Patterns of Hormone Replacement Therapy use in women with hysterectomy and bilateral oophorectomy; a retrospective study of women in Central Scotland.

Abstract

There have been many published papers exploring women‟s the use of hormone replacement therapy (HRT), but most of these studies have not examined surgically menopausal women exclusively. This particular group of women may differ in their HRT needs from the general HRT - using population, in that they require an oestrogen-only preparation and often have a premature menopause. For surgically menopausal women, therapy can be considered as a true replacement treatment as it compensates for often abrupt and premature oestrogen loss. The purpose of this study is to describe HRT use in a sample of surgically menopausal women and determine if these women undergoing hysterectomy with bilateral oophorectomy have different patterns of HRT use when compared to HRT users in general. This study examines HRT use in women who had a hysterectomy with bilateral oophorectomy before the age of 51 years; in the period 1992-2001.All the women were treated in a region of Central Scotland, in one of two district hospitals administered by the same NHS Trust. The clinical indication for their surgery was heavy menstrual bleeding (menorrhagia), a benign and common condition. The study is retrospective, and women were asked to complete a postal questionnaire. The questionnaire was designed to elucidate the prevalence and duration of HRT use in these women, and the reasons they give for stopping treatment. Certain factors associated with adherence to medication in general, and with HRT use in particular, are considered. These variables include the age of the patient and her socio-economic status, the location of her treatment, and the individual consultant gynaecologist in charge of her care. Associations between post-operative HRT use and physician- 3 gender are explored, together with the reasons these women give for the discontinuance of treatment. This study found that one hospital performed more operations than the other, which is probably explained by in-patient bed capacity. One of the consultants performed over a quarter of the total number of operations, probably reflecting the differing clinical roles held by different consultants in the department, or perhaps indicating individual practice. Some further evidence of differences in practice between individual consultants is demonstrated by the fact that two consultants jointly operate on significantly younger women when compared to their colleagues. There is an association found in the target sample (n = 306) between socio-economic group and the age at which women undergo hysterectomy, with women from less deprived backgrounds being significantly older. This difference, however is not significant in the achieved sample (n = 190), and is possibly due to the small sample size. Socio-economic status is not associated with whether or not HRT is prescribed in hospital, but women from less deprived backgrounds take HRT for longer. There are some differences, between women from different socio-economic backgrounds, in how important the possible cardiovascular protection afforded by HRT is rated. The Women‟s Health Initiative dispelled the claim that HRT was valuable in preventing cardiovascular events in 2002. When discussions about the benefits of taking HRT are considered, it appears that the women treated in one hospital recall such discussions in greater number than those treated in the other hospital do. Discussions about the risks of treatment are not 4 remembered by 65.2% of women, and there is no statistical difference according to where they were treated. The problem associated with the accuracy of data reliant on subject memory is discussed. Most women cite the doctor as the main source of information about HRT, but over a third of those who start HRT say they did not have enough information (the problem associated with the accuracy of data reliant on subject memory is discussed). Whatever the level of information is given, these women start HRT in almost exactly the same high number regardless of where they were treated. When comparing the findings from these surgically menopausal women with those from previously published studies on HRT users in general, it is apparent that there are some subtle differences in that use. These women are more likely to take HRT, and take it for longer, than the peri-menopausal and naturally menopausal women, who are grouped together as HRT users in general. They stop using HRT for many of the reasons given by the wider HRT-using population, but are more likely to consult their doctor before doing so. These surgically menopausal women, compared to HRT users in general, cite side-effects of treatment less frequently, but the side-effects they do complain of are the same, with the exception of bleeding problems (from which they obviously do not suffer). The socio-economic difference associated with HRT uptake in the wider population, is not seen in these surgically menopausal women, but the duration of HRT use is associated with higher social status, as found in the general population. The women in this study who came from higher socio-economic groups were older than those from more deprived backgrounds at the time of their hysterectomy, which concurs with 5 previous research. There is acknowledgement, within the text, that since this research was undertaken there have been significant changes in HRT prescribing guidelines and indeed in the treatments available for menorrhagia. These changes have affected the study findings in terms of how relevant they might be today.