Women's knowledge, attitudes, and management of the menopausal transition

Introduction: Hormone therapy (HT) has been considered as a safe treatment for menopausal symptoms. Use of HT increased dramatically in the 1980s and 1990s. Results from large randomized clinical trials (RCT) could, around the turn of the century, however not find evidence for long-term benefits with HT. These results attracted great attention from media and the scientific community leading to changed treatment guidelines and decreased use of HT. Aim: The overall aim of this thesis was to explore Swedish women’s conceptions, knowledge, management, and attitudes regarding the menopausal transition and HT. Material and methods: To explore and describe women’s conceptions of the menopausal transition women seeking medical advice due to climacteric symptoms were interviewed (n=20) and their statements were analyzed with a qualitative method (paper I). In 1999 (n=1760) and 2003 (n=1733) attitudes to (paper II) and knowledge of (paper III) the menopausal transition and HT among 53- and 54 year old women were investigated with a cross-sectional design using postal questionnaires. We also analyzed if attitudes differed before and after new scientific findings were published on risks and benefits of HT and if knowledge differed between educational levels. Since many women try to abandon use of HT a RCT was performed to study the effect of two different methods to discontinue HT, on recurrence of hot flushes, resumption of HT and on health related quality of life (HRQoL). Women (n=87) with vasomotor symptoms before initiating HT participated. Results: We found that the majority of the middle aged women in our study viewed the menopausal transition as a natural process the nature of which is affected by both hormonal changes and by ageing. Each woman seems to experience a set of psychological and physical symptoms that are in some sense unique to her experience. Women’s answers to the questions about HT demonstrate that attitudes towards HT held by women going through menopause have changed rather dramatically between 1999 and 2003. These changes probably reflect the influence on the women of media reports based on research that identified risks associated with HT that had not been identified before 1998. Women’s knowledge of the effects of HT seems to be unsatisfactory from a clinical perspective. No differences in hot flush frequency and resumption of HT were found between the women randomized to two different modes of discontinuation of HT. Almost 50 % of the women restarted HT within one year after discontinuation. Deteriorated wellbeing and severity of hot flushes were important predicting factors for resumption of HT. Conclusion: It is important to be aware of the individual woman’s conceptions and attitudes about and knowledge of the menopausal transition and HT to be able to individualize the counselling situation. Women who initiate HT due to hot flushes may experience recurrence of vasomotor symptoms and deteriorated HRQoL after discontinuation. A great proportion of them may resume HT. At present knowledge of possible advantages for the taper-down method when discontinuing HT is still lacking

menopausal

Linköping University Medical Dissertation No. 1153 Women’s knowledge, attitudes, and management of th

Vasomotor symptoms usually reappear after cessation of postmenopausal hormone therapy : a Swedish population-based study.

OBJECTIVE:: The purpose of this study was to investigate the extent of reappearance of vasomotor symptoms after cessation of postmenopausal hormone therapy (HT) in women who started HT because of hot flashes. METHODS:: A cross-sectional postal survey was conducted. A validated questionnaire was sent to all women 53 to 54 years old living in Linköping, Sweden (n = 1,733), including questions about menopause, HT, and vasomotor symptoms. Pearson's chi test and logistic regression were used for statistical analyses. RESULTS:: Response rate after one reminder was 77.3%. After omitting incomplete answers, 72.9% remained for analysis. In all women, 319 (25.3%) were current users of HT, 242 (19.2%) were previous users, and 702 (55.6%) were never-users. Of the 242 previous users, 165 (69%) women stated that they had vasomotor symptoms before starting HT. Vasomotor symptoms recurred after cessation of HT in 143 (87%) of these 165 women. We found no significant difference in symptom recurrence in comparisons of the three groups based on usage of HT for 0 to 1, 2 to 4, or 5 years or more. CONCLUSIONS:: Most women who had vasomotor symptoms when they initiated HT reported recurrence of symptoms after cessation of HT (87%), although the flashes were usually reported to be less frequent and bothersome than they were before HT. Effective and safe treatment approaches for women with recurrence of vasomotor symptoms are needed.This is a non-final version of an article published in final form in:Lotta Lindh-Åstrand, Jan Brynhildsen, Mikael Hoffman and Mats Hammar, Vasomotor symptoms usually reappear after cessation of postmenopausal hormone therapy: a Swedish population-based study, 2009, Menopause (New York, N.Y.).http://dx.doi.org/10.1097/gme.0b013e3181a53221Copyright: Raven Press, Ltd

Risk communication in consultations about hormone therapy in the menopause – concordance in risk assessment and framing due to the context

