‘Hormone averse’ fears remain after WHI: Monash study

Australian midlife women have a poor understanding of the long term consequences of the menopause and hold negative attitudes to hormone replacement therapy, Victorian researchers say.

A study of 32 women aged 46–69 years conducted by Professor Susan Davis and colleagues at the Women’s Health Research Program, Monash University, found that most understood the immediate implications of the menopause on fertility and possible symptoms such as hot flushes.

However few were aware of the longer term effects of menopause such as osteoporosis and fracture risk.

When asked about how they were prepared to manage their health through the menopause, most women referred to lifestyle changes such as diet and exercise, and the use of complementary therapies to manage symptoms.

Menopausal hormone therapy (MHT) was viewed negatively, with a perception that is was synthetic and posed a risk of breast cancer. Several of the women said they would be reluctant to start medication to manage either symptoms of long term consequences  of menopause, saying they had heard of safety concerns.

Half of the eight postmenopausal women interviewed said they believed HRT was overprescribed and they didn’t believe it was necessary because their symptoms “weren’t bad enough.”

And while most of the postmenopausal women said they had seen a medical practitioner – usually a GP – about their menopause, in most cases it was to discuss immediate symptoms. Few had discussions about the long term implications or had any kind of menopause management plan.

The study investigators said their findings revealed “an almost complete absence of knowledge of potential long-term menopause-associated health effects, that health-care seeking pertains to immediate symptoms, and that most women remain MHT averse.”

They said it was also notable that none of the women referred to non-hormonal prescription therapy for menopausal symptom relief.

The authors said the negative attitudes to HRT showed that fears and unease raised by the early findings from the Women’s Health Initiative hormone therapy have remained embedded in the community, despite guideline recommendations that HRT may be used for osteoporosis prevention.

“Taken together, the message is clear: clinicians need to be more proactive in providing women with unambiguous information about menopause-associated health sequelae and the benefits and risks of all available treatment options,” they concluded.

The study is published in Climacteric.

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