Bibliografie Hormone Replacement Therapy (HRT)

Bibliografie Hormone Replacement Therapy (HRT) Periode 2000 – 2011 (19 oktober)* Inleiding In deze bibliografie is de centrale vraag: gebruiken vrouwe...
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Bibliografie Hormone Replacement Therapy (HRT) Periode 2000 – 2011 (19 oktober)* Inleiding In deze bibliografie is de centrale vraag: gebruiken vrouwelijke artsen hormone replacement therapy (HRT) vaker in vergelijking met andere vrouwen? Er werden zoekacties uitgevoerd in PubMed en Embase. Als tijdsperiode werd gekozen: vanaf 2000, omdat toen vele complicaties rondom HRT-gebruik in de literatuur bekend werden. Er waren geen restricties voor wat betreft de taal. De zoekacties leverden ongeveer 130, veelal irrelevante, referenties (tijdschriftartikelen) op. PubMed leverde 12 relevante referenties op, Embase leverde nog 1 extra relevante referentie op. In Scopus werd nog gezocht naar recentere of oudere relevante literatuur op basis van de citaties en referenties behorend bij de relevante publicaties uit PubMed en Embase. Helaas leverde dit niets extra’s op, zodat er in totaal 13 relevante publicaties zijn. Het percentage gynaecologen dat HRT gebruikte ligt rond de 70% (Filho, Kaplan, Pedersen, Thunell). Bij huisartsen en oncologen ligt dat percentage lager (Biglia, 2006). In de abstracts van een aantal artikelen wordt geen uitsluitsel gegeven over hoeveel vrouwelijke artsen HRT gebruiken en wordt er ook niets gezegd over HRT-gebruik onder de gewone bevolking, maar de artikelen zelf kunnen toch wel van belang zijn (Frank, Gupta, Jamin enWeismann-Brenner). In een paar gevallen wordt er alleen gezegd dat HRT-gebruik meer voorkomt onder vrouwelijke artsen dan onder de gewone bevolking (Biglia, 2006; Gjelsvik).

Brazilië Uit een Braziliaanse studie uitgevoerd in 2001 blijkt dat van de vrouwelijke gyneacologen die in de menopause zaten, 61,1% huidige gebruikers waren en 10,3% voormalige gebruikers van HRT, totaal dus ongeveer 70% (Filho) Er zijn helaas geen gegevens over het gebruik van HRT door de algemene bevolking.

Israël Uit een Israëlische studie rond 2001 bleek dat 70% van de vrouwelijke gynaecologen die in de menopause zat ooit HRT had gebruikt (Kaplan). Helaas zijn er geen gegevens over het gebruik van HRT door de algemene bevolking.

Italië Uit een Italiaanse studie blijkt dat 56,5% van de vrouwelijke artsen en partners van mannelijke artsen in Noord-Italië in de post-menopause HRT hadden gebruikt, en 68,3% daarvan waren huidige gebruikers van HRT (Biglia, 2004). Uit een latere Italiaanse studie blijkt dat 37% van de vrouwelijke artsen en 39% van de partners van mannelijke artsen ooit HRT heeft gebruikt na de menopause, waarvan 64%, respectievelijk 58% huidige gebruikers zijn (Biglia, 2006). Biglia constateert de volgende verschillen tussen enkele specialismen: van de gynaecologen gebruikt 56 – 59% HRT, bij de huisartsen is dat 30 – 31%, en bij de oncologen is dat 16 – 30%. In Italië gebruiken vrouwelijke artsen en de partners van mannelijke artsen veel vaker HRT dan de doorsnee bevolking in de post-menopause.

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Aanwezig in VALUE Databank. Bibliografie afgerond op 16 november 2011

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Scandinavische landen (Denemarken, Noorwegen en Zweden) Een studie onder vrouwelijke gynaecologen en partners van mannelijke gynaecologen in Denemarken, Zweden en Noorwegen, uitgevoerd in 2002-2003, laat zien dat de prevalentie van HRT onder beide groepen in de menopause tussen 68% en 74% ligt (Pedersen). In 2003 lag het huidige gebruik van HRT onder Zweedse vrouwelijke gynaecologen in de menopause op 71% (in 1996 was dat 88%) (Thunell). Het aandeel Noorse vrouwelijke huisartsen in de menopause dat in 2004 zelf HRT gebruikt is behoorlijk stabiel gebleven en is substantieel hoger dan dat van de gemiddelde bevolking (Gjelsvik, taal: Noors). De drie studies geven helaas niet aan hoeveel hoger het gebruik van HRT onder gynaecologen en huisartsen is ten opzichte van de gemiddelde bevolking.

