Publications

OBJECTIVE: To describe decision making and trust of women who were on hormone therapy (estrogen and progestin or estrogen alone) when the Women's Health Initiative findings were initially released July 9, 2002.

METHODS: Telephone surveys of 204 patients randomly selected from a large academic primary care practice (66% response rate) were conducted from July to September 2003. Women age 50 years and older who were taking hormone therapy on July 9, 2002, were included. The survey assessed: prevalence of discontinuing hormone therapy; knowledge of and reactions to the Women's Health Initiative; trust in medical recommendations; and future prevention behavior.

RESULTS: Of 204 women, their mean age was 61 years, 70% were white, 56% were college educated, and 54% were taking both estrogen and progestin. Most (94%) had heard of the Women's Health Initiative and the majority (70%) stopped hormone therapy. Being nonwhite (adjusted RR 1.37, 95% CI [1.16-1.48]) and having taken estrogen and progestin (1.37, [1.18-1.49]) were significantly associated with stopping hormone therapy. Among women who had heard of the Women's Health Initiative (n = 191), 26% reported losing trust in medical recommendations generally and 34% were less willing than before the Women's Health Initiative to take new drugs to prevent heart disease. Nonwhites were less willing than whites to take new drugs for heart disease prevention (aRR 1.58 [1.02-2.18]).

CONCLUSIONS: Most women discontinued hormone therapy after the Women's Health Initiative results were published. Given their experience with hormone therapy, some women, particularly nonwhites, are now less trusting of medical recommendations and less likely to take drugs for cardiovascular disease prevention.

OBJECTIVE: To describe the management of menopausal symptoms and the prevalence of prevention counseling among women who stopped hormone therapy (HT) after publication of the initial findings of the Women's Health Initiative.

METHODS: Telephone survey between July and September 2003 of 142 women 50 years and older, randomly selected from a large academic primary care practice, who stopped taking HT after the WHI publication, July 9, 2002 (66% response rate).

RESULTS: Among 142 women, the median age was 60 years, 63% were white, 52% had at least a college degree, and 60% were taking estrogen and progestin as of July 9, 2002. The majority (82%, n = 117) who stopped HT suffered some menopausal symptom: 25 restarted HT, 13 received another prescription medication, and 56 tried at least one complementary and alternative medicine. Women most commonly used soy (n = 40) or black cohosh (n = 25) for their symptoms, although less than one third of women found either of these treatments effective. Only 49% (57 of 117) of women with symptoms visited a doctor for their symptom. Few women reported receiving counseling about prevention topics after the WHI, such as risk of osteoporosis (34%), risk of heart disease (26%), diet (41%), and exercise (45%).

CONCLUSIONS: Most women who stopped HT after the WHI experienced some menopausal symptoms. Few women found commonly used alternative medicines effective, and few received other prescription medications. Counseling about osteoporosis and heart disease risk was infrequent after the WHI. Future studies should focus on finding safe and effective therapies for menopausal symptoms.

OBJECTIVES: To estimate the national rates of mammography screening in women aged 80 and older and examine the relationship between health status and screening within the previous 2 years.

DESIGN: Population-based survey.

SETTING: United States.

PARTICIPANTS: Eight hundred eighty-two women aged 80 and older who responded to the 2000 National Health Interview Survey, representing an estimated 3.83 million noninstitutionalized women nationally.

MEASUREMENTS: Screening mammography, disease burden, and functional status were assessed using a questionnaire.

RESULTS: Of the 882 women, 41.5% were aged 85 and older; 19.6% had two or more significant diseases; and 12.1% were dependent in at least one activity of daily living (ADL). More than half (50.8%) had received a screening mammogram within the previous 2 years. Women with two or more significant diseases were less likely to have received screening than those without significant disease, but the difference was not statistically significant (43.9% vs 54.0%, P=.152). Women dependent in at least one ADL were less likely to receive screening mammography than women without functional impairment (37.2% vs 55.9%, P<.001). After adjustment, the likelihood of screening remained lower in women with two or more significant diseases (adjusted odds ratio (AOR)=0.63, 95% confidence interval (CI)=0.40-1.05) and in women with at least one ADL dependency (AOR=0.44, 95% CI=0.22-0.88). Of 294 women likely to have life expectancies of less than 5 years because of poor health, 39.4% received screening mammography.

CONCLUSION: More than half of women aged 80 and older in the United States receive screening mammograms. Nearly 40% of women very unlikely to benefit because of poor health received screening mammography.