Hormone Therapy Decision Making in Older Women: Report of a Pilot Study

 

Purpose/Aims:  The purpose of this study is to increase the understanding of reasons why women chose to continue using menopausal hormone therapy beyond treatment guidelines.  Rationale/Conceptual Basis/Background:  Evidence supports the finding that use of hormone therapy (systemic estrogen with or without a progestin) for more than three to five years after the cessation of menses puts women at increased risk for breast cancer, coronary heart disease, ischemic stroke, thromboembolism, gallbladder disease, incontinence, and dementia.  For this reason, prescription of hormone therapy is not recommended beyond this therapeutic window except in rare circumstances, such as for osteoporosis that cannot be treated with bisphosphonates.  Nevertheless, more than a quarter of prescriptions for hormone therapy are written for women over the age of 60, which raises the question of why.  Surveys of women approaching menopause have found that hormone therapy decisions are strongly influenced by health care providers, the prescribers. A belief that estrogen has cosmetic, youth-prolonging benefits has been shown to be a predictor of estrogen use among women in their 40s and early 50s.  Limited research on hormone therapy decision making by women over 60 years of age was found in the literature, and these processes may differ from those of younger women. For example, older women may perceive the risks and benefits of hormone therapy differently due to age- or cohort-specific medical or personal histories. It is also not clear whether hormone users or their providers are the primary drivers of hormone use in this population.  This study uses a qualitative design to examine hormone therapy decision-making processes of women 60 years and older, women who are at the greatest risk for hormone therapy related diseases. Methods:  Grounded theory methodology was employed to explore the questions: “What factors influence older women to use hormone therapy beyond the menopause transition?” and “How do older women weigh the risks and benefits of hormone therapy?”  In-depth interviews were conducted with women who are long-term users of systemic estrogen therapy.  Interviews explored the women’s knowledge, beliefs, and attitudes about hormone therapy and aging. Perceptions of risk, both embodied risk (such as for osteoporosis) and risk related to using hormones were explored.  Results:  Final study results and conclusions are not reported here, as this poster depicts a pilot study with interviews of only five women.  The pilot interviews suggest that women share similar concerns and fears.  Key verbatim quotes are presented.  Implications:  Research findings will help clinicians address patient’s concerns about aging.  It will help build a body of knowledge that can be used to help women make informed decisions about their use of hormone therapy.  Theory generated from this formative study will be tested in future research and used to guide development of an intervention, such as a decision tool, to facilitate informed decision making about long-term use of hormone therapy.