POSTMENOPAUSAL HORMONE-THERAPY - FACTORS INFLUENCING WOMENS DECISION-MAKING

Our objective was to determine the factors that influence women's deci sion making about hormone replacement therapy, particularly with respe ct to coronary heart disease and breast cancer risk. We mailed questio nnaires to a random sample of women ages 45-55 years. We requested inf ormation on demographics; menopausal state; current, past, and intende d hormone replacement therapy use; beliefs and attitudes about the eff icacy of hormone replacement therapy; and the relationship of hormone replacement therapy to the risks of osteoporosis, heart disease, and b reast and endometrial cancer. One hundred twenty-six women (42% respon se rate) returned the questionnaire. Although the majority of women (8 1%) knew that the risk of osteoporosis increased after menopause, only about half knew that the risk of heart disease (53%) and breast cance r (45%) increased as well. Although 69% of women knew that hormone rep lacement therapy decreased osteoporosis risk, only 48% knew about the association between hormone replacement therapy and heart disease risk . Bivariate and multivariate logistic regression models were used to a ssess the predictors of ever using hormone replacement therapy. The mo st important predictor was health care provider recommendation of (odd s ratio 22.8: 95% confidence interval 4.2,124.5) hormone replacement t herapy. Other factors that remained important predictors in a multivar iate model included concern for developing osteoporosis (odds ratio 1. 8: 95% confidence interval 1.2,2.7), feeling that taking estrogen is t oo much trouble (OR 0.5: 95% confidence interval 0.3,0.7), and family history of breast cancer (OR 0.2: 95% confidence interval 0.04,0.9). A lthough most women were aware of the associations between menopause, h ormone replacement therapy, and osteoporosis, fewer women were aware o f the associations with coronary heart disease or breast cancer. No as pects of heart disease risk were associated with a woman's decision to take hormone replacement therapy. Physicians should include coronary heart disease and breast cancer in their discussions with patients con sidering hormone replacement therapy.