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Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment

Parish, Sharon J., MD1; Nappi, Rossella E., MD, PhD2,3; Kingsberg, Sheryl, PhD4

doi: 10.1097/GME.0000000000001088
Review Article

Objective: This narrative review strives to give healthcare providers (HCPs) who care for menopausal women better tools and skills to initiate discussions with women about menopause and hormone therapy (HT), communicate complex concepts and data, and promote shared decision-making.

Methods: We review relevant studies on HT, barriers to treatment of menopausal symptoms, and effective communication strategies. We also provide recommendations for communicating with patients about HT based on the medical literature and our own professional experience.

Results: Both patient and HCP-related barriers can prevent women from accessing treatment for bothersome symptoms of menopause. Many women and HCPs have a poor understanding of the complex, nuanced data regarding HT. The benefits and risks vary with patient age and time since menopause, duration of use, inclusion of a progestin, and patient medical history. Women may also have fears about potential side effects of HT and feel unable to make informed choices. Strategies for effective patient communication and shared decision-making include use of open-ended questions to elicit patient's concerns and preferences, reflecting back to the patient what the HCP heard, presenting evidence about benefits and risks in language the patient can understand, keeping risks in perspective (eg, provide absolute, and also relative risks) without minimizing them, and making conscious efforts to minimize potential bias.

Conclusions: Necessary components for achieving high-quality, shared decisions about HT involve a combination of medical evidence, communication skills, and recognition of patient goals and concerns. Use of such strategies can enhance women's satisfaction with care.

1Weill Cornell Medical College, New York, NY

2Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Italy

3Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy

4University Hospitals Cleveland Medical Center, Cleveland, OH; MacDonald Women's Hospital, Cleveland, OH.

Address correspondence to: Sharon J. Parish, MD, Professor of Medicine in Clinical Psychiatry, Professor of Clinical Medicine, Weill Cornell Medical College, Director of Medical Services, NY Presbyterian Hospital, Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605. E-mail:

Received 19 October, 2017

Revised 30 January, 2018

Accepted 30 January, 2018

Funding/support: Funded by Pfizer Inc.

Financial disclosure/conflicts of interest: SJP is an advisory board participant for Allergan, AMAG, and Valeant; is a speaker for AMAG, Pfizer, and Valeant; and has received writing support from Allergan and Pfizer. REN has served as a consultant, lecturer, and/or member of an advisory board for Bayer Healthcare, Endoceutics, Gedeon Richter, MSD, Novo Nordisk, Pfizer, Shionogi, and Teva. SK is a consultant and/or advisory board member for AMAG, Endoceutics, Pfizer, Palatin, Valeant, Emotional Brain, TherapeuticsMD, Materna, Nuelle, Shionogi, Duchesney, Sermonix, and SST.

© 2018 by The North American Menopause Society.