Doctors use hormones more often than prescribe them
Doctors may be more willing to use hormone replacement therapy (HRT), or recommend it to their wives, than to prescribe it to their patients, a study of German gynecologists suggests.
Nearly all were willing to recommend HRT for hot flashes, a typical menopause problem, whether to a partner or a patient. But with other potential uses, there was some disconnect.
For example, 59 percent of the doctors said they would take hormones to ward off osteoporosis, or recommend it to their partners. But of that group, only three-quarters had suggested the same thing to at least some patients.
That's not surprising, given the issues swirling around HRT, according to Dr. Michele Curtis of the University of Texas Medical School at Houston, who was not involved in the study.
The survey, which includes responses from more than 2,500 doctors, was done in 2010, eight years after the Women's Health Initiative hit the news.
The WHI was a large U.S. clinical trial that found that women given estrogen-plus-progesterone HRT had higher risks of blood clots, heart attack, stroke and breast cancer than placebo users did.
Up to that point, HRT had commonly been prescribed to prevent heart disease, which is generally not advised anymore.
However, hormone therapy is the most effective way to ease menopausal hot flashes and vaginal dryness, and it is still an option for those symptoms. Similarly, since HRT protects bone mass, it's an option for treating the bone-thinning disease osteoporosis -- though it's considered a "second-line" option after other treatments.
Many women have been scared off of hormone therapy because of the risks reported in the WHI, Curtis said.
But she said she's not surprised that doctors would have a more favorable opinion of HRT, and be more willing to use it than prescribe it. "I think this would be applicable to doctors in the U.S., too," Curtis said.
That may be partly because gynecologists would be aware of more studies on HRT.
Studies since the WHI have, for example, found that HRT seems safer for women who use it at a younger age (soon after menopause begins), and that those women may even have a lower risk of heart disease. Women in the WHI were older - in their early 60s, on average.
And in the U.S., Curtis said, doctors' fear of lawsuits could keep them from recommending HRT to patients even if they'd use it themselves. "I don't know about Germany," she said, "but in the U.S. that absolutely is an issue."
Dr. Kai J. Buhling, the lead researcher on the study, said that when it comes to osteoporosis, gynecologists may have a friendlier attitude toward HRT for themselves because they are aware of the side effects of bisphosphonates - the "first-line" medications for the bone disease.
Bisphosphonates, which include drugs like Fosamax and Boniva, can cause heartburn, upset stomach and muscle or joint pain. They've also been linked to two rare but serious effects: breakdown in the bones of the jaw and thighbone fractures.
But since guidelines suggest HRT as only a second option for osteoporosis, doctors may be less willing to see it as an option for patients, according to Buhling, a gynecologist at the University Hospital Hamburg-Eppendorf.
However, the study, which appears in the journal Menopause, also found that doctors often had favorable views on HRT for uses beyond hot flashes and bone health.
Just over 40 percent said they would use it or recommend it to their partner to prevent "cognitive disorders." But only 58 percent of those doctors had suggested the same to a patient.
Similarly, 42 percent were in favor of using HRT for "overall well-being" for themselves or their partner. When it came to suggesting that to their patients, though, only 59 percent of those doctors were in favor.
HRT has not been proven to ward off memory decline or boost general health. But Buhling and Curtis both pointed out that there are studies suggesting that HRT users have less memory decline.
That's does not prove that HRT is the reason. But, Buhling said, doctors may be aware of the research and open to using HRT for any potential mental benefits, even if they wouldn't suggest it to patients.
Curtis did, however, point out that the average age of doctors in this survey was 51.
"If this survey were done again in 10 years, the results might be different," she said. That's because younger doctors being trained in the post-WHI years are unlikely to have the same favorable views on HRT as their predecessors. "Now it's just assumed that HRT is bad," Curtis said.
Male vs female doctors
The new study also shows that male doctors were generally keener on prescribing HRT for their female partners than women doctors were on taking the hormones themselves.
For instance, 43 percent of male doctors would put their partner on HRT if she had "reduced libido," while only 31 percent of the female doctors thought that was a good option for themselves.
The same pattern was found when it came to incontinence, osteoporosis, vaginal problems and other issues that face many women as they get older.
So what can women do with the conflicting messages about HRT?
Curtis suggested taking your time to talk with your doctor and gather information on HRT risks and benefits. "If you're a woman in your 40s, start now," she said.
That way, she noted, if you do develop severe hot flashes or vaginal symptoms, you're less likely to feel rushed into a decision on therapy.