PHILADELPHIA — A decade after the Women’s Health Initiative clinical trials, misperceptions regarding hormone therapy and gaps in knowledge prevent women from accessing treatment for menopausal symptoms, according to a study presented at the Annual Meeting of the North American Menopause Society.
JoAnn Pinkerton, MD, of the University of Virginia Midlife Health Center and North American Menopause Society executive director, and colleagues sought to uncover knowledge gaps among health care providers who treat postmenopausal women.
Nearly 1,100 participants, including physicians (50%), nurse practitioners (18%) and physician assistants (12%), were asked a series of questions about the accurate interpretation of data from the WHI both before and after undergoing a 30-minute educational program.
Among participants who work in an obstetrics and gynecology setting, the percentages of those who answered correctly before the activity were 57% of physicians, 49% of nurse practitioners and 52% of physician assistants. More participants responded correctly after the educational program: 70% of physicians, 68% of nurse practitioners and 70% of physician assistants.
On questions about attributes of new menopausal medications, all three groups saw increases in percentage of correct responses: physicians, from 39% to 58%; nurse practitioners, from 36% to 62%; and physician assistants, from 50% to 77%. Questions about appropriate application of clinical guidelines also saw an increase in percentage of correct responses from physicians (81% to 92%), nurse practitioners (84% to 88%) and physician assistants (70% to 97%).
“There was an expectation that obstetrician/gynecologists would demonstrate better results in both the pre- and post-activity tests than what was recorded. Improvements were seen in some key areas, but our data suggest that there remains uncertainty about HT risks, differences between findings for estrogen alone or with progestin, the interpretation of WHI follow-up studies, and the benefits and risk of newer menopausal medications,” the researchers wrote.
Direct comparisons could not be made between pre- and post-education answers because more program participants completed the test after the activity than completed the pre-test, according to the researchers.
“It was surprising to learn how much confusion and uncertainty still exists in the medical community about risks of hormone therapy, particularly for women who are good candidates- those who are closer to menopause with bothersome symptoms or elevated risk of bone loss,” Pinkerton told Endocrine Today. “Providers need more education about the lower risks if estrogen alone is used, compared to risks with synthetic or newer progestogens and that there is now an option for women with a uterus that doesn't even need a progestogen.”
The researchers said there should be future interventional strategies to bridge the knowledge gaps for HT in symptomatic menopausal women. - by Cassie Homer
Pinkerton JV, et al. Poster-52. Presented at: Annual Meeting of the North American Menopause Society; Oct. 11-14, 2017; Philadelphia.
Disclosure: The study was funded by Pfizer. Pinkerton reports she receives grant support from TherapeuticsMD.