Verenigd Koninkrijk Een studie uit 2005 onder vrouwelijke artsen in het Verenigd Koninkrijk laat zien dat onder vrouwelijke artsen van 50-64 jaar die ooit HRT hadden gebruikt was toegenomen van 53,4% in 1993 naar 66,2% in 2003 (Isaacs 2005). Bij vrouwelijke artsen onder de 50 jaar nam het gebruik van HRT af. De prevalentie van het huidige gebruik van HRT bij vrouwelijke artsen tussen 50 – 64 jaar bleef onveranderd 38,1%. Helaas zijn er geen gegevens over het gebruik van HRT door de algemene bevolking.

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1. Biglia, N. et al., "Personal use of HRT by postmenopausal women doctors and doctors' wives in the north of Italy," Gynecological endocrinology 18 (3): 165-174 (2004). Abstract: This study aimed to describe the prevalence of hormone replacement therapy (HRT) use by women doctors and doctors' wives in northern Italy, to explore the relationship between their personal characteristics and HRT use, and to gather information about the use of alternative remedies. A questionnaire was mailed to all physicians born between 1935 and 1955 included in the database of the Medical Register of Turin County (Northern Italy). The questions were meant to explore medical, behavioral, and professional characteristics; personal use of HRT; reasons for and against HRT use; side effects and use of other therapies. 56.5% of postmenopausal women who completed the questionnaire had used HRTand 68.3% of them were current users. The median duration of HRT use was 3.7 years. Only 18.5% of the women had used HRT for 5 years or more; in this case, HRT was started significantly earlier than in the other groups. More than 50% had taken oral HRT, while 39% had used patches; estrogens only had been taken by 21.9%. HRT users had a significantly lower basal body mass index and more vasomotor and dystrophic symptoms at menopause onset compared with non-HRT users. More women on HRT were in good physical health and had an active sex life. Previous breast cancer and family history of cardiovascular diseases were inversely associated with HRT use. The main reason for not taking HRT or stopping it was fear of breast cancer (43.7% and 34.8%, respectively); irregular bleeding and weight gain were also frequently reported as a reason for HRT (30% and 22%). Overall, 22% of women had used alternative drugs to alleviate menopausal symptoms or prevent menopause-related diseases, mainly tibolone (21% among never HRT users and 2% among HRT users; p = 0.015) and phytoestrogens. The prevalence and duration of use of HRT by Italian physicians is consistent with the available data from other Western countries, and is much higher than in the general population. This is in contrast with the very low prevalence of use in the general population and may lead, in the near future, to a larger use of HRT in Italy.

2. Biglia, N. et al., "Personal use of hormone therapy by postmenopausal women doctors and male doctors' wives in Italy after the publication of WHI trial," Maturitas 54 (2): 181-192 (2006). Abstract: OBJECTIVE: To describe the prevalence of hormone replacement therapy (HT) use by postmenopausal women doctors and doctors' wives in Italy and to explore the relationship between their personal characteristics and HT use. DESIGN: A total of 500 women doctors and 500 men doctors answering on behalf of their female partners were interviewed by a specialised company in the first months of 2003. Questions were meant to explore medical, behavioural and professional characteristics, personal use of HT, reasons for or against HT use and side effects of HT. The distribution of doctors' specialisation (general practitioners (GPs), gynaecologists, medical oncologists) in the sample interviewed was the same as that of the Italian medical community. RESULTS: Overall, 37% of women doctors and 39% of doctors' wives had ever used HT after menopause, of which 64 and 58%, respectively, were current users. The median duration of HT in the past users was 2.7 years for women doctors and 3.7 for doctors' wives. There were wide differences of HT use according to the type of specialisation: gynaecologists were more willing to use HT (56-59%) than GPs (30-31%) or medical oncologists (16-30%). Vasomotor symptoms (68-69%), followed by the prevention of osteoporosis (28-39%), were the main reasons for commencing HT. The main reasons not to take or to stop HT were the absence or resolution of menopausal symptoms. Only 8% of women doctors and 4% doctors' wives stopped HT after the publication of the WHI data. CONCLUSIONS: In Italy, women doctors/doctors' wives personally use HT much more than postmenopausal general population.

