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Evolving practice patterns and attitudes toward hormone therapy of obstetrician-gynecologists

Power, Michael L. PhD1; Schulkin, Jay PhD1; Rossouw, Jacques E. MD2

doi: 10.1097/01.gme.0000229571.44505.cb

Objective: The objective of this study was to examine the opinions and prescribing practices of obstetrician-gynecologists regarding hormone therapy (HT) and the results from the Women's Health Initiative.

Design: Surveys were sent to 2,500 randomly selected American College of Obstetrics and Gynecology fellows during December 2004 to March 2005; their responses are compared with those from a survey conducted in November to December 2003.

Results: Respondents remained skeptical of the combined HT results (49.1% did not find the results convincing). Compared with the 2003 survey, men were more skeptical (58.8% did not consider the findings convincing in 2004 vs 53.4% in 2003, P = 0.045), and women were somewhat less skeptical (39.5% did not consider the findings convincing in 2004 vs 45.3% in 2003, P = 0.056). There was less skepticism about the estrogen-only trial, although 4 of 10 did not find the results convincing. Men were more skeptical than women; a majority of men disagreed with the decisions to stop the trials. Physicians who completed their residency more recently were more likely to accept the trial results. Respondents reported a reduction in HT prescription practice relative to the year 2000, but 62.7% reported they did not expect their prescribing practices to change further in the near future. The proportion of respondents who considered alternative therapies to HT as viable treatment options increased between 2003 and 2004 (37.1% vs 28.1%, P < 0.001). There was strong support for the use of HT for vasomotor symptoms, vaginal dryness, and osteoporosis, but most physicians did not consider HT useful for cardiovascular disease or dementia.

Conclusions: Many obstetrician-gynecologists continue to express skepticism about the results and conduct of the Women's Health Initiative trials. The survey could not determine the reasons for skepticism.

Many obstetrician-gynecologists continue to be skeptical about the results of the Women's Health Initiative hormone therapy trials, and to disagree with the decision to stop the trials.

From the 1Department of Research, American College of Obstetricians and Gynecologists, Washington, DC, and the 2National Heart, Lung, and Blood Institute, Bethesda MD.

Received March 12, 2006; revised and accepted May 8, 2006.

Funding/support: This research was supported by National Heart, Lung, and Blood Institute grant N01-HO-34205.

Financial disclosure: None reported.

Address correspondence to: Michael L. Power, PhD, Department of Research, American College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, DC 20024. E-mail:

©2007The North American Menopause Society