Clinical Review

The legacy of WHI? Confusion and apprehension, possibly

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A survey finds widespread fog over the Women’s Health Initiative. The forecast isn’t for clearing skies.

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Patients, physicians, the media—in other words, just about everybody—are confused about the findings of the Women’s Health Initiative (WHI),1 according to a recent survey.

Why? And is this state of confusion permanent? Most of all, how are your colleagues dealing with that lack of clarity in their practice?

Questions put to your peers

In early September, the Hormone Foundation, public education affiliate of the Endocrine Society, released the results of a national survey of doctors involved in menopause care.2 The survey was designed to gauge the effects of the WHI on clinical practice and was conducted on behalf of the Hormone Foundation with financial support from Novogyne Pharmaceuticals. Among the findings:

  • Only 15% of the physicians believe their patients’ perceptions of the risks of hormone replacement are accurate
  • Only 18% of physicians—this includes ObGyns—report that they themselves have “no confusion at all” about the findings of the WHI
  • 83% of physicians believe their patients are as confused now as when the WHI findings were released in 2002—or more so
  • 81% of physicians believe the media are as, or more, confused as when the findings were released.2
So what is the state of menopause care today, 5 years after the WHI made its splash?

“There’s a lot of noise,” says Nanette Santoro, MD, director of reproductive endocrinology at Albert Einstein College of Medicine, Bronx, New York, and a member of the Hormone Foundation’s Women’s Health Task Force. “And there have been a lot of arguments back and forth.”

What can a physician do to achieve a little clarity?

Staying up-to-date on the clinical practice guidelines is the best way to combat confusion, Dr. Santoro says. A good starting point, she notes, is the Hormone Foundation Web site (Hormone. org), which links to the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine (ASRM), and the North American Menopause Society (NAMS), all of which publish reliable guidelines.

“I think that’s probably the best way of keeping abreast of what’s happening now if [physicians] are not really deeply into menopause care,” she says. “But getting filtered information, or getting information from pundits or from the media is, I think, more hazardous because the quality of that information can be variable. And the days of getting your information from pharmaceutical representatives are long gone in this area because, again, it is not sufficiently reliable.”

Misinformation, frustration over WHI findings run high among the public, survey reveals

During the spring of this year, 404 physicians responded to a survey about menopause management in the 5 years since the first Women’s Health Initiative (WHI) findings were published.1 The physicians represented the following primary care specialties: endocrinology, obstetrics and gynecology, internal medicine, and family and general practice. To qualify for the survey, each clinician had to devote at least 70% of his or her working day to clinical practice and see at least two women each month with menopausal symptoms.

The survey was conducted by Richard Day Research of Evanston, Illinois, for the Hormone Foundation. To review the full survey, visit www.hormone.org/pdf/meno_survey_qa.pdf.

Here are highlights:

Primary medical specialty
Family or general practice29%
Internal medicine27
Obstetrics and gynecology40
Endocrinology4
Percentage of patients with menopausal symptoms currently taking HT37%*
Percentage reluctant to start HT42%*
Percentage that specifically asks to be put on HT19%*
Percentage that specifically asks not to be put on HT29%*
For moderate or severe menopausal symptoms, do you think of HT as a:
first-line treatment?74%
second-line treatment (or third, fourth, etc)?26%
Which of the following are very important to you when deciding whether to prescribe HT for your patients?
Severity of symptoms81%
Patient’s personal medical history77
Risks of HT61
Range and specific types of symptoms50
Patient request44
Age of patient33
Prevention of osteoporosis24
Which risks concern you about prescribing estrogen–progestin therapy for menopausal symptoms?
Blood clots88%
Breast cancer87
Coronary heart disease74
Stroke73
Dementia14
What do you see as valuable about estrogen–progestin therapy for menopausal symptoms?
Relieves hot flashes100%
Relieves vaginal dryness and painful intercourse92
Improves sleep problems88
Prevents bone loss84
Reduces depression and mood changes68
Reduces risk of colorectal Ca37
Prevents cardiovascular disease16
Which risks concern you about prescribing estrogen-only therapy for menopausal symptoms?
Blood clots86%
Breast cancer71
Stroke68
Coronary heart disease51
Dementia8
Uterine cancer4
What do you see as valuable about estrogen-only therapy for menopausal symptoms?
Relieves hot flashes99%
Relieves vaginal dryness and painful intercourse94
Improves sleep problems84
Prevents bone loss81
Reduces depression and mood changes71
Reduces risk of colorectal Ca35
Prevents cardiovascular disease19
In your view, are the risks of HT understated, overstated, or accurately perceived by the following groups?
Means, based on the following:
1 = understated
2 = accurately perceived
3 = overstated
Media2.9 (Mean)
Patients2.7
Family or general practitioners2.4
Internists2.4
ObGyns2.0
Endocrinologists2.1
As of today, how much confusion do you feel there is about the WHI findings?
Means, based on the following:
1 = not confused at all
2 = not very much confusion
3 = some confusion
4 = great deal of confusion
For you personally2.3 (Mean)
Media3.7
Patients3.7
Family or general practitioners3.1
Internists3.0
ObGyns2.5
Endocrinologists2.5
*Mean

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