Top

BMC Public Health

Published in:

Open Access 01-12-2007 | Research article

Changes of the prescription of hormone therapy in menopausal women: An observational study in Taiwan

Authors: Weng-Foung Huang, Yi-Wen Tsai, Fei-Yuan Hsiao, Wen-Chun Liu

Published in: BMC Public Health | Issue 1/2007

Abstract

Background

To evaluate the impact of the 2002 Women's Health Initiative (WHI) study results on the prescription of menopausal hormone therapy (MHT) to treat menopause-related symptoms in Taiwan.

Methods

This retrospective study participant data collected from women interviewed in 2001 Taiwan's National Health Interview Survey (NHIS) and the National Health Insurance (NHI) outpatient claims for women being treated for menopause-related symptoms. We compared prescriptions made for MHI to women seeking outpatient treatment for menopause-related symptoms before and after the publication of the 2002 WHI to study its effect of prescription behavior in Taiwan. There was one dichotomous outcome variable, which was whether MHT was prescribed or not in an outpatient visit to treat menopause-related symptoms.

Results

Our study included 504 women 45 years old or above whose outpatient visits for menopause-related symptoms were covered by National Health Insurance in 2002. In total, these 504 women made 2549 outpatient visits to be treated for these symptoms. The proportion of outpatient visits in which MHT was prescribed dropped from 83.0% (n = 1,155) before WHI to 73.0% (n = 844) after WHI. We found a decrease in likelihood that women would be prescribed MHT for menopause-related symptoms after the release of the WHI report (OR = 0.36, 95%CI = 0.25 to 0.52, p < 0.05). Gynecologists and obstetricians are more likely to prescribe MHT than physicians with other medical specialties (5.34; 95%CI = 3.45 to 8.26, p < 0.05). Women with college level educations or higher became less likely to be prescribed MHT (Model 2; OR 0.30; 95% CI 0.11–0.83), and academic medical centers became less likely to prescribe MHT than other medical care institutions (Model 3; OR 0.15; 95% CI 0.34–0.63).

Conclusion

The WHI report caused a substantial decline in the use of MHT to treat menopause-related symptoms in Taiwan. It was found to exert most of its influence in patients with higher educations, physicians with specialties other than gynecologists and obstetricians, and academic medical centers.

Keating NL, Cleary PD, Rossi AS, Zaslavsky AM, Ayanian JZ: Use of menopausal hormone therapy by postmenopausal women in the United States. Ann Intern Med. 1999, 130: 545-53.CrossRefPubMed

Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R: Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA. 2000, 283: 485-91. 10.1001/jama.283.4.485.CrossRefPubMed

Ross RK, Paganini-Hill A, Wan PC, Pike MC: Effect of menopausal hormone therapy on breast cancer risk: estrogen versus estrogen plus progestin. J Natl Cancer Inst. 2000, 92: 328-32. 10.1093/jnci/92.4.328.CrossRefPubMed

Colditz GA, Hankinson SE, Hunter DJ, Willett WC, Manson JE, Stampfer MJ, Hennekens C, Rosner B, Speizer FE: The Use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995, 332: 1589-93. 10.1056/NEJM199506153322401.CrossRefPubMed

Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E: Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA. 1998, 280: 605-13. 10.1001/jama.280.7.605.CrossRefPubMed

Grodstein F, Manson JE, Stampfer MJ: Postmenopausal hormone use and secondary prevention of coronary events in the Nurses' Health Study: a prospective, observational study. Ann Intern Med. 2001, 135: 1-8.CrossRefPubMed

Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SAA, Howard BV, Johnson KC, Kotchen JM, Ockene J, Writing Group of Women's Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002, 288: 321-33. 10.1001/jama.288.3.321.CrossRefPubMed

FDA: The estrogen and progestin dilemma: new advice, labeling guidelines. [http://www.fda.gov/fdac/features/2003/203_estrogen.html]

U.S. Preventive Services Task Force: Postmenopausal menopausal hormone therapy for primary prevention of chronic conditions: recommendations and rationale. Ann Intern Med. 2002, 137: 834-9.CrossRef

10.

Hoffmann M, Hammar M, Kjellgren KI, Lindh-Astrand L, Brynhildsen J: Changes in women's attitudes towards and use of hormone therapy after HERS and WHI. Maturitas. 2005, 52: 11-7. 10.1016/j.maturitas.2005.06.003.CrossRefPubMed

11.

Kaunitz AM, Women's Health Initiatives: Use of combination menopausal hormone therapy in light of recent data from the WHI. Medscape Women's Health. 2002, 7: 8-PubMed

12.

Haas JS, Kaplan CP, Gerstenberger EP, Gerstenberger EP, Kerlikowske K: Changes in the use of postmenopausal hormone therapy after the publication of clinical trials results. Ann Intern Med. 2004, 140: 184-89.CrossRefPubMed

13.

Lawton B, Rose S, McLeod D, Dowell A: Changes in use of menopausal hormone therapy after the report from the Women's Health Initiative: cross sectional survey of users. BMJ. 2003, 327: 845-6. 10.1136/bmj.327.7419.845.CrossRefPubMedPubMedCentral

14.

Ettinger B, Grady D, Tosteson ANA, Pressman A, Macer JL: Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy. Obstet Gynecol. 2003, 102: 1225-32. 10.1016/j.obstetgynecol.2003.08.007.PubMed

15.

Bestul MB, McCollum M, Hansen LB, Saseen JJ: Impact of the Women's Health Initiative Trial Results on Menopausal hormone therapy. Pharmacotherapy. 2004, 24: 495-9. 10.1592/phco.24.5.495.33349.CrossRefPubMed

16.