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3. Filho, A. S. et al., "Attitudes and practices about postmenopausal hormone therapy among female gynecologists in Brazil," Maturitas 51 (2): 146-153 (2005). Abstract: OBJECTIVES: The aim of this study was to investigate the attitudes and practices of Brazilian female gynecologists surrounding their personal use of menopausal/postmenopausal hormone therapy (HT). METHODS: This study was conducted in February 2001 using a mail survey. Three thousand eighty nine (n = 3089) female gynecologists over the age of 35 years and affiliated with the Brazilian Federation of Obstetricians and Gynecologists (FEBRASGO) were sent a questionnaire inquiring about their demographic, professional, medical, and behavioral background as well as their personal use of HT. RESULTS: The response rate was 56.3%. Information on the menopausal status was available for 1655 respondents: 755 (45.7%) were postmenopausal, 172 indicated that they had irregular menses cycles (9.2%), and 728 (44.1%) underwent regular menses. Approximately, 47% of the postmenopausal respondents had been subject to a hysterectomy and were above the age of 50 years or had undergone bilateral oophorectomy. When asked about personal HT use, 61.1% and 10.3% of the respondents indicated that they were current or former users, respectively. 28.6% of the respondents had never used HT. The highest frequency of use occurred during their fifth decade. The main reasons for their use of HT included the attenuation of vasomotor symptoms, the prevention/treatment of osteoporosis, or the prevention of cardiovascular disease. Combined estrogen/progestin therapy was the preferred choice for postmenopausal gynecologists with an intact uterus. Family or personal histories of breast cancer or smoking were reported as deterrents against HT use for the female gynecologists. CONCLUSION: Brazilian postmenopausal gynecologists engage in a high frequency of HT use. High levels of personal use may influence the general population towards HT prescription and compliance.

4. Frank, E. and L. Elon, "Clinical and personal relationships between oral contraceptive and hormone replacement therapy use among US women physicians," Menopause 10 (2): 133-141 (2003). Abstract: OBJECTIVE: To examine relationships between a history of oral contraceptive (OC) use and current use of or intention to use hormone replacement therapy (HRT). DESIGN: The Women Physicians' Health Study examined a stratified random sample of US women MDs, aged 30 to 70 years (4,501 respondents; a 59% response rate). RESULTS: Among postmenopausal physicians who previously used OCs, current HRT use was significantly associated ( < 0.05) with being younger, living somewhere besides the East Coast, being sexually active, being an obstetrician/gynecologist, having no history of breast cancer, having a longer use of OCs, and being posthysterectomy. Among premenopausal physicians, intended future HRT use was significantly associated with being white, being an obstetrician/gynecologist, being in good health, living somewhere besides the East Coast, being a longer user of OCs, and having more extensive, recent continuing medical education. Among women who had taken both OCs and HRT, there were no significantly elevated rates in any of the 15 health conditions we examined (after controlling for family history). Postmenopausal physicians who took HRT (and premenopausal OC-using physicians intending to take HRT) were significantly more likely to counsel their patients on HRT use. Among post-OC HRTusers, 44% counseled their postmenopausal female patients on HRT at least yearly versus 22% of post-OC HRT-nonusers (74% v 45% among such primary care physicians). CONCLUSIONS: Physicians' personal OC/HRT use may strongly affect their patient counseling practices. HRT use after OC use was not associated with any obvious increases in examined diseases in this population.

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5. Gjelsvik, B., E. Swensen, and P. Hjortdahl, "[The general practitioner's view on hormone replacement therapy during and after menopause]," Tidsskrift for den Norske laegeforening 127 (11): 1500-1503 (2007). Abstract: BACKGROUND: The evidence base for hormone replacement therapy of women during and after menopause has been strengthened in recent years. The aim of the study was to investigate Norwegian GPs' attitude to hormone replacement treatment in menopause, their knowledge of effects and indications, the risk of side effects, and the personal use of hormone treatment by female GPs. MATERIAL AND METHODS: A questionnaire was sent to 400 Norwegian GPs, randomly drawn from the membership list of GPs in the Norwegian Medical Association, in May 2004. RESULTS: We received answers from 72%. The answers imply that most Norwegian GPs know the current evidence base regarding the effects and side effects of hormone replacement therapy. Most of them indicate that they follow the Norwegian recommendations about indications and contra-indications, but that they continue the treatment longer than recommended. A large majority of the respondents agreed to the statements that hormone treatment increases the risk of breast cancer, that it does not prevent heart infarction and that the most important reason to prescribe hormone treatment is bothersome hot flushes. Female GPs seem to be better updated on some aspects of the treatment than men. 14 out of 17 peri- and postmenopausal female GPs were using or had used such treatment. INTERPRETATION: Norwegian GPs are generally well updated regarding new evidence in this field. The proportion of menopausal female GPs who take hormone treatment themselves has remained quite stable and is substantially higher than that for the average for the population. This finding may imply that menopausal female GPs regard the risks of treatment as low, and that most of them find the benefits of treatment greater than the risks.

