomb et al, 2002;Porch et al, 2002;Weiss et al, 2002; Million Women Study, 2003;Olsson et al, 2003;Stahlberg et al, 2004), and in relation to histologic subtype of breast cancer (Schairer et al, 2000;Daling et al, 2002;Newcomb et al, 2002;Newcomer et al, 2003;Ursin et al, 2002;Weiss et al, 2002).We conducted a meta-analysis of the results reported by the CGHFBC and studies published since that overview through March 2004 to provide a more precise estimate of the risk from EPT and how it is affected by schedule of progestin administration and histologic subtype. MATERIALS AND METHODSWe used the Medline database to compile a list of studies subsequent to the CGHFBC report investigating the relationship between EPT and incident breast cancer risk using the Medical Subject Headings (MeSH): postmenopausal, oestrogen progestin therapy (or combined therapy), and breast cancer. For this analysis we did not include studies that presented results only for overall HT, nor did we include studies that only evaluated ET use, nor studies only evaluating breast cancer mortality. A total of 22 studies were identified for possible inclusion (Persson et al, 1996(Persson et al, , 1997Magnusson et al, 1999;Li et al, 2000Li et al, , 2002Li et al, ,...

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Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy

Abstract: During the 6-8 months after publication of Women's Health Initiative trial findings, most regular postmenopausal HT users tried to stop using HT, despite not being well informed about the Women's Health Initiative findings.

Cited by 151 publications

References 8 publications

Estrogen therapy for postmenopausal osteoporosis

Estrogen therapy for postmenopausal osteoporosis

Primary health care practitioner perspectives on the management of insomnia: a pilot study

An overview of menopausal oestrogen–progestin hormone therapy and breast cancer risk

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