The mythology of hormone replacement therapy



I was very interested to read the article by Hartmann and Huber (Vol 104, February 1997)1 which described the problems of compliance associated with hormone replacement therapy (HRT), possibly relating to incorrect contraindications stipulated on the data sheet that accompany these drugs. I have also looked at this issue in a survey that was recently presented2.

Despite the benefits of HRT3 only 7% to 18% of women aged 40 to 69 years take or have ever taken HRT throughout the United Kingdom4, possibly related to poor compliance. General practitioners (GPs) have the key role of offering informed, comprehensive and continuous treatment to women who would most benefit from HRT but this may be clouded by the explosion of marketed HRT products and an equally overwhelming amount of data about warnings and contraindications. The survey2 showed that decreased compliance was compounded by the known negative feelings that some GPs may have towards HRT5; especially when there was a history of ischaemic heart disease or hypertension.

Eighty—one percent felt that HRT was contraindicated in postmen- opausal women with a past history of ischaemic heart disease. Comparable with a previous report5, this attitude was greatest in general practitioners with more than 10 years experience (84%) compared with those newly qualified (62%), and higher in male GPs (83%) compared with female GPs (65%) (P < 0.05). HRT was given to women with a history of hypertension by only 62% of GPs.

The reluctance to prescribe HRT to women with a previous history of ischaemic heart disease and hypertension, despite convincing published evidence to the contrary3, is based on the fact that 64% of GPs strictly adhered to the warnings and contraindications given in prescription leaflets. Since the attitude and working knowledge of GPs may be important determinants of a woman's choice on whether to use HRT and for how long, it is incumbent upon those who have the authority to recommend strongly that corrections are made to the information that currently accompany many HRT products.