6. Gupta, S., N. Forbes, and R. Kirkman, "Attitudes to menopause and hormone replacement therapy among Asian and Caucasian women general practitioners," Maturitas 39 (2): 169-175 (2001). Abstract: OBJECTIVE: To look for any differences in attitudes to menopause and hormone replacement therapy (HRT) between Asian and Caucasian women standardised for educational background, socio-economic status and access to medical information. METHOD: Self administered postal questionnaire sent to 144 women doctors (general practitioners) in defined geographical areas. RESULTS: The overall response rate was 61%. Both Asian and Caucasian women responded in a similar manner for most aspects. A high proportion of these women doctors (over 75%) would seek HRT at the climacteric. More Asian respondents reported a fear of breast cancer (P=0.001), and that a woman feels less of a woman after the menopause (P=0.02). More Caucasian respondents felt positively about the potential for HRT to enhance enjoyment of life (P=0.01). CONCLUSIONS: The lack of major differences between the ethnic groups in our sample suggests that variations reported elsewhere may be due to lack of knowledge and/or differences in socio-economic status.

7. Isaacs, A. J. D., "UK women doctors' use of hormone replacement therapy: 10-Year follow up," Climacteric 8 (2): 154-161 (2005). Abstract: Objectives: To determine changes in the prevalence and duration of use of hormone replacement therapy (HRT) by women doctors over 10 years, Methods: Questionnaire survey of 1234 UK women doctors (randomized, stratified sample), compared with a similar survey in 1993. Results: In women aged 50-64 years, the age-standardized prevalence of ever-use of HRT had increased from 53.4% in 1993 to 66.2% in 2003 (p < 0.001). There was a marked reduction in uptake by women under 50 years, while the age-standardized prevalence of current use in 5

women aged 50-64 years was unchanged at 38.1%. The discontinuation rate in this age group had increased from 27.8% to 42.4% (p < 0.001). Over 20% of women aged 65-74 years were still using HRT. The median duration of HRT use was 8.1 years by current users and 5 years by past users. The major indications were symptom relief and osteoporosis prevention. Current users of HRT tended to have more definite views about the potential risks and benefits of longterm use than past or never-users. Conclusions: The proportion of women doctors starting HRT increased after 1993, but uptake and continuation rates have now both declined, consistent with prescription data, probably reflecting the changing nature of the evidence base. However, many women doctors still intended to continue long-term HRT. 2005 International Menopause Society.

8. Jamin, C. et al., "[How WHI study influences women doctors' behaviour towards menopause]," Gynécologie, Obstétrique & Fertilité 34 (6): 499-505 (2006). Abstract: OBJECTIVE: A survey entitled FEMME was conducted during 2002 in order to evaluate among French women doctors their own actual or future menopause perception and this before the WHI publication. The results of this American trial possibly modified the perception of these French women doctors. Therefore the same experts group conducted a new survey, from May to September 2003. The main aim of this survey was to evaluate the possible changes in the medical management of the actual or future menopause of these women, and secondarily to evaluate the changes in their patients' behaviour towards hormone replacement therapy (HRT). POPULATION AND METHODS: Postal auto administered questionnaires were sent to the same 10 000 French women doctors (GP or gynaecologist) whatever their menopausal status or their age. 1365 women doctors (respectively 18,5 or 11% of the gynaecologists or GPs contacted) were volunteers to participate in this survey. Among them, 1120 (84,9%) had already participated in the first part of this survey which took place before the WHI publication. RESULTS: 80% of these women doctors have been informed on WHI results principally by professional press or conferences. 70,9% changed their own actual or future menopause perception as follows. No additional selection of non hormonal treatment have been mentioned in comparison with the first part of the survey. On the other hand for HRT, selections of free estrogen plus progestin associations increased whereas those of fixed combinations decreased: this might be linked to the greater variety of estrogen doses, types of progestin and schedules of treatment (mostly with bleeding) offered by this kind of associations. Finally, duration of HRT is included between three and ten years in most cases. DISCUSSION AND CONCLUSION: Thus, unlike most of their patients, these women's physicians always preferred hormonal treatment for their own actual or future menopause. Only the conditions of these treatments have changed.

