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Informing Women About Hormone Replacement Therapy
Menopausal hormone therapy, bone metabolism and fracture prevention: Based on the currently available data, menopausal hormone therapy (MHT) is an effective tool for preventing postmenopausal acceleration of bone metabolism and osteoporotic fractures. A sufficient calcium, vitamin D and protein dietary intake is a decisive factor for normal bone metabolism and successful fracture prevention and has to precede any hormonal or non-hormonal prevention of fragility fractures. Therapeutic importance of menopausal hormone therapy: Together with correct nutrition, adequate physical activity and the elimination of factors increasing the risk of falling, MHT occupies an important place in decreasing the fracture incidence in the perimenopause and early postmenopause. In postmenopausal women with increased fracture risk below the age of 60 years or within 10 years after menopause, MHT is one of the first line therapies for prevention and treatment of postmenopausal osteoporosis and fragility fractures. Every MHT should always be individualized. Personal and family history, the results of relevant investigations and the individual needs for fracture prevention have to be considered. In preventing fragility fractures, the benefits of MHT clearly outweigh the risks. As a rule, in the presence of premature ovarian insufficiency MHT should be started without delay and continued at least until the average age of natural menopause. Alternatively, tibolone and selective estrogen receptor modulators can be used depending on the indications, existing climacteric symptoms and the personal risk-benefit profile. In the later postmenopause and in the presence of manifest osteoporosis, a specific treatment with one of the established non-hormonal alternatives should be used.
Hormone therapy (HT) in the menopause is still a tricky question among healthcare providers, women and mass media. Informing women about hormone replacement therapy was a Consensus Conference (CC) organized in 2008: the project Know the Menopause has been launched to shift out the results to women and healthcare providers and to assess the impact of the cc's statement.
And Findings: The project, aimed at women aged 45-60 years, was developed in four Italian Regions: Lombardy, Tuscany, Lazio, Sicily, each with one Local Health Unit (LHU) as "intervention" and one as "control". Activities performed were: survey on the press; training courses for health professionals; educational materials for target populations; survey aimed at women, general practitioners (GPs), and gynaecologists; data analysis on HT drugs' prescription. Local activities were: training courses; public meetings; dissemination on mass media. About 3,700 health professionals were contacted and 1,800 participated in the project. About 146,500 printed leaflets on menopause were distributed to facilitate the dialogue among women and health care professionals. Training courses and educational cascade-process activities: participation ranged 25- 72% of GPs, 17-71% of gynaecologists, 14-78% of pharmacists, 34-85% of midwives. Survey: 1,281 women interviewed. More than 90% believed menopause was a normal phase in life. More than half did not receive information about menopause and therapies. HT prescription analysis: prevalence fell from 6% to 4% in five years. No differences in time trends before-after the intervention. Major limitations are: organizational difficulties met by LHU, too short time for some local activities.
A huge amount of information was spread through health professionals and women. The issue of menopause was also used to discuss women's wellbeing. This project offered an opportunity to launch a multidisciplinary, multimodal approach to menopause looking not only at pharmacological aspects, but also at quality of life and information.
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