Background It is important for the physician and the patient to have a mutual understanding of the possible consequences of different treatment alternatives in order to achieve a partnership in decision making. Objective The aim of this study was to explore to which degree first-time consultations for discussion of climacteric discomfort achieved shared understanding of the risks and benefits associated with hormone therapy in the menopausal transition (HT). Methods Analysis of structure and content of transcribed consultations (n=20), and follow-up interviews of the women (n=19 pairs of consultations and interviews), from first-time visits for discussion of climacteric discomfort and/or HT with five physicians at three different out-patient clinics of gynaecology in Sweden. Results Four distinctively different interpretations of risk, depending on whether or not benefits were discussed in the same context, emerged from the analysis. On average 5 advantages (range 0-11) and 2 (0-3) disadvantages were mentioned during the consultations. In the interviews the women expressed on average 4 advantages (0-7) and 1 disadvantage (0-3). There were major variations between advantages and disadvantages expressed in the consultation and the following interview. Conclusion Even though the consultations scored high in patient involvement, the information in most consultations was not structured in a way that made it possible to achieve a shared or an informed decision making.Original publication: Hoffmann M, Hammar M, Kjellgren K I, Lindh-Åstrand L and Ahlner J, Risk communication in consultations about hormone therapy in the menopause – concordance in risk assessment and framing due to the context, 2006, Climacteric, (9), 5, 347-354. http://dx.doi.org/10.1080/13697130600870220. Copyright © Taylor & Francis Group, an informa busines

Hot flushes, hormone therapy and alternative treatments: 30 years of experience from Sweden

Objectives The use of hormone therapy (HT) for hot flushes has changed dramatically over the past five decades. In this cross-sectional questionnaire study, the aim was to describe the use of HT and alternative treatments and to study the frequency of hot flushes. A further aim was to compare data from the present questionnaire with data from previous studies made in the same geographic area. Method A questionnaire was sent to a random sample of 2000 women aged 47-56 years living in Ostergotland County, Sweden. The results were compared with findings from previous studies regarding use of HT, alternative treatment and hot flushes, and the number of HT prescriptions dispensed during the corresponding time using data derived from the Swedish Prescribed Drug Registry. Results The response rate was 66%. Six percent used HT, in line with prevalence data from the Swedish Prescribed Drug Registry. Alternative treatments were used by 10%. About 70% of postmenopausal women reported flushes and almost one-third of those with flushes stated that they would be positive to HT if therapy could be shown to be harmless, a view more often stated by women with severe complaints of hot flushes (67%). Conclusion The use of HT and alternative treatments is low and many women suffer from flushes that could be treated. Women considered their knowledge of the climacteric period and treatment options as insufficient. Individualized information should be given and women with significant climacteric complaints, without contraindications, should be given the opportunity to try HT.Funding Agencies|Lions Foundation; County Council of Ostergotland; Linkoping University</p

Geoinformatic techniques on mapping and reclamation of wastelands in Chitradurga district, Karnataka, India

Wastelands are essentially understood as low-quality land from an agricultural point of view, often referred to as degraded land. Unscientific handling of land resources has resulted in the development of vast stretches of wastelands and also formed one of the major factors of decrease in per capita arable land causing ecological imbalances. The present paper aims to identify the Wastelands of Chitradurga District, Karnataka through hi-tech tools of Geoinformatics. The major causes of land degradation and subsequent formation of wastelands can be primarily attributed to 'faculty agricultural practice and indiscriminate deforestation'. Agricultural practices include the lack of soil conservation measures and irrigation practices that often lead to the formation of the salt affected soils. The study was taken up to map and record the wastelands using Survey of India (SoI) toposheets of 1:50,000 scale, IRS 1D PAN+LISS III satellite data and Google Earth software with limited Ground Truth Check (GTC) and final wasteland layer is generated. The database provides spatial baseline information in distribution, extent and temporal behavior of wastelands in planning and implementation of development strategies in wastelands reclamation of the countr

Attitudes towards the menopause and hormone therapy over the turn of the century

Objective: To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT). Material and methods: In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT. Results: Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies. Conclusions: Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women’s attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women’s actual use of HT. Probably women’s and health care provider’s apprehension of the risk-benefit balance of HT use is one such factor.Original publication: Lotta Lindh-Åstrand, Jan Brynhildsen, Mikael Hoffmann, Susanne Liffner and Mats Hammar, Attitudes towards the menopause and hormone therapy over the turn of the century, 2007, Maturitas, (56), 1, 12-20. http://dx.doi.org/10.1016/j.maturitas.2006.05.002. Copyright: Elsevier B.V., http://www.elsevier.com