To explore women's decision-making regarding use of complementary and alternative medicines (CAM) during menopause.
Qualitative interviews were conducted with 20 women who were currently or had previously used hormone replacement therapy (HRT), including questions about their experiences with alternatives to HRT. This was followed by a non-random questionnaire survey of 285 demographically representative Canadian women aged 45-65 who were current or former HRT users.
Fifty-seven percent (57%, n = 162) of women reported either having used or considered a CAM approach for menopause. Women who had tried or considered CAM were significantly younger (mean age = 54.9 years versus 56.8 years; t(280) = 3.4, p
OBJECTIVE: Many observational studies suggest hormone therapy protects against coronary heart disease in contrast to findings from large randomised clinical trials and an observational Danish study. A potential bias in the observational literature concerning the cardiovascular risk and benefits associated with use of hormone therapy is the so-called 'healthy user' phenomenon, i.e. self-selection to HT use is associated with healthier cardiovascular risk profile. This study investigates whether a random sample of Danish women using HT was characterised by a favourable cardiovascular risk profile prior to menopause. METHODS: A sample of 621 women born in 1936 living in Copenhagen County was included in a prospective population-based study initiated in 1976 with follow-ups in 1981, 1987 and 1996. Investigations comprised questionnaires and physical examinations. RESULTS: At 51 and 60 years, respectively, one-third and one-half had ever used HT. At 40 years women who subsequently use HT had lower body mass index, lower self-rated health and lower fasting glucose, but no differences according to blood pressure, cholesterol, triglyceride, physical activity, smoking habits or alcohol consumption. CONCLUSION: In a cohort of Danish women from the general population ever users of HT could not be characterised as unambiguous 'healthy users'.
OBJECTIVES: To assess changes in women's attitudes towards risk and benefits of, and use of hormone treatment in the menopausal transition (HT) before and after Heart and Estrogen/Progestin Replacement Study (HERS) and the oestrogen and progestin trial of Women's Health Initiative (WHI). METHODS: Postal questionnaires to all women 53 and 54 years of age in a Swedish community in 1999 (n=1.760) and 2003 (n=1.733). Data on sales of HT were collected from the database of the National Corporation of Swedish Pharmacies. RESULTS: The fraction of women reporting current use of HT fell from 40.5 to 25.3% (p
OBJECTIVE: To investigate the impact of an information-package (direct mailing) concerning oestrogen therapy, deriving from a consensus conference in 1990, on general practitioners' (GPs') attitudes and knowledge. DESIGN AND SUBJECTS: Controlled randomised study. Two groups of Norwegian GPs. The Intervention group received an information-package consisting of the recommendations from the consensus conference, some headline questions with answers, and a classification of the oestrogens available in Norway, including a table and a graphical presentation of the costs of the different treatments. GPs stated their views on prescribing oestrogen on a five step scale, related to nine short case histories, each containing cues on complaints, smoking, family history suggesting risk for cardiovascular disease, and osteoporosis. MAIN OUTCOME MEASURES: GPs' views on prescribing oestrogen, relation to age, sex, practice type (solo/group) and practice location. RESULTS: The differences in answer distributions between the Intervention (n = 193) and Control (n = 181) groups did not reach statistical significance for any of the nine case histories. The answers indicate a more liberal attitude towards replacement therapy in 1992 compared to a study performed in 1990. The views on contraindications was fundamentally unaltered. CONCLUSION: The study did not reveal any significant effect of direct mailing as means of disseminating consensus conference recommendations to GPs.
Osteoporosis results in fractures and treatment of osteoporosis has been shown to reduce risk of fracture particularly in those who have had a history of fracture.
A prospective study was conducted using patients admitted to a hip fracture rehabilitation program at a large referral center to evaluate the use of treatments recommended for secondary prevention of osteoporotic fracture between September 1, 2001 and September 30, 2003. The frequency of medication use for the treatment of osteoporosis including estrogen replacement therapy, bisphosponates, calcitonin, calcium and vitamin D therapy was determined on admission, at 6 weeks post discharge and one year following discharge. All patients were discharged to the care of their family physician. All family physicians in the referral region received a copy of the Canadian Consensus recommendations for osteoporosis management 1-3 months prior to the study.
During the study period, 174 patients were enrolled and 121 completed all assessments. Fifty-seven family physicians were identified as caring for 1 or more of the study patients. Only 7 patients had previous BMD, only 5 patients had previously been prescribed a bisphosponate and 14 patients were taking calcium and/or vitamin D. All patients were prescribed 2500 mg calcium, 400 IU vitamin D and 5 mg residronate daily during rehabilitation and at discharge.Following discharge, a significant improvement was seen in all clinical indices of functional mobility, including the functional independence measure (FIM), walking distance, fear of falling score (FFS), and the Berg balance score (BBS). At six weeks a significant (p
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The authors investigated a possible contextual effect of neighborhood on individual use of hormone replacement therapy (HRT) and antihypertensive medication (AHM) and the impact of neighborhood social participation on individual use of these medications. They attempted to disentangle contextual from individual influences. Multilevel logistic regression modeling was used to analyze data on 15,456 women aged 45-73 years (first level) residing in 95 neighborhoods (second level) of the city of Malmö, Sweden (250,000 inhabitants) who participated in the Malmö Diet and Cancer Study (1991-1996). AHM use was studied among 7,558 participants with defined hypertension. Of the total variability in medication use in this population, only 1.7% (HRT) and 0.5% (AHM) was between neighborhoods. After adjustment for age, individual socioeconomic factors, individual low levels of social participation, and health and behavioral variables, no neighborhood effect on AHM use was found. However, women living in neighborhoods with low social participation were much less likely to use HRT (odds ratio = 0.36, 95% confidence interval: 0.21, 0.63), especially if they themselves experienced low social participation (synergy index, 1.53) or were immigrants (synergy index, 1.68). The Malmö neighborhoods were homogeneous with regard to HRT and especially AHM use. However, differences in neighborhood social participation affected HRT use independently of individual characteristics.
