BOSTON, Sept. 5 /PRNewswire/ via Individual Inc. -- A recent survey of 252 members of the Prime Plus menopause support group found that a woman's decision whether to use hormone replacement therapy (HRT) is affected not only by HRT treatments that fail to alleviate symptoms, but also by the way in which menopause health care is delivered. The study findings were presented today at the 8th annual meeting of the North American Menopause Society, held in Boston.
The study was conducted to identify the factors in health care delivery and women's experience using HRT, both of which influence long-term adherence, to better help health care providers understand menopausal and post-menopausal women's rationale for treatment.
"Despite the known benefits of hormone replacement therapy, it is estimated only 8 to 12 percent of post-menopausal women use HRT for two years or more, an insufficient time to accrue the long-term bone and cardiovascular benefits," said Dr. Philip Sarrel, professor of obstetrics and gynecology and psychiatry, Yale University School of Medicine, who administered the study.
In the study, the reasons women take HRT include:
- To control symptoms (77%)
- Prevent osteoporosis (73%)
- Prevent heart disease (55%)
- Maintain sexual function (41%)
- Prevent stroke (37%)
- Prevent Alzheimer's disease (32%)
Reasons why post-menopausal women do not use HRT:
- Bleeding (34%)
- Fear of cancer (17%; increased to 22% among peri-menopausal women)
- Weight gain (14%)
- Failure to control symptoms (12%)
Added Dr. Sarrel, "These findings emphasize the need for women to know the symptoms related to hormone deficiency and the effectiveness in adequate HRT in controlling these symptoms. It's also worth noting that maintaining one's sex life is a high priority for using HRT for over 40 percent of the women who use it."
Androgen Education Lags Behind
While 98% of women believe that, for the female body, estrogen is a natural hormone and 67% believe that progesterone is natural, only 46% believe that testosterone (or androgen) is a natural hormone. And, only 17% knew that androgens can prevent osteoporosis.
Androgens are hormones produced in the ovaries and adrenal glands that act on the musculoskeletal, nervous, hepatic and vascular tissues. Women actually make more androgens than estrogens daily and convert the androgens to estrogens. In adult women, androgens have long been known to play a key role in sexuality and to prevent bone loss and increase bone density. Like estrogen, androgen production drops significantly after menopause. Yet the impact of post-menopausal androgen decline has been far less studied than that of estrogen.
"The notion that menopause is a one- or two-year 'event' is an outdated way of looking at what is really a spectrum of symptoms, experienced over as long as a decade, for many women," Dr. Sarrel noted. "Androgen production, except in women undergoing surgical menopause, decreases gradually over the years leading up to menopause and for a decade later. As a result, symptoms due to androgen depletion are to be expected as the menopausal transition begins to persist into late menopause."
According to Dr. Sarrel, these symptoms, observed in surgically menopausal women receiving estrogen replacement therapy, can include more severe and frequent hot flashes, more and long-lasting symptoms due to urogenital atrophy and a greater frequency of psychologic difficulties, including mental depression and loss of libido.
"In another study, women who received estrogen plus androgen showed improvement in sexual desire, fantasy, response and frequency and a decrease in pain with intercourse compared to women who received estrogen alone," he added.
Providers' Role Strongly Influences HRT Usage
Among the key factors influencing the decision to use HRT: the advice of a doctor or nurse and personal experience using the hormones affected almost half the women, while the desire to prevent medical problems affected one- third. However, only half the respondents felt their providers' approach to HRT evaluation was "thorough and complete." Nearly half rated the approach "adequate" and one out of five were dissatisfied with the approach used for their care. And finally, 22% changed providers to find someone who could help them.
Most women (85%) believe that the first menopause visit with their physician should last 30 minutes or longer. Seventy-five percent of women believe a follow-up visit should fall within six months. By contrast, actual first visits lasted less than 15 minutes for approximately 40% and less than 30 minutes for another third.
Sarrel emphasized that the time spent during an appointment proved a key factor in long-term treatment adherence. If the appointment lasted 30 minutes or longer, 85% of the women showed a long-term adherence rate. During these visits, Sarrel suggests physicians discuss the risks and benefits of HRT; conduct a thorough physical examination before prescribing treatment; and tailor the discussion to address an individual woman's symptoms and questions so treatment can be customized, including the addition of androgen to estrogen.
"When women left the appointment fully understanding what the treatment was all about, the long-term continuance rate was over 90 percent," Sarrel said. "If they didn't understand, then the long-term continuance rate was less than two-thirds."
The questionnaire survey was administered to members of Prime Plus during monthly chapter meetings. The respondents included women aged 41 to 69, with an average mean age of 51. Forty-four percent were 12 months post-menopause, and the remainder were peri-menopause with respect to age and symptoms. The survey was underwritten by an unrestricted educational grant by Solvay Pharmaceuticals.
SOURCE: Dr. Philip Sarrel
CONTACT: Claudia D'Avanzo or Megan McDowell, 404-659-4446, for Dr. Philip Sarrel