The attitude of gynecologists in São Paulo, Brazil 3 years after the Women's Health Initiative study.
OBJECTIVE
The objective of this study was to evaluate gynecologists' knowledge of the WHI study, and its repercussions on their attitudes and practice 3 years after publication.


METHODS
A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the São Paulo Society of Obstetrics and Gynecology.


RESULTS
The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of the respondents were aware of the WHI study, only 24.4% knew of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p<0.0001). The principal reason for physicians to discontinue HT in a patient was increased risk of breast cancer (62.3%), whereas, according to the physicians, the most important factor for the patients was fear of HT (80.3%).


CONCLUSIONS
A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose.
Lazar
Felipe
F
Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (Unicamp), R. Vergueiro, 3086, Cj. 13, 04102-001 São Paulo, SP, Brazil. flj@uol.com.br
Costa-Paiva
Lucia
L
Morais
Sirlei S
SS
Pedro
Adriana Orcesi
AO
Pinto-Neto
Aarão Mendes
AM
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001938:Brazil; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D016387:Women's Health; D000078329:Workforce