To assess the patterns of use of reimbursed systemic hormone therapy (HT) and vaginal estrogen preparations among women aged 45 and older in Finland.
Reimbursed purchases of prescribed systemic HT and vaginal estrogen preparations for the years 2003-2012 were obtained from a nationwide prescription registry. Systemic preparations included estrogen patches, gels and tablets, tibolone, continuous combination preparations and sequential combination preparations. Prescribed vaginal estrogens included a vaginal ring and vaginal tablets.
Annual period prevalence for systemic HT and vaginal estrogen use.
The total prevalence of prescribed HT use remained relatively constant (at 26-27%) throughout the studied period, but the share of women using systemic preparations decreased from 21% to 12%, while the share of women using vaginal estrogens increased from 9% to 19%. Decreases were observed for all classes of systemic preparations, although the decrease was largest for sequential combination preparations (from 4.9% to 1.6%) and estrogen tablets (from 5.2% to 2.9%). Continuous combination preparations remained the most commonly used types of systemic preparation (5.4-4.2%). Systemic HT use decreased most among 45-49 year old women (9.5-4.3%), while the use of vaginal estrogens increased most among those aged 65 and over.
Based on the register data, the trends in HT use indicate changed prescribing patterns in accordance with clinical guidelines. It is notable that since 2009, vaginal estrogen was more commonly prescribed than systemic HT.
OBJECTIVES: To assess the current and previous use of hormone replacement therapy (HRT) and alternative remedies in a postmenopausal population and to relate HRT use to previous use of oral contraceptives. MATERIAL AND METHODS: All 1323 women living in Linköping of 55 or 56 years old during 1995 were sent a questionnaire asking for data with relation to health and climacteric symptoms as well as to previous and current use of HRT, oral contraceptives and alternative remedies. RESULTS: Current use of HRT was more common among women who previously used oral contraceptives (41.3%) than among women who had never used oral contraceptives (23.1%). HRT users were also more often physically active, had undergone hysterectomy and had lighter occupation than non-users. Of all women 35% were current users of HRT, half of them for at least 2 years, whereas only 5% had tried HRT and abandoned therapy. Alternative remedies were used by 5% of the women as therapy for climacteric complaints, and about four times as many women had tried such therapy but abandoned it. The only characteristic about use of alternative medicines was that they were used less often by women who had been hysterectomized. No women treated for breast cancer used HRT and only few of them used alternative remedies. CONCLUSIONS: The prevalence of HRT use, as well as compliance, was high. Previous use of oral contraceptives probably affected the attitude towards using HRT.
The use of hormone therapy (HT) for hot flushes has changed dramatically over the past five decades. In this cross-sectional questionnaire study, the aim was to describe the use of HT and alternative treatments and to study the frequency of hot flushes. A further aim was to compare data from the present questionnaire with data from previous studies made in the same geographic area.
A questionnaire was sent to a random sample of 2000 women aged 47-56 years living in Östergötland County, Sweden. The results were compared with findings from previous studies regarding use of HT, alternative treatment and hot flushes, and the number of HT prescriptions dispensed during the corresponding time using data derived from the Swedish Prescribed Drug Registry.
The response rate was 66%. Six percent used HT, in line with prevalence data from the Swedish Prescribed Drug Registry. Alternative treatments were used by 10%. About 70% of postmenopausal women reported flushes and almost one-third of those with flushes stated that they would be positive to HT if therapy could be shown to be harmless, a view more often stated by women with severe complaints of hot flushes (67%).
The use of HT and alternative treatments is low and many women suffer from flushes that could be treated. Women considered their knowledge of the climacteric period and treatment options as insufficient. Individualized information should be given and women with significant climacteric complaints, without contraindications, should be given the opportunity to try HT.
The objective was to assess the impact of different levels of risk of disease on a woman's preferences for health states. Women were provided with health scenarios incorporating different levels of lifetime risks for breast cancer, hip fracture, and coronary heart disease (CHD). In this way, we were able to determine the incremental effect of changes in risks of each disease on preference values.
Preference values and utility scores were obtained for six health scenarios by both the feeling thermometer (FT) and standard gamble (SG) methods. Scenarios presented the different lifetime risks of CHD, breast cancer, and hip fracture associated with and not associated with long-term use of hormone replacement therapy (HRT) and raloxifene. Risks of breast cancer were based on perceived risks and population risks. The sample population consisted of 40 healthy female volunteers aged between 45 and 65 years randomly selected from the Ottawa-Carleton district.
Based on their perceived risk of breast cancer, the women had higher value scores for the raloxifene risk profile than for both HRT (p = .002) and no therapy (p = .003), with similar results for analyses based on population risks and from utility scores. Regression analysis showed that the risk of breast cancer (p