Gynecologists' attitudes towards hormone therapy in the post "Women's Health Initiative" study era.
OBJECTIVE
To assess the impact of the Women's Health Initiative (WHI) study on gynecologists' attitudes regarding hormone therapy (HT).


METHODS
Questionnaires were mailed to a random sample of Lebanese gynecologists (n=178). The questionnaires solicited practice patterns of HT for postmenopausal women and information provided while counseling before and after the WHI study. Descriptive statistical methods were used to evaluate the responses.


RESULTS
Questionnaires were returned by 140 physicians (78.7%), 93.6% of whom were aware of the WHI study. More than 90% of respondents routinely offered HT prior to the study. Of the 85.6% who used a combination of oral estrogen and progesterone (E/P), 40.0% used conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA). Around 67% of gynecologists reported a change in their therapeutic approach after the study. The main changes were: not offering CEE+MPA (27.3%), prescribing CEE+MPA to a select group of patients (37.5%), using other forms of HT (56.8%), or abandoning any form of HT (6.8%). Other practice modifications included a shift to the use of tibolone (18.2%) or alternative therapies (29.5%). Whereas 76.2% of physicians counseled their patients about a decreased risk of cardiovascular events with HT prior to WHI study, only 34.1% continued to do so after the study (p<0.001). The percentage of gynecologists that inform their patients of an increased risk of breast cancer on HT rose from 45.2 to 73.2% (p=0.018). Almost 51% of gynecologists allow their patients to participate in decision making regarding the type of HT, 42.4% would choose for their patients after counseling, while 6.8% of physicians do not counsel their patients in order not to confuse them.


CONCLUSIONS
In a representative sample of Lebanese gynecologists, there was a significant change in physicians' attitudes towards HT following the publication of the WHI study.
Nassar
Anwar H
AH
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, P.O. Box 113-6044/B36, Beirut, Lebanon. an21@aub.edu.lb
Abd Essamad
Hasan M
HM
Awwad
Johnny T
JT
Khoury
Nabil G
NG
Usta
Ihab M
IM
D000328:Adult; D001291:Attitude of Health Personnel; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000600:supply & distribution; D005260:Female; D006176:Gynecology; D006801:Humans; D007861:Lebanon; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000600:supply & distribution; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires
D004966:Estrogens, Conjugated (USP); D017258:Medroxyprogesterone Acetate