Trends in Japanese gynecologists' attitudes toward prescribing hormone replacement therapy

The National Institutes of Health (NIH) of the United States announced discontinuation of the large-scale prospective clinical study of hormone replacement therapy (HRT) in postmenopausal women in the Womenfs Health Initiative (WHI) Hormone Program after interim data collection in July 2002. Since this announcement was also conveyed to Japan by several information media, it seemed necessary to survey the recognition of and attitudes toward this HRT among physicians who can actually perform it for middle-aged or elderly women, and to obtain information useful for considering the direction of menopausal medical treatment in the future.<br> We examined the influence of this announcement and recognition of hormone replacement therapy by sending a questionnaire to Japanese gynecologists living in the Kinki district. The results were analyzed. The recovery rate was 23.3% (420/1800).<br> 1. The percentage of gynecologists who responded to this survey was low (23.3%), probably reflecting the low concern about HRT. However, a high percentage of respondents (76.6%) had much knowledge of the NIHfs announcement reported by the media.<br> 2. Of the respondents, 69.7% answered that discontinuation of the study concerned cannot be directly applied to perimenopausal management in Japan. A little more than 30“ of these respondents attributed this view to the difference in risk of developing breast cancer or heart disease among Japanese women from that among US women. On the other hand, 30.3% of the respondents answered that the NIHfs announcement can be applied to Japan, and 32.7“ of these respondents had taken some actions to change their policy of perimenopausal management or other necessary actions.<br> 3. When the first impression of gynecologists on the NIHfs announcement was surveyed, the percentage of respondents who felt that HRT is dangerous and is not advisable was 21.4%. Of all respondents, only 5.0% answered that they would discontinue use of this therapy immediately, while 11.0% answered that they would gradually discontinue use of this therapy.<br> 4. Of all respondents, 40.2% answered that they would continue using HRT. However, 54.3“ of these respondents answered that they would use this therapy only for patients with some limited symptoms or conditions such as symptoms resembling vasomotor nerve disorder and disturbance of intercourse.<br> 5. Regarding how to administer HRT in the future, a majority of the respondents answered that informed consent should be obtained from each patient after providing adequate information not only about the benefits of the therapy but also information about possible risks such as breast cancer (76.0“of the respondents considered this information indispensable), endometrial cancer and thrombosis.<br> This survey thus revealed that although the level of concern of Japanese gynecologists about HRT was not always high, they calmly accepted the mediafs report on WHI and some of them took some actions immediately. Of the respondents, 60% were considering some changes in their policy on use of HRT. They were well aware of the risks and benefits of HRT as well as the necessity to provide adequate information (including the risk) about HRT to patients. It therefore seems unlikely that the mediafs report on the NIH announcement will greatly affect the situation surrounding HRT or perimenopausal management in Japan.<br> In the future, it is desirable that clinical studies of the usefulness and risk of HRT involving the population for which HRT is potentially applicable be performed. It is also desired that new guidelines on HRT be prepared on the basis of evidence collected from studies whose end-point is prevention of the onset of estrogen-deficiency diseases. [Adv Obstet Gynecol, 55(4) : 373-387, 2003(H15.11)]<br>