The two most common reasons given for noncompliance with hormone replacement therapy (HRT) are fear of breast cancer and resumption of unwanted bleeding. A recent study sought to shed additional light on why women tend to reject the menopause treatment their doctors are most likely to recommend (1). A second study sought to verify the percentage of new users who discontinue use within one year (2).

Methods:

In the first study, a 17-item extensively validated survey was conducted by phone and mail from a suburban Chicago community teaching hospital. Women surveyed ranged in age from 50-80. The women had a higher income and educational level than the national average-two factors associated with higher use of HRT. In the other study, information was derived from computer databases of a large prescription benefit management company whose extensive data would result in a nationwide picture of hormone compliance. The data focused on women chiefly in the 45-60 age range.

Results:

Survey
28% of the surveyed group reported being on HRT, of whom 76% had been taking it for more than two years. Of those who were not on hormones, almost half, 49%, reported they were not on HRT. Specific reasons given included: 45% said they do not want to take it, 28% were afraid to take it, and 27% declared they were no longer menopausal. Of the women surveyed, it was determined that 27% did not recognize the common signs and risks of lower estrogen levels that occur as a result of menopause. These women had determined they were not menopausal although their survey answers indicated otherwise.

Prescription Database Study
Noncompliance within one year of receiving a prescription from a doctor is associated with a younger age and living in the South. Significantly more noncompliance occurred when women received their prescriptions from other than OB/GYNs. In the general population, 54.4% of women were no longer filling their prescriptions by the end of the first year (see figure).

Discussion:

Several observations can be made. Women are not likely to take HRT long enough to derive long term health benefits such as lowered heart disease and osteoporosis. More than one-half of the women seemed unaware that a lack of menopausal symptoms does not relate to the continuing decline of estrogen production and increased associated medical risks. Women focused on symptoms as bellwethers of whether or not they were "menopausal." The simple message "symptoms are annoying, risks kill" is a statement that needs to be heard.

Since compliance with HRT is so low, patient education on lifestyle and nutritional medicine is imperative. These patient-perceived "user-friendly" alternatives for diseases of the aging female are important and valid considerations for long-term health.

References

1. Rabin D, et al. Why Menopausal Women Do Not Want to Take Hormone Replacement Therapy. volume 6, number 1, pp.61-66, 1999.
2. Faulkner D, et al. Patient Noncompliance with Hormone Replacement Therapy: A Nationwide Estimate Using a Large Prescription Claims Database. Vol.5, number 4, pp. 226-229, 1998.