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Research ArticleOriginal Research

Treatment of Menopausal Symptoms in Family Medicine Settings following the Women’s Health Initiative Findings

; The Florida Behavioral Health Research Consortium, Mary Ann Burg, Kathryn Fraser, Serena Gui, Kathryn Grant, Shae Graham Kosch, Barry Nierenberg, Oliver Oyama, Heidi Pomm, Kimberly Sibille, Timothy Spruill and Virginia Swartz
The Journal of the American Board of Family Medicine March 2006, 19 (2) 122-131; DOI: https://doi.org/10.3122/jabfm.19.2.122
Mary Ann Burg
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Kathryn Fraser
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Serena Gui
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Kathryn Grant
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Shae Graham Kosch
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Barry Nierenberg
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Oliver Oyama
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Heidi Pomm
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Kimberly Sibille
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Timothy Spruill
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Virginia Swartz
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Percentage of Physicians Using Specific Treatment Modalities for Vaginal Dryness.

  • Figure 2.
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    Figure 2.

    Percentage of Physicians Using Specific Treatment Modalities for Vasomotor Symptoms.

  • Figure 3.
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    Figure 3.

    Percentage of Physicians Using Specific Treatment Modalities for Sleep Disturbance.

  • Figure 4.
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    Figure 4.

    Percentage of Physicians Using Specific Treatment Modalities for Decreased Libido.

  • Figure 5.
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    Figure 5.

    Percentage of Physicians Using Specific Treatment Modalities for Emotional Lability.

  • Figure 6.
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    Figure 6.

    Percentage of Physicians Using Specific Treatment Modalities for Anxiety.

  • Figure 7.
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    Figure 7.

    Percentage of Physicians Using Specific Treatment Modalities for Depression.

  • Figure 8.
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    Figure 8.

    Percentage of Physicians Using Specific Treatment Modalities for Irregular Menses.

  • Figure 9.
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    Figure 9.

    Percentage of Physicians Using Specific Treatment Modalities for Fatigue.

Tables

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    Table 1.

    Characteristics of Physician Respondents to Survey

    NPercentage
    Residents14872.5
    Faculty6227.5
    Female12057.7
    Male8842.3
    Female Residents8054.1
    Male Residents6845.9
    Female Faculty3562.5
    Male Faculty2137.5
    Average number of women patients aged 45 to 65 seen each week:
        1 to 1010853.7
        11 to 205728.4
        21 or more3617.9
    • View popup
    Table 2.

    Percentage of Physicians Who Say That Common Menopausal Symptoms Are Present in Majority of Women Patients Aged 45 to 65:

    Symptoms Reported in Majority of PatientsPercentage of Physicians
    Fatigue40.1
    Vasomotor symptoms38.9
    Irregular menses36.9
    Emotional lability35
    Sleep disturbance25.4
    Depression24
    Anxiety23.7
    Decreased libido17.9
    Vaginal dryness13.6
    • View popup
    Table 3.

    Hierarchy of Treatment Recommendations For Common Menopausal Symptoms (Percentages)

    Irregular MensesVaginal DrynessVasomotor SymptomsSleep DisturbanceDecreased LibidoEmotional LabilityFatigue
    HigherHRT (50.9)HRT (68.4)HRT (50.9)Lifestyle changes (58.5)HRT (39.2)Psych meds (68.4)Lifestyle changes (67.5)
    Wait and see (50)CAM (12.7)CAM (39.6)Psych meds (33)Lifestyle changes (33.5)Lifestyle changes (41)Wait and see (25.9)
    CAM (8)Lifestyle changes (11.3)Wait and see (27.4)Wait and see (22.2)Wait and see (24.1)HRT (18.4)Psych meds (20.8)
    Lifestyle changes (6.1)Wait and see (8.5)Psych. Meds (17.5)CAM (15.6)Psych meds (17.5)Wait and see (16.5)CAM (19.8)
    LowerPsych.meds (1.9)Psych.meds (0.5)Lifestyle changes (14.6)HRT (10.4)CAM (15.1)CAM (14.2)HRT (13.2)
    • HRT, hormone replacement therapy; CAM, complementary and alternative medicine.

    • View popup
    Table 4.

    Percentage Who Recommend Hormone Therapy for Menopausal Symptoms: Comparison of Residents to Faculty

    Percentage Who Recommend Hormone Therapy For Specific Symptoms
    Vaginal DrynessVasomotor SymptomsSleep DisturbanceDecreased LibidoEmotional LabilityAnxietyDepressionIrregular MensesFatigue
    Residents68.941.26.135.112.87.46.145.98.9
    Faculty69.676.823.253.635.717.912.566.123.2
    P valueNS.001.001.025.001.001NS.012.009
    • View popup
    Table 5.

    Percentage of Respondents Who Changed Practice Patterns after Women’s Health Initiative Study Findings Were Published: by Gender, Training Status, and Average Number of Women Aged 45 to 65 Seen Each Week

    ChangedNot changedP Value
    Total sample
    Gender
        Female85.814.2.014**
        Male71.628.4
    Training status
        Resident75.224.8.005*
        Faculty92.77.3
    Average number of female patients aged 45 to 65 seen each week
        1 to 1075.224.8.018**
        11 to 2080.719.3
        21 or more97.12.9
    • * P < .05.

    • ** P < .001.

    • View popup
    Table 6.

    Common Answers to the Question, ‘How Has Your Prescribing of Hormone Replacement Therapy (HRT) Changed Since Women’s Health Initiative (WHI)?’

    “I don’t use HRT as preventive therapy. Still use as treatment for acute symptoms after risks/benefits explained. Try to get people off it in 2 years or less. Use as a treatment rather than prevention or global measure”
    “I prescribe HRT and ERT significantly less, taper it more quickly, and seek certain alternatives (specifically topical estrogen and Effexor) much more.”
    “Not confident about prescribing HRT anymore and only given for postmenopausal symptoms refractory to other treatment modalities. Confused about what emphasis to put on past research.”
    “The results were overblown. The absolute risks were not as staggering as the relative risks reported. For me, it triggers a discussion with the patient.”
    “I would like to know more about natural options. I would like to see more of this in residency training.”
    “I really don’t like HRT and would not recommend it to any patients. I think things like soy and really more behavioral psychology approaches may be more helpful.”
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The Journal of the American Board of Family Medicine: 19 (2)
The Journal of the American Board of Family Medicine
Vol. 19, Issue 2
March-April 2006
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Treatment of Menopausal Symptoms in Family Medicine Settings following the Women’s Health Initiative Findings
Mary Ann Burg, Kathryn Fraser, Serena Gui, Kathryn Grant, Shae Graham Kosch, Barry Nierenberg, Oliver Oyama, Heidi Pomm, Kimberly Sibille, Timothy Spruill, Virginia Swartz
The Journal of the American Board of Family Medicine Mar 2006, 19 (2) 122-131; DOI: 10.3122/jabfm.19.2.122

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Treatment of Menopausal Symptoms in Family Medicine Settings following the Women’s Health Initiative Findings
Mary Ann Burg, Kathryn Fraser, Serena Gui, Kathryn Grant, Shae Graham Kosch, Barry Nierenberg, Oliver Oyama, Heidi Pomm, Kimberly Sibille, Timothy Spruill, Virginia Swartz
The Journal of the American Board of Family Medicine Mar 2006, 19 (2) 122-131; DOI: 10.3122/jabfm.19.2.122
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