Have healthcare professionals come to terms with menopausal hormone therapy?
A concerning number of healthcare providers lack awareness or confidence around when to prescribe menopausal hormone therapy (MHT), according to a new study from our Women’s Health Research Program published in Climacteric recently. The results reveal need for training around the safety and efficacy of MHT, a key therapy for the approximately one third of post-menopausal Australian women under 55 years who experience uncomfortable symptoms.
Around twenty years ago, two randomized controlled trials under the Women’s Health Initiative – a large study into the efficacy of MHT – suddenly ceased recruitment, after data safety monitors flagged an increased rate of cardiac events, stroke and breast cancer among participants in the intervention group. The resultant media scrum created confusion and destroyed confidence in MHT among a generation of women, and led to a hiatus in menopause training affecting clinicians, nurses and other allied health professionals. Use of MHT in Australia dropped by 40 per cent.
First author Professor Susan Davis says, “It was a huge shame, because what we’ve learnt in the intervening years, through numerous, well-constructed and very robust studies, is that the benefits of MHT for women with menopausal symptoms far outweigh the risks. There were problems with the formulation of MHT used in those early studies, and the sample of women used wasn’t very representative of the women we treat. Many of those risks have been well and truly debunked.”
Yet of the third of Australian of post-menopausal Australian women under 55 years who could benefit from MHT, only 11 per cent are prescribed it.
“Given the bad press, and the gap in training that resulted, we wanted to assess the confidence of those health providers who routinely manage menopausal symptoms – GPs, Gynaecologists and pharmacists – in prescribing MHT to their patients.”
The team conducted 30 telephone interviews, 10 from each of the three professional groups. Lasting on average for 20 minutes, they covered a range of topics using a standardized list of questions. Demographic data was collected, including year of graduation, and whether they’d undertaken menopause-specific training in the last three years.
They found good general awareness around symptoms and issues surrounding menopause, with the exception of vaginal symptoms, which were well-recognised by Gynaecologists and GPs, but less so by pharmacists. There was consistently high recognition of the risks of bone loss associated with untreated menopause, but mixed awareness around the risks of cardiovascular disease, mood swings and cognitive effects.
Although the use of MHT was supported by Gynaecologists and GPs, there remained a general reticence to prescribe it, with most indicating it should be limited to women experiencing significantly impaired quality of life, and not to prevent osteoporosis. This is despite the Therapeutic Goods Administration’s inclusion of the prevention of bone mineral density loss as an indication for MHT.
Several health-care providers in each group said they lacked knowledge about MHT use, with some doctors declaring they did not feel confident prescribing it.
Use of complementary medicines by women to treat menopausal symptoms was acknowledged to be widespread. While the lack of evidence to support the efficacy of complement was also acknowledged, and their efficacy a placebo effect, the majority of each practitioner group supported women trialing them for their menopausal symptoms.
“This study is important, because it identifies areas where more training is needed, and conversely, where it is not needed. This means we can create targeted educational campaigns that get to the point.
“On its own osteoporosis is a big concern, affecting somewhere in the region 15 and 23 per cent of Australian women over 50, who are at increased risk of fractures as a result. Better prescribing patterns for MHT could alleviate a lot of the risk around that, in addition to better managing all of the other symptoms these women experience.”
Click here for more news from the School of Public Health and Preventive Medicine