Physicians and the prescription of hormone replacement therapy in Spain
Introduction
Hormone replacement therapy (HRT) is a pharmacological intervention during a woman's climacteric stage, which began several decades ago despite there being no conclusive results as to its hypothetical beneficial role.
Defence of this therapy is based mainly on the position held by some authors who consider the menopause to be an endocrinopathy due to the cessation of ovary function, the reduction of estrogen levels as a risk factor for various diseases, and as a result of recommendations based on the results of observational studies not backed up by randomised controlled trials (RCT) [1], [2], [3].
From a more biological viewpoint, HRT has been considered the treatment of choice not only to alleviate symptoms resulting from estrogen decline, but also to prevent diseases that constitute the most frequent causes of mortality in this sector of the population [4], [5], [6], [7].
Today, scientific debate on this therapy is particularly current, following the results of several RCT which not only question the preventive role of the therapy but also associate it with pathologies such as invasive breast cancer, heart disease, ictus and pulmonary embolism, which led to one of the most important RCT in this field to be suspended [8], [9], [10], [11], [12].
The literature frequently uses the terms “prevalence of use” and “frequency of prescription” indistinctly, which may go some way to explaining the detected variability between countries, and even within a country. With regard to prevalence of use, the highest figures found in the literature are in the USA (37.6%) and Australia (40.5%) [13], [14]. In northern Europe, frequency of prescription ranges from 33.4% in Denmark to 67% in Belgium [15], [16].
Few studies have been carried out in Spain on the subject, and the results are equally disparate. Sales data for 1991 and 1992 gave a frequency of prescription lower than 1% [17], whereas in a cross-sectional survey carried out in 1995, prevalence of use reached 40% [18].
Little in-depth research has been done on the factors that have conditioned the prescription of HRT in such confusing circumstances but, according to the literature, it is higher in women with early and surgical menopause, and in women with climacteric symptoms [19], [20], [21]. It is also notable that the majority of users were of a higher social class, with a higher educational level and a paid job [22], [23], [24].
The characteristics of prescribing doctors have hardly been analysed, although the information they have at their disposal and their predisposition towards this treatment would seem to have an influence [25], [26], [27].
The aim of this study is to determine the frequency of HRT prescription and identify women's sociodemographic and climacteric factors, as well as variables related to healthcare, associated with the treatment's prescription in women aged 45–65 years in the reference population of a primary healthcare centre in the city of Granada (Spain).
Section snippets
Materials and methods
A descriptive cross-sectional telephone survey was conducted in July 2002, with women aged 45–65 years from the reference population of a primary healthcare centre in the city of Granada (Spain).
The centre has an assigned population of 19,000 inhabitants, from a medium-low socio-economic level. All those attending the centre are registered the first time they attend (for any reason) on a database, from which the sample was extracted, using a simple random process.
A sample size of 364 women was
Results
On the list provided by the centre, the telephone number did not figure in 72 cases, 49 were incorrect and threee women had died. The women immediately below them on the list replaced all. It was impossible to locate 68 women with the three calls that were made at different times of day. Finally, contact was made with 395 women, of whom 15 did not meet the inclusion criteria, and nine did not wish to answer, leaving a total of 371 interviews, and a response rate of 82.8%.
Table 1 shows the
Discussion
Before discussing the results, we would like to comment on the problem of validity that this study could have. Given that this is a retrospective study, the subjects’ memory may be diminished, particularly in the information given by women who underwent the menopause some time ago. To minimise this error, the questions in the survey referred to very specific information which was, in general, easy to remember. Moreover, women were asked to provide the name of the drug and the administration
References (37)
- et al.
Factors influencing the prescription of hormone replacement therapy
Obstetrics and Gynaecology
(1997) - et al.
A comparative study of prescribing of hormone replacement therapy in USA and Europe
Maturitas
(1996) - et al.
Correlates of hormone replacement therapy use in Italian women
Maturitas
(1999) - et al.
Physicians’ perceptions of menopause and prescribing practices in Morocco
International Journal of Gynaecology and Obstetrics
(2001) - et al.
Physician specialty is significantly associated with hormone replacement therapy use
Gynaecology and Obstetrics
(2003) - et al.
What factors account for hormone replacement therapy prescribing frequency?
Maturitas
(2001) - et al.
Determinants of long-term hormone replacement therapy and reasons for early discontinuation
Gynaecology and Obstetrics
(2000) - et al.
Why do postmenopausal women discontinue hormone replacement therapy?
Maturitas
(1999) - et al.
Hormone replacement therapy in Norwegian women, 1996–1997
Maturitas
(2001) - et al.
Hormone replacement therapy: knowledge, attitudes, self-reported use and sales figures in Nordic women
Maturitas
(2000)
Knowledge and use of hormone replacement therapy among Polish women: estimates from a nationally representative study: HORTPOL 2002
Maturitas
Risk of coronary heart disease in women after menopause
Journal of the Indian Medical Association
Postmenopausal hormone replacement therapy: how could we have been so wrong?
Annals of Internal Medicine
Hormone replacement therapy in epidemiologic studies and randomized clinical trials: are we checkmate?
Epidemiology
Hormone replacement therapy and cognition: systematic review and meta-analysis
JAMA: the journal of the American Medical Association
Postmenopausal hormone replacement therapy: scientific review
JAMA: the journal of the American Medical Association
Prevention for the older womanA practical guide to prevention and treatment of osteoporosis
Geriatrics
Observations and advertising: controversies in the prescribing of hormone replacement therapy
Health Care Women International
Cited by (13)
The North-East Moroccan physicians' management of menopause: Prescription vs. nonprescription of hormonal treatment
2022, African Journal of Reproductive Health