A significant change in Norwegian gynecologist's attitude to hormone therapy is observed after the results of the Women's Health Initiative Study

Abstract

In Norway about 40% of climacteric women have been on hormone therapy (HT). The women usually seek advice from their doctor concerning HT. The attitude of the medical profession thus has great impact on the decision to use or to restrain from use of HT. We, therefore, in 1997 (1) and in 2002 conducted a survey among all Norwegian gynecologists to investigate the attitude and prescribing practice concerning HT. The 2002 survey was carried out in April to June 2002, immediately before the results of the Women's Health Initiative (WHI) (2) and the Heart and Estrogen/progestin Replacement Study (HERS) II (3) were published. It offered us an opportunity to investigate if remarkable publications had an immediate impact on the opinion concerning HT. In 1997 80.4% of Norwegian gynecologists (382 of 475) answered a written questionnaire, in 2002 66.8 (397 of 594) responded. Selected questions that might be influenced by the WHI and HERS II were repeated in November 2002. This latter questionnaire was addressed to colleagues having responded to the previous inquiry but was not sent to retired gynecologists or those living abroad. The survey was anonymous and no reminder was sent. The response rate was 69.9 (244 of 349). The WHI report was known to 93.4% of the respondents. Thirty four percent had read the original article itself, whereas the others had information about the results from other sources such as medical journals, media or information from colleagues or from pharmaceutical companies. The percentage of gynecologists answering positive to selected questions is seen in Table I. There was a significant change in attitude from being liberal to be more reluctant concerning prescribing HT after the two publications came out. An increasing awareness of HT as a risk factor for breast cancer was seen through the three inquiries. In 1997 more than one third regarded HT to protect against thrombosis, but this assumption almost disappeared in the two 2002 surveys. In the first study, 77% of doctors considered HT to give protection for ischemic heart disease (primary prevention), in spring 2002 still 32% shared this opinion, but in autumn 2002 the number dropped to 7%. Concerning angina pectoris and recurrent heart attack, HT was in 1997 considered indicated for secondary prevention, but this attitude had changed in 2002 after the HERS I study (4) and almost had disappeared in the last investigation after the HERS II study (3). Knowledge about HT being protective against colon cancer was observed in less than 50% of the gynecologists during the spring of 2002, but in the autumn more than 80% were aware of this fact. In our 1997 survey (5) we asked about the female gynecologists or the partners of the male gynecologists personal use of HT, 78 and 77%, respectively, used HT. These figures were almost unaltered in the investigation performed during the spring 2002 where 74 and 75%, respectively, were HT users. In the last inquiry it turned out that none of them had stopped the treatment due to the results of the WHI study. It was evident that newly-published studies were quickly picked up by the gynecologists. Further, their views were adapted according to the new information, but their personal attitude to their own or their spouses use of HT was not affected. This is in contrast to Norwegian statistics showing an almost 40% drop in sales of HT since the summer of 2002 when the WHI study was published, a trend that also has been observed in US (6). We do, however, not know if the decrease in the use of HT and the changed attitude towards HT will be permanent.