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

doi:10.3122/jabfm.19.2.122

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Figure 1.
Percentage of Physicians Using Specific Treatment Modalities for Vaginal Dryness.
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Figure 2.
Percentage of Physicians Using Specific Treatment Modalities for Vasomotor Symptoms.
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Figure 3.
Percentage of Physicians Using Specific Treatment Modalities for Sleep Disturbance.
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Figure 4.
Percentage of Physicians Using Specific Treatment Modalities for Decreased Libido.
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Figure 5.
Percentage of Physicians Using Specific Treatment Modalities for Emotional Lability.
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Figure 6.
Percentage of Physicians Using Specific Treatment Modalities for Anxiety.
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Figure 7.
Percentage of Physicians Using Specific Treatment Modalities for Depression.
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Figure 8.
Percentage of Physicians Using Specific Treatment Modalities for Irregular Menses.
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Figure 9.
Percentage of Physicians Using Specific Treatment Modalities for Fatigue.

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Table 1.

Characteristics of Physician Respondents to Survey

	N	Percentage
Residents	148	72.5
Faculty	62	27.5
Female	120	57.7
Male	88	42.3
Female Residents	80	54.1
Male Residents	68	45.9
Female Faculty	35	62.5
Male Faculty	21	37.5
Average number of women patients aged 45 to 65 seen each week:
1 to 10	108	53.7
11 to 20	57	28.4
21 or more	36	17.9

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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 Patients	Percentage of Physicians
Fatigue	40.1
Vasomotor symptoms	38.9
Irregular menses	36.9
Emotional lability	35
Sleep disturbance	25.4
Depression	24
Anxiety	23.7
Decreased libido	17.9
Vaginal dryness	13.6

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Table 3.

Hierarchy of Treatment Recommendations For Common Menopausal Symptoms (Percentages)

	Irregular Menses	Vaginal Dryness	Vasomotor Symptoms	Sleep Disturbance	Decreased Libido	Emotional Lability	Fatigue
Higher	HRT (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)
Lower	Psych.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.

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Table 4.

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

	Percentage Who Recommend Hormone Therapy For Specific Symptoms
	Vaginal Dryness	Vasomotor Symptoms	Sleep Disturbance	Decreased Libido	Emotional Lability	Anxiety	Depression	Irregular Menses	Fatigue
Residents	68.9	41.2	6.1	35.1	12.8	7.4	6.1	45.9	8.9
Faculty	69.6	76.8	23.2	53.6	35.7	17.9	12.5	66.1	23.2
P value	NS	.001	.001	.025	.001	.001	NS	.012	.009

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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

	Changed	Not changed	P Value
Total sample
Gender
Female	85.8	14.2	.014^{^**}
Male	71.6	28.4
Training status
Resident	75.2	24.8	.005^{^*}
Faculty	92.7	7.3
Average number of female patients aged 45 to 65 seen each week
1 to 10	75.2	24.8	.018^{^**}
11 to 20	80.7	19.3
21 or more	97.1	2.9

* P < .05.
** P < .001.

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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.”