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Risks and benefits of hormone replacement therapy are not the only factors that women consider

Doctors advising postmenopausal women about hormone replacement therapy (HRT) typically mention the benefits of HRT to prevent cardiovascular disease and osteoporosis. They also note the slightly increased risk of breast cancer associated with HRT. But women have other concerns that enter into the HRT decision, such as whether HRT will help with sleep loss and genitourinary problems that often accompany menopause.

These issues also are not addressed by counseling guides used by doctors and developed by the American College of Physicians, American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force. What's more, women typically incorporate their doctor's opinion, media reports, and the experiences of friends and family when making the HRT decision, areas often left unmentioned in the guides. Women would find HRT counseling guides much more useful if they addressed these areas, concludes a preliminary study supported by the Agency for Health Care Policy and Research (National Research Service Award fellowship F32 HS00107).

Maureen T. Connelly, M.D., M.P.H., of Harvard Medical School, and her colleagues interviewed 26 women in a health maintenance organization who had received an initial prescription for HRT. On average, women reported 15 factors (range, 6 to 24 factors) as critical to their HRT decision, whereas the guides produced by these three organizations only addressed 6 factors. Although most women cited their doctor's opinion (96 percent), reports in the media (81 percent), and experiences and opinions of friends (77 percent) as critical to their HRT decision, counseling recommendations addressed none of these concerns.

Only one guide acknowledged the powerful effect that the doctor's opinion may have on patient decisionmaking. None of the guides addressed the ability of HRT to decrease sleep disturbance and genitourinary problems, even though more than half of the women studied said that these problems strongly influenced their decision about HRT. None of the guides suggested that clinicians explore patients' exposure to HRT media reports or experiences of friends and family, either to challenge or verify the information.

See "Patient-identified needs for hormone replacement therapy counseling: A qualitative study," by Dr. Connelly, Nancy Ferrari, A.B., Nicole Hagen, B.A., M.H.S., and Thomas S. Inui, Sc.M., M.D., in the August 1999 Annals of Internal Medicine 131(4), pp. 265-268.

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