9. Kaplan, B. et al., "Attitude towards health and hormone replacement therapy among female obstetrician-gynecologists in Israel," Maturitas 43 (2): 113-116 (2002). Abstract: OBJECTIVE: To assess Israeli women gynecologists toward their own health, their health related behaviors and to assess attitude towards and the use of hormone replacement therapy (HRT). METHODS: Ninety five actively employed hospital and community women gynecologist completed a questionnaire on attitude towards self-health, way of life, smoking habits, and regular breast, blood, pap smear examinations and HRT. RESULTS: Mean BMI was 25.3 Kg/m(2)+/-4.2, 61% considered themselves above average weight, and only 39% estimated their weight as appropriate. Fifty six percent were on active weight-loss diets, and 35% were current smokers. Blood tests, pap smears and breast evaluations were regularly done by 73.4, 91.5, and 64.1%, respectively. Overall, 74% of the gynecologists had a positive opinion about HRT; 70% of the menopausal subgroup had ever used HRT, and 93.3% of the perimenopausal 6

subgroup intended to use it. The main reason for starting HRT was climacteric symptoms, and for stopping or avoiding HRT were equally bleeding, fear of cancer and adverse reactions towards HRT. By far the oral HRT mode was the most popular and 90% of users expressed satisfaction with treatment. CONCLUSIONS: Israeli women gynecologists are aware and maintain carefully their health, excluding cigarette smoking. The high rate of use and awareness of HRT among this group is encouraging considering that gynecologist serves as role model for the public and maintains the main source of HRT in the community.

10. Pedersen, A. T. et al., "Impact of recent studies on attitudes and use of hormone therapy among Scandinavian gynaecologists," Acta Obstetricia et Gynecologica Scandinavica 86 (12): 14901495 (2007). Abstract: BACKGROUND: Climacteric medicine has been in focus during the last 2 decades, and an intensive debate has been ongoing regarding the positive and negative aspects of postmenopausal hormone therapy (HT). Recent randomised controlled studies have been unable to confirm data from observational studies of primary or secondary preventive effects of HT on coronary heart disease, and other studies have indicated an increased risk of breast cancer, stroke and venous thromboembolism among HT users. In 2001, we reported on knowledge, attitudes, management strategies and use of HT among Scandinavian gynaecologists. The aim of the present study was to re-assess the same parameters concerning HT among Scandinavian gynaecologists in 2002-2003, and compare the results with the data collected in 1995-1997. METHODS: All practicing gynaecologists in Denmark, Sweden and Norway were invited by letter to complete and return a questionnaire regarding their knowledge, attitudes and management strategies concerning HT. Female gynaecologists were questioned if they were currently using HT, and the same question was posed concerning spouses of male gynaecologists. RESULTS: The questionnaire was completed and returned by 60, 76 and 72%, respectively of gynaecologists in Denmark, Sweden and Norway. Of the 1,591 physicians who responded, 13% thought that all women should be offered HT provided there were no contraindications, while 86% recommended HT only to selected women after considering the individual advantages and disadvantages of the treatment. Of the gynaecologists, 37% considered HT to be without relevance in the primary prevention of osteoporosis in healthy women. As for duration of the treatment, 40% of the gynaecologists would recommend HT for 10 years. The prevalence of HT use among the menopausal female gynaecologists varied between 71 and 74%. Among the menopausal spouses of male gynaecologists, 68-72% were current users of HT. CONCLUSION: During the last years of ongoing debate, gynaecologists from Denmark, Sweden and Norway have become more modest in their recommendations of postmenopausal HT. Scandinavian specialists are more cautious in prescribing hormones for women with symptomatic CVD or previously treated for breast cancer, however, their personal use of HT has not changed dramatically and still reflects a positive attitude.

