Two-thirds of U.S. women aged 40-79 have heard about research results suggesting that the risks of hormone therapy outweigh the benefits, and three-fourths are confused about whether to use it to alleviate symptoms of menopause and prevent diseases related to aging, according to findings from a national telephone survey.1 While the majority of women in this age-group are interested in obtaining more information, only one-quarter of those who have heard about the research findings have taken any steps to do so. Women's age and socioeconomic status are key factors in how they have responded to reports about hormone therapy.
In early July 2002, investigators conducting a large clinical trial of a hormone therapy product containing estrogen and progestogen released a report documenting associations between use of the drug and increased risks of breast cancer, heart disease, stroke and venous thromboembolism; an observational study released a few days later implicated unopposed estrogen in the development of ovarian cancer. The telephone survey, which included 819 women in a sample of randomly selected households, was conducted shortly after the second study was publicized, to assess women's awareness of and reactions to these findings.
The data were weighted to reflect the national distribution of women between the ages of 40 and 79 by census region, age, race or ethnicity, and educational attainment. Respondents represented a broad range of income categories; more than half were employed, and four in five owned their home. Nearly three-quarters were postmenopausal or perimenopausal (67% and 10%, respectively), and one-third had had a hysterectomy. Twenty-five percent were using hormone therapy or had discontinued its use within the previous month, 12% had used it in the past and 63% had never used it.
In all, 64% of women had heard about the findings regarding the safety of hormone therapy, and 74% reported being confused about whether to use it. Only 24% of women who were aware of the findings had sought additional information about hormone therapy--primarily from health care professionals (48% of this group), but also from print media (33%), the Internet (29%), social networks (8%) and broadcast media (5%). Slightly more than half of respondents were worried about the effects of hormone therapy (57%) and felt uninformed about the study findings (56%); 79% thought it would be helpful to have additional information about the therapy.
The researchers conducted logistic regression analyses to assess predictors of responses to the news of the hormone study findings. These analyses showed that women with more than a high school education had elevated odds of being aware of the findings (odds ratios, 2.1 for those with some postsecondary education and 2.4 for college graduates), as did those who had ever used hormone therapy (3.1). Women who lived in rental housing were less likely to know about the study results than were homeowners (0.5).
Confusion about hormone therapy was less likely among respondents aged 65-79 than among 40-54-year-olds (0.4), and less likely among women with the highest level of education than among those who had gone no further than high school (0.7). Women who had ever used hormone therapy had half again never-users' odds of expressing confusion (1.5).
Among respondents who were aware of the study findings, the oldest women and those who did not own their homes had reduced odds of seeking additional information (0.4 and 0.5, respectively). Women with more than a high school education, those who were perimenopausal or postmenopausal, ever-users of hormone therapy and residents of the North Central region had significantly elevated odds of trying to learn more; odds ratios ranged from 1.9 to 2.6.
Few factors emerged as independent predictors of worry about the effects of hormone therapy: Women older than 54 had reduced odds of worrying (0.3-0.6), while respondents who lived in the Northeast and those who had ever used hormone therapy had elevated odds (1.8 and 1.9, respectively). Similarly, only two factors were associated with women's odds of thinking that it would be helpful to have more information about the therapy: being 55 or older (odds ratio, 0.5) and ever having used hormone therapy (1.6).
The likelihood that women felt uninformed about the study findings was elevated among nonwhite women and those who had had a hysterectomy (odds ratio, 1.6 in each case). It was reduced among respondents who had graduated from college, those who were postmenopausal and those who had ever used hormone therapy (0.5-0.6).
Given what is known about the effects of hormone therapy, the researchers remark, "an important next step will be to continue to convey accurate information to women, their health care providers, and the media." At the same time, "the biomedical community must help the public understand that clinical studies are long journeys, sometimes taking decades, and that advances [occur] in a series of small steps." Moreover, the researchers conclude, health messages must be tailored to individual women's needs and "made relevant to the subset of underrepresented women who do not have sufficient information to make informed decisions about their own health care."--D. Hollander
1. Breslau ES et al., The hormone therapy dilemma: women respond, Journal of the American Medical Women's Association, 2003, 58(1):33-43.