Hillman JJ, Zuckerman IH, Lee E: The impact of the Women's Health Initiative on menopausal hormone therapy in a Medicaid Program. J Women's Health. 2004, 13: 986-92. 10.1089/jwh.2004.13.986.CrossRef

17.

Ness J, Aronow WS, Newkirk E, McDanel D: Use of hormone replacement treatment by postmenopausal women after publication of the Women's Health Initiative Trial. J Gerontol A Biol Sci Med Sci. 2005, 60: 460-2.CrossRefPubMed

18.

Kenkel D: Consumer health information and the demand for medical care. Rev Econ Stat. 1990, 72: 587-95. 10.2307/2109598.CrossRef

19.

Hsieh C-R, Lin S-J: Health information and the demand for preventive care among the elderly in Taiwan. J Hum Resours. 1997, 32: 308-33. 10.2307/146217.CrossRef

20.

Viscusi WK, Magat WA, Huber J: Informational regulation of consumer health risks: an empirical evaluation of hazard warnings. Rand J Econ. 1986, 17: 351-65. 10.2307/2555716.CrossRef

21.

Blumel JE, Castelo-Branco C, Chedraui PA, Binfa L, Dowlani B, Gomez MS, Sarra S: Patients' and clinicians' attitudes after the Women's Health Initiative study. Menopause. 2004, 11: 57-61. 10.1097/01.GME.0000075503.60230.61.CrossRefPubMed

22.

Manzoli L, Di Giovanni P, Del Duca L, De Aloysio D, Festi D, Capodicasa S, Monastra G, Romano F, Staniscia T: Use of menopausal hormone therapy in Italian women aged 50–70 years. Maturitas. 2004, 49: 241-51. 10.1016/j.maturitas.2004.02.003.CrossRefPubMed

23.

Mueller JE, Doring A, Heier M, Lowel H: Prevalence and determinants of menopausal hormone therapy inGerman women 1984–1995. Maturitas. 2002, 43: 95-104. 10.1016/S0378-5122(02)00185-8.CrossRefPubMed

24.

Abraham S, Perz J, Clarkson R, Llewellyn-Jones D: Australian women's perceptions of menopausal hormone therapy over 10 years. Maturitas. 1995, 21: 91-5. 10.1016/0378-5122(94)00881-7.CrossRefPubMed

25.

Wilhelm SL: Factors affecting a woman's intent to adopt menopausal hormone therapy for menopause. J Obstet Gynecol Neonatal Nurs. 2002, 31: 698-707.CrossRefPubMed

26.

Griffiths F: Women's control and choice regarding MHT. Soc Sci Med. 1999, 49: 469-82. 10.1016/S0277-9536(99)00141-0.CrossRefPubMed

27.

Connelly MT, Ferrari N, Hagen N, Inui TS: Patient-identified needs for menopausal hormone therapy counseling: a qualitative study. Ann Intern Med. 1999, 131: 265-8.CrossRefPubMed

28.

Arrow K: Uncertainty and the welfare economics of medical care. Am Econ Re. 1963, 53: 941-73.

29.

Phelps CE: Diffusion of information in medical care. J Econ Perspec. 1992, 6 (3): 23-42.CrossRef

30.

Levy BT, Ritchie JM, Smith E, Gray T, Zhang W: Physician specialty is significantly associated with menopausal hormone therapy use. Obstet Gynecol. 2003, 101: 114-22. 10.1016/S0029-7844(02)02381-5.PubMed

31.

Greendale GA, Carlson KJ, Schiff I: Estrogen and progestin therapy to prevent osteoporosis: attitudes and practices of general internists and gynecologists. J Gen Intern Med. 1990, 5: 464-9. 10.1007/BF02600870.CrossRefPubMed

32.

Rolnick SJ, Kopher RA, Compo RB, Kelley ME, Defor TA: Provider attitudes and self-reported behaviors related to menopausal hormone therapy. Menopause. 1999, 6: 257-63.CrossRefPubMed

33.

Saver BG, Taylor TR, Woods NF, Stevens NG: Physician policies on the use of preventive hormone therapy. Am J Prev Med. 1997, 13: 358-65.PubMed

34.

Chang C, Chang CH: Women health and medicalization. Women Academic Journal. 1998, 9: 145-85.

35.

Chang C: Menopausal women's' health is an issue of public health policy. Taiwan J Public Health. 2003, 22: 245-50.

36.

Stefanick ML: Estrogens and progestins: background and history, trends in use, and guidelines and regimens approved by the US Food and Drug Administration. Am J Med. 2005, 118 Suppl 12B: 64-73. 10.1016/j.amjmed.2005.09.059.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/7/56/prepub

Title: Changes of the prescription of hormone therapy in menopausal women: An observational study in Taiwan
Authors: Weng-Foung Huang
Yi-Wen Tsai
Fei-Yuan Hsiao
Wen-Chun Liu
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2007
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/1471-2458-7-56

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Changes of the prescription of hormone therapy in menopausal women: An observational study in Taiwan

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2007

The association between weekly hours of physical activity and mental health: A three-year follow-up study of 15–16-year-old students in the city of Oslo, Norway

Health impacts of exposure to second hand smoke (SHS) amongst a highly exposed workforce: survey of London casino workers

Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study

A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS?

High prevalence of lack of knowledge of symptoms of acute myocardial infarction inPakistan and its contribution to delayed presentationto the hospital

The protocols for the 10/66 dementia research group population-based research programme