11. Thunell, L. et al., "Scientific evidence changes prescribing practice--a comparison of the management of the climacteric and use of hormone replacement therapy among Swedish gynaecologists in 1996 and 2003," BJOG. 113 (1): 15-20 (2006). Abstract: OBJECTIVES: To study changes in attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynaecologists in Sweden. DESIGN: Comparative questionnaire study. SETTING: National survey. POPULATION: Practising gynaecologists. METHODS: In 1996, gynaecologists in Sweden (n= 1323) were invited to return a postal questionnaire concerning their attitudes, knowledge and management strategies concerning HRT. They were also asked about their own use of HRT. In 2003, a similar 7

questionnaire was sent to practising gynaecologists (n= 1320) in Sweden. MAIN OUTCOME MEASURES: Attitudes to and personal use of HRT. RESULTS: The response rate was 76% in 2003 when 11% of the gynaecologists thought that all women without contraindications should be offered HRT compared with 44% in 1996 and 89% found it difficult to evaluate pros and cons with HRT in a clinical situation (74% in 1996). More gynaecologists in 2003 believed that HRT increased the risk for breast cancer (95% vs 71%). Twenty-five percent in 2003 stated that risk factors for osteoporosis were absolute indications for HRT (60% in 1996). Current ischaemic heart disease was considered to be an indication for HRT by 7% in 2003 (60% in 1996). In 2003, current use of HRT was reported by 71% of female menopausal gynaecologists (88% in 1996). CONCLUSIONS: Swedish gynaecologists were more cautious in their management strategies concerning HRT in 2003 compared with 1996, probably influenced by results from the Heart and Estrogen/Progestin Replacement Study (HERS) and Women's Health Initiative (WHI) studies. Current use of HRT was still high among female gynaecologists, although it had decreased since 1996.

12. Weissmann-Brenner, A. et al., "Women gynecologists' attitude toward their own health," Medical Science Monitor 16 (4): H35-H39 (2010). Abstract: BACKGROUND: Following the publication of the results of Women's Health Initiative in 2002 there have been gross changes in the attitude of women and physicians towards the risks and benefits of hormone replacement therapy (HRT). We evaluated the attitude of women gynecologist towards their own health, including adherence to recommended screening tests and self usage and prescription of hormone replacement therapy. MATERIAL/METHODS: Questionnaires regarding performance of screening tests, self usage and recommendation of HRT were posted by mail to all Israel's women gynecologists. RESULTS: Ninety questionnaires were eligible for analysis (43.2% response rate). Average age was 48+/-7.7 years. Only 7/90 (7.8%) gynecologists smoke regularly and average body mass index was 25+/-3.8 kg/m2. Most participants performed at least one screening tests in the past 2 years. The median interval from the last self breast exam, mammography, gynecologisy exam, Papanicolaou test, colonoscopy and bone density test was 0.2, 1.82, 1.79, 1.95, 3.27 and 1.41 years, respectively. Most of them (68.3%) did not routinely recommend HRT to their patients. The duration of self HRT usage ranged between 1-20 years (average 5.1+/-3.4 years). Most gynecologists (87.7%) recommended continuous estrogen and progesterone for women with their uterus in place. CONCLUSIONS: The health profile of Israeli women gynecologists is chracterized by a high performance of screening tests for cancer and low rate of smoking. Our study also demonstrates that the impact of the results of the WHI trial is still well manifested and most Israeli women gynecologists do not routinely recommend HRT to postmenopausal women.

13. Weissmann-Brenner, A. Brenner, "Women gynecologists' attitude toward their own health and hormone replacement therapy," Maturitas Conference (var.pagings): May (2009). Abstract: Background: Following the publication of the results of Women's Health Initiative in 2002 there have been gross changes in the attitude of women and physicians towards the risks and benefits of hormone replacement therapy (HRT). Objectives: We sought to evaluate the attitude of female gynecologist towards their own health, including adherence to recommended screening tests as well as self usage and prescription of hormone replacement therapy. Methods: Questionnaires regarding performance of screening tests, self usage and recommendation of HRT were posted by mail to all Israel's female gynecologists. Results: Ninety questionnaires were completed and were eligible for analysis. Average age was 48+/-7.7 years. Only 7/90 (7.8%) gynecologists smoke regularly and average body mass index was 25+/-3.8 8

kg/m2.Most participants performed at least one screening tests in the past 2 years. The median interval from the last self breast exam, mammography, gynecologisy exam, Papanicolaou test, colonoscopy and bone density test was 0.2, 1.82, 1.79, 1.95, 3.27 and 1.41 years, respectively. Most of them (68.3%) did not routinely recommend HRT to their patients. The duration of self HRT usage ranged between 1-20 years (average 5.1+/-3.4 years). Most gynecologists (87.7%) recommended continuous estrogen and progesterone for women with their uterus in place.

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