Multiple physician groups and the U.S. Preventive Services Task Force recommend that physicians counsel postmenopausal patients about the individual risks and benefits of using hormone therapy. Currently, information about the risks and benefits of hormone therapy is incomplete. In addition, no current studies assess the attitudes, perceptions, and motivations of women faced with the choice of using hormone therapy. Women usually start hormone therapy to relieve menopausal symptoms. They continue or discontinue hormone therapy based on concerns about breast cancer, uterine and endometrial cancer, menstrual bleeding, and other side effects. Few nonusers understand that they have an increased risk of developing osteoporosis based on their estrogen deficiency. Scheid and colleagues examined the relationship between the use of hormone therapy and women's perceptions of the risks and benefits.
Women who participated in a screening program for bone mineral density through 64 centers made up the sample population. Women who agreed to participate were asked to complete a questionnaire that included information on demographics, clinical characteristics, body orientation, health, menopausal symptoms and attitudes about these symptoms, and use of prescribed or nonprescribed treatments for menopause symptoms or osteoporosis prevention. The participants were asked to estimate their lifetime probability of developing breast cancer, uterine cancer, or osteoporosis. They also were asked the same question concerning lifetime probability of myocardial infarction when taking or not taking hormone therapy. The questionnaire had a final section that collected information on the women's quality of life at their current health status and what it would be if they developed breast cancer, uterine cancer, osteoporosis, or myocardial infarction.
The attitudes of women who used or did not use hormone therapy did not differ with regard to preventing menopausal symptoms, general health, body orientation, and locus of control. Women who were using hormone therapy perceived a greater reduction in the risk of developing osteoporosis and myocardial infarction than women who did not use hormone therapy. Both groups estimated their lifetime probability of developing breast cancer, uterine cancer, osteoporosis, and myocardial infarction at inflated levels when compared with established probabilities. Women who did not use hormone therapy perceived a greater increase in the risk of developing breast or uterine cancer if they started hormone therapy, compared with the perceived risk among women who were already using hormone therapy. Women who used hormone therapy believed that they had a lower risk of developing osteoporosis and myocardial infarction because they were using hormone therapy. Quality-of-life measurements were similar in both groups except in regard to osteoporosis.
The authors conclude that women overestimate the risk of the four diseases studied regardless of their current hormone therapy status. Women who use hormone therapy believe these medications convey a greater reduction in risks for osteoporosis and myocardial infarction, with a smaller increase in the risk of developing breast and uterine cancers. Continuing efforts to assist women in understanding the risks and benefits of hormone therapy would be helpful.
editor's note: Physicians should be aware of their patients' understanding of the risks and benefits of hormone therapy during menopause. Along with studies questioning some previous assumptions about this therapy, patients are looking to their physicians for balanced information. The study by Scheid and colleagues demonstrates that, despite much information in the lay press, patients still lack an understanding of the risks and benefits of hormone therapy and tend to overestimate both. When discussing hormone therapy with patients, physicians should provide balanced information and obtain informed consent if patients choose to initiate this therapy.—K.E.M.