A SURVEY OF VIEWS ON HORMONE REPLACEMENT THERAPY

Objective To investigate the attitude of consultant gynaecologists and general practitioners to various aspects of hormone replacement thera py and to compare the findings in these two groups. Design Anonymous p ostal survey of 589 general practitioners and 998 consultant gynaecolo gists; 373 (63 %) and 655 (66 %) valid replies, respectively, were rec eived. Main outcome measures Views on universal treatment of eligible women, indications for hormone replacement therapy, prescribing practi ce, pretreatment investigation, monitoring, and contraindications to t reatment. Results More consultants (64 %) than general practitioners ( 56 %) thought hormone replacement therapy should be offered to all eli gible women, with a significant trend against treatment amongst more s enior consultants. Most practitioners were prepared to offer treatment before the cessation of menstruation, but only 27 % of consultants an d 11 % of general practitioners recommended indefinite treatment. Most limited treatment to less than 10 years. Menopausal symptoms, prematu re natural and surgical menopause, and a family history of osteoporosi s were regarded as indications for treatment, but less than half felt established osteoporosis an indication. Hormone replacement therapy wa s judged to reduce the risk of ischaemic heart disease and osteoporosi s by both groups but there was less consensus on the prevention of cer ebrovascular accident. In general, consultants had more faith in hormo ne replacement therapy as prophylaxis. One-quarter of consultants said that hormone replacement therapy should be initiated by consultants. Only 4 % of general practitioners shared this view. About 30 % of both groups required mammography, but less than 10 % required sophisticate d tests. A range of common cardiovascular conditions were regarded as contraindications, although general practitioners were more likely to regard thrombosis and cerebrovascular accident as contraindications. B reast cancer and a family history of breast cancer were regarded with suspicion by both groups. Conclusions Practitioners were positively in clined to hormone replacement therapy, but many were unconvinced of it s chronic use and use in those with cardiovascular conditions. There w ere differences in views as to who should initiate therapy.