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Attitudes of Icelandic women to use of Hormone Replacement Therapy
– Reported, January 24, 2012
A cross-sectional design was conducted with a sample of 561 women drawn from the National Registry of Iceland. A self-administered questionnaire, measuring attitudes towards hormone replacement therapy, attitudes towards menopause, extent and source of menopausal education, symptom experience, health and lifestyle and knowledge about the findings of the Womens Health Initiative, was used. The overall
response rate was 56%. Attitudes to hormone replacement therapy were compared using ANOVA, t-tests and correlations.
Results Participants generally had positive attitudes. Knowledge about the Womens Health Initiative study was not associated with more negative attitudes. However,receiving the information from and discussing it with a doctor were associated with more positive attitudes. Positive attitudes towards hormone therapy were also
associated with higher age, time since last menstrual period and current use of hormone replacement therapy. Negative attitudes towards were associated with use of natural remedies and receiving information or discussing it with family or friends.
Research is needed to identify the dynamics of the medical interview, and the nature of input from friends, spouse and other family members. The content Attitudes of Icelandic women to use of HT of these messages may be different and conflicting, for example between doctors and family members. The nature of this conflict and conflicts of interests need to be identified in order to inform the decision-making process of women. In addition,action needs to be taken in order to strengthen the advisory role of nurses.
There was an increase in the use of combined hormone replacement therapy during menopause in many western countries during the 1990s.
In 2002 the first double blind clinical trial on use of combined hormone replacement therapy among healthy women (Womens Health Initiative study) during menopause was discontinued due to unfavourable risk associated with its use.
Prior to the release of the study findings, a strong association had been found between use of hormones and womens positive attitude towards its use.
What this study adds Icelandic women aged 47 to 53 have rather positive attitudes towards the use of hormone replacement therapy with hormone users having a more positive view than non-users.
Physicians exert a strong influence on womens decision-making about use of hormone replacement therapy around menopause.The further women are into menopause, the more favourable their attitudes.
The findings of the Womens Health Initiative (WHI) study, showed that the risk of using hormone replacement therapy (HRT), consisting of combined hormones of oestrogen and progesterone during menopause, exceeded its benefits (Writing Group for the Womens Health Initiative 2002). The risk was considered so important as to prompt discontinuation of the study 3 years earlier than the initial plan. These findings provoked strong reactions. The medical perspective was described by Cyr as shaking the medical communitys fundamental beliefs about hormone therapy , while the feminist and activist Worcester (2004) claimed that no one should have been surprised by the news that HRT did not prevent heart disease and that its long-term safety was questioned. Many researchers and activists have been saying this for over a decade .
Prior to this, an increase in the use of HRT had been noted in many western countries. In Germany, 3% of 45 to 65 year old women used HRT in 1984/85, while 23% were HRT users in 1994/95 . In Norway, the proportion of HRT users aged 45 to 69 years was 16.3% in 1994 and 19.1% in 1998.
Similar trends were observed in Iceland, where a 5.7 fold increase in use of HRT was observed from 1986 to 1995 , and 57% of 52 to 57 year old women used HRT during the years 1996 2001. Long-term use also increased steadily in Iceland, with 67% of HRT users having been users for more than 5 years in 1999-2001, compared with 49% in 1996-1998.
The dominant HRT discourse began to focus on the risk/benefit ratio of using hormones. Protection against coronary heart disease, osteoporosis, and during the later years, also Alzheimer’s disease had been identified as major benefits. The risk was considered minimal and mostly related to a small increase in the prevalence of breast cancer. The major findings of the study were that healthy women using combined hormones, compared with women using placebo, experienced statistically significantly more serious diseases during the five-year trial period,including an excess of blood clots, cardiovascular disease, breast cancer and stroke.
The relationship between attitudes to HRT and various indicators of menopausal status was tested. A series of ANOVAs and t-tests failed to show any effect of perceived regularity of period, menopausal status (whether menopause is reached or not) or the use of contraceptives on attitudes to HRT. However, a medical intervention such as unilateral oophorectomy is associated with more negative attitudes towards hormone therapy, bilateral oophorectomy is associated with more positive attitudes. No significant differences in attitudes are associated with hysterectomy.
Further research needs to identify the content of the messages sent out to women via the media, the dynamics of the medical interview, and the nature of input from friends, spouse and other family members. The content of these messages may be different and conflicting, as the present study shows to be the case, e.g. between
doctors and family. The nature of this conflict, and possible conflicts of interests, needs to be identified in order to inform the decision making process of women. In addition, action needs to be taken in order to strengthen the advisory role of nursing.
Credits: http://hirsla.lsh.is/lsh/bitstream/2336/5823/1/womens_sveinsdottir_ot.pdf