Susan Wilhelm, Ph.D., assistant professor in UNMC’s College of Nursing Scottsbluff Division, was as surprised as many with the recent news that the National Institutes of Health halted a hormone replacement therapy (HRT) study about three years early, citing health risks.
The NIH’s National Heart, Lung, and Blood Institute cut short the study after it found an increased risk of invasive breast cancer, coronary heart disease, stroke and pulmonary embolism in study participants on estrogen plus progestin, compared to women who were taking placebo pills.
HRT is prescribed to treat symptoms of menopause, including hot flashes, night sweats, sleeplessness and vaginal dryness, as well as to prevent some long-term conditions more common in women after menopause.
The study found a 41 percent increase in strokes, 29 percent increase in heart attacks, doubling of rates of blood clots, 22 percent increase in total cardiovascular disease, 26 percent increase in breast cancer, 37 percent reduction in cases of colorectal cancer, one-third reduction in hip fracture rates, and 24 percent reduction in total fractures. Although benefits included fewer cases of hip fractures and colon cancer, the NIH said the harm was greater than the benefit.
Dr. Wilhelm’s study recognized
In June, Dr. Wilhelm, also a clinical nurse specialist who has been involved in obstetric nursing for about 25 years, received an award for a clinical research poster and dissertation titled, “Exploring the Relationship of Attitudes, Knowledge, Support and Self-efficacy on Intent to Adhere to Hormonal Replacement Therapy for Menopause.”
She presented the poster at the annual Association of Women’s Health, Obstetric and Neonatal Nurses convention in Boston. The study, which she concluded last year, also has recently been accepted for publication in the Journal of Obstetric, Gynecologic, and Neonatal Nursing.
While the award stands on its own merit, the recent news most likely will affect follow-up in the study.
Dr. Wilhelm’s study looked at the factors affecting a woman’s decision on whether to take hormone replacement therapy. Not surprising, she found one of the biggest determinants was safety. She also found a majority of women were worried about breast cancer but not about heart disease.
“What is worrisome about the findings of the Women’s Health Initiative is the lack of support for HRT as a primary cardiovascular disease prevention therapy because for years, we (health professionals) thought HRT prevented heart disease,” Dr. Wilhelm said. “The findings seem to reinforce what women are already afraid of. It also shows we should be more concerned about heart disease than breast cancer as far as occurrences.”
She studied 167 peri-menopausal and menopausal rural women, 39 to 58 years old, who were considering whether to go on HRT. One of the goals was to assist women in the decision-making process. The majority of study participants were not yet experiencing menopausal symptoms that interfered with their daily activities and did not have a history of chronic illnesses, uterine problems or a history of osteoporosis.
Findings of the study
The purpose of Dr. Wilhelm’s study was to explore attitudes toward menopause, their knowledge of menopause, the perception of support from relatives, friends and health providers in taking HRT and self-efficacy for HRT.
Women were asked to respond, on a scale from one to seven, with seven being very likely, whether they would take HRT. Most answered five, that they were slightly likely to take HRT.
She found one of the most significant factors in whether to take HRT or not is access to information in order to make an informed decision. She said women consistently report a lack of access to what they believe are valid and reliable sources of knowledge concerning the menopause experience.
When Dr. Wilhelm rated the study participants on their knowledge of menopause issues, they scored 72 percent, with knowledge especially lacking on the benefits and risks of HRT and physiology (signs and symptoms).
Dr. Wilhelm knows firsthand the struggle of finding the right information.
“When I turned 40, I became menopausal,” Dr. Wilhelm said. “When I tried to find valid information about menopause, I had a very difficult time. I thought if I had a difficult time as an ob nurse, I know others would too.”
Other studies report that although benefits of HRT are known, the majority of women do not take it. Dr. Wilhelm said this also might be due to how women view menopause.
Women with a more positive attitude towards menopause might not perceive the need to adopt HRT, she said, citing one study that found attitude was related inversely to HRT use.
“Women have been leery about taking hormones. For one thing, if we are going to promote HRT, we need to help women feel more confident in taking it and provide them with the knowledge and benefits versus the risk ratio.”
Her study also found women are significantly more likely to take HRT if they believe their relatives, friends and health care providers support their taking HRT.
The rural location of the participants may have been a factor in the level of intent to seek HRT treatment, Dr. Wilhelm said.
“Rural individuals tend to take medications and seek treatment for health problems only if they cannot perform their activities of daily living,” she said. “There also seems to be a difference in managing menopause between women who view menopause as a medical condition that needs to be treated and those women who view menopause as a natural transition.”
Whatever the outcome of the NIH study, Dr. Wilhelm hopes the recent news will prompt health professionals to more thoroughly educate women about the risks and benefits of HRT. The issue has a large impact, she said, considering estimates that by 2015, half of all women in the United States will be menopausal.
“You have to look at your own risk factors and look at the quality of life issues now and weigh the personal benefits and risks,” she said.