MANAGEMENT OF HORMONE REPLACEMENT THERAPY - THE SWEDISH EXPERIENCE

Objective: To describe the experience of Swedish physicians in the man agement of hormone replacement therapy (HRT). Methods: A postal questi onnaire was sent to a sample of Swedish women aged between 46 and 62 y ears of age. The sample represented one woman in two from the birth co horts 1946, 1942, 1938, 1934 and 1930. Results: A total of 5990 women were sent the questionnaire and 4525 (76%) completed and returned it. Of this sample, 21% currently used HRT and a further 20% had used it i n the past. A high proportion who continued using HRT derived benefit from it which was reflected in relief from vasomotor symptoms, irritab ility, insomnia, vaginal dryness and muscle and joint pain. Only 27% o f those trying other, non-hormonal therapy considered that they had be nefited from it. The major reasons for not taking HRT was fear of side -effects, a belief that the menopause should not be interfered with, a nd at the recommendation of their physician. The same reasons were giv en by those women starting HRT but discontinuing it later. Conclusions : The figure of 21% using HRT compares favourably with other Scandinav ian countries. A high proportion of HRT is prescribed by gynaecologist s reflecting that many GPs were unfamiliar with its use. When HRT is g iven by GPs, many favour the transdermal route. Compliance is a major problem and few women continue long enough to benefit fully. One way o f minimizing this is to ensure that patients are fully informed and ha ve any fears and misconceptions dealt with. Adverse and misleading inf ormation from the media may have to be countered. Individualization of therapy is important and should be tailored to particular age groups. Transdermal HRT may be more acceptable in some cases.