Ob/gyns continue to prescribe hormone therapy

June 1, 2007

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It seems that many ob/gyns, particularly those who are male and older, remain skeptical of the results of the 2002 Women's Health Initiative (WHI) study regarding hormone replacement therapy (HRT) and continue to prescribe the therapy, particularly for vasomotor symptoms, vaginal dryness, and osteoporosis.

In comparing surveys sent to 2,500 randomly selected American College of Obstetricians and Gynecologists fellows during the first quarter of 2005 with surveys sent in 2003, researchers found that more men have become skeptical of the WHI findings: 58.8% did not consider the findings convincing in 2004 versus 53.4% in 2003 (P=0.045), while women have become less skeptical: 39.5% in 2004 versus 45.3% in 2003 (P=0.056). While there was less overall skepticism about the estrogen trial, 40% of respondents still did not find the results convincing.

Respondents reported reducing the number of prescriptions they write for HT since 2000, but 62.7% do not expect their prescribing practices to change any further. Finally, more of you are considering alternatives to HT as viable treatment options: 37.1% in 2004 versus 28.1% in 2003 (P<0.001).

Commentary by Nanette Santoro, MD,Professor and Director, Division of ReproductiveEndocrinology, Albert Einstein College of Medicine,Bronx, N.Y.

This survey of obstetrician-gynecologists has beenwidely interpreted as indicating a failure of physiciansto adapt their practice to the WHI results. However,despite the expression of widespread skepticism,most physicians did not prescribe hormone therapyas a preventive treatment for cardiovasculardisease-the central message of the WHI. Thus,while the debate continues and new research pointstoward a reduction in CHD risk with early initiation ofhormones, most physicians seem to haveincorporated the WHI’s message into their practice.