Advertisement

Characteristics associated with initiation of hormone replacement therapy among Finnish women: A register-linkage study

      Highlights

      • Most important factors that predicted whether a woman would start HRT were: living with a partner, weak SOC, BMI under 30 kg/m2 and heavy alcohol use.
      • Women with a good sense of coherence can cope with climacteric symptoms without resorting to hormone replacement therapy.
      • Clinicians need to bear in mind the burden of the menopause on a woman’s personal and working life when hormone replacement therapy is being considered.

      Abstract

      Objective

      To investigate which patient characteristics are associated with the initiation of hormone replacement therapy (HRT) in a cohort of Finnish women.

      Study design

      Responses to postal questionnaires distributed to a nationwide, randomly selected cohort of women in 1998, 2000, 2003, 2005 and 2010 were analyzed. The cohort members were aged 40–44 years at the beginning of the study. Information on hormone replacement therapy was received from the national prescription register. Women who started taking HRT between January 1, 1999 and December 31, 2011 were included and previous users were excluded from the analysis.

      Main outcome measures

      Initiation of HRT was the main outcome measure. The following explanatory factors for predicting the use of HRT were examined: sociodemographic factors, personality, health behavior, physiological and mental symptoms, chronic diseases and use of psychopharmaceuticals. The associations between starting HRT and the explanatory factors were analyzed with single-predictor and multi-predictor logistic regression models.

      Results

      Factors predicting that a woman would start taking HRT were: living with a partner, weak sense of coherence, BMI less than 30 kg/m2, heavy or moderate alcohol use, symptoms of hyperactivity of the sympathetic nervous system, climacteric symptoms and use of psychopharmaceuticals.

      Conclusions

      Women with a good sense of coherence can cope with climacteric symptoms without resorting to HRT. Clinicians need to bear in mind the burden of menopausal symptoms on a woman’s personal and working life when HRT is being considered.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stefanik M.
        Estrogens and progestins: background and history, trends in use, and guidelines and regimens approved by the US Food and Drug Administration.
        Am. J. Med. 2005; 118: 64S-73S
        • Stearns V.
        • Ullmer L.
        • Lopez J.F.
        • Smith Y.
        • Isaacs C.
        • Hayes D.
        Hot flushes.
        Lancet. 2002; 360: 1851-1861
        • Nelson H.
        Menopause.
        Lancet. 2008; 371: 760-770
        • Huang A.
        • Grady D.
        • Jacoby V.
        • Blackwell T.
        • Bauer D.
        • Sawaya G.
        Persistent hot flushes in older postmenopausal women.
        Arch. Int. Med. 2008; 168: 840-846
        • Barnabei V.M.
        • Grady D.
        • Stovall D.W.
        • Cauley J.A.
        • Lin F.
        • Stuenkel C.A.
        • et al.
        Menopausal symptoms in older women and the effects of treatment with hormone therapy.
        Obstet. Gynecol. 2002; 100: 1209-1218
        • Jokinen K.
        • Rautava P.
        • Mäkinen J.
        • Ojanlatva A.
        • Sundell J.
        • Helenius H.
        Experience of climacteric symptoms among 42–46 and 52–56-year-old women.
        Maturitas. 2003; 46: 199-205
        • Jalava-Broman J.
        • Mäkinen J.
        • Ojanlatva A.
        • Jokinen K.
        • Sillanmäki L.
        • Rautava P.
        Chance in the frequency of HRT use from 2000 to 2005 and reasons to discontinue; follow-up of a normal cohort in Finland.
        Acta. Obstet. Gynecol. Scand. 2011; 90: 351-357
        • Jalava-Broman J.
        • Mäkinen J.
        • Ojanlatva A.
        • Jokinen K.
        • Sillanmäki L.
        • Rautava P.
        Treatment of climacteric symptoms in Finland prior to the controversial reports on hormone therapy.
        Acta. Obstet. Gynecol. Scand. 2008; 87: 682-686
        • Simpson E.
        Predictors of intentions to use hormone replacement therapy in clinical postmenopausal women.
        Climacteric. 2012; 15: 173-180
        • Korkeila K.
        • Suominen S.
        • Ahvenainen J.
        • Ojanlatva A.
        • Rautava P.
        • Helenius H.
        • et al.
        Non-response and related factors in nationwide health survey.
        Eur. J. Epidemiol. 2001; 17: 991-999
        • Antonovsky A.
        The structure and properties of the sense of coherence scale.
        Soc. Sci. Med. 1993; 25: 725-733
        • Kivimäki M.
        • Vahtera J.
        • Koskenvuo M.
        • Uutela A.
        • Pentti J.
        Response of hostile individuals to stressful change in their working lives: test of a psychosocial vulnerability model.
        Psychol. Med. 1998; 28: 903-913
        • González M.
        • Viáfara G.
        • Caba F.
        • Molina E.
        Sexual function, menopause and hormone replacement therapy (HRT).
        Maturitas. 2004; 48: 411-420
        • Ainsworth B.E.
        • Haskell W.L.
        • Leon A.S.
        • Jacobs D.R.
        • Montoye H.J.
        • Sallis J.F.
        • et al.
        Compendium of physical activities: classification of energy costs of human physical activities.
        Med. Sci. Sports Exercise. 1993; 25: 71-80
        • Heistaro S.
        • Jousilahti P.
        • Lahelma E.
        • Vartiainen E.
        • Puska P.
        Self rated health and mortality: a long term prospective study in eastern Finland.
        J. Epidemiol. Commun. Health. 2001; 55: 227-232
        • Beck A.T.
        • Steer R.A.
        • Garbin M.G.
        Psychometric properties of the Beck Depression Inventory; twenty-five years evaluation.
        Clin. Psychol. Rev. 1988; 8: 77-100
        • Vahtera J.
        • Kivimäki M.
        • Hublin C.
        • Korkeila K.
        • Suominen S.
        • Paunio T.
        • et al.
        Liability to anxiety and severe life events as predictors of new-onset sleep disturbances.
        Sleep. 2007; 30: 1537-1546
        • Stadberg E.
        • Mattsson L.-A.
        • Milsom I.
        Factors associated with climacteric symptoms and the use of hormone replacement therapy.
        Acta Obstet. Gynecol. Scand. 2000; 79: 282-292
        • Kupperman H.S.
        • Blatt M.H.
        • Wiesbader H.
        • Filler W.
        Comparative clinical evaluation of estrogenic preparations by the menopausal and amenorrheal indices.
        Endocrinology. 1953; 13: 688-703
        • Parazzini F.
        • Di Donato P.
        • Giulini N.A.
        • Bacchi Modena A.
        • Cicchetti G.
        • Comitini G.
        • et al.
        Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy.
        Maturitas. 2005; 52: 181-189
        • Katainen R.
        • Siirtola T.
        • Engbom J.
        • Erkkola R.
        • Polo-Kantola P.
        A population-based survey of quality of life in middle-aged Finnish women.
        Menopause. 2014; 22: 402-413
        • Moilanen J.
        • Aalto A.-M.
        • Hemminki E.
        • Aro A.R.
        • Raitanen J.
        • Luoto R.
        Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women.
        Maturitas. 2010; 67: 368-374
        • Du Y.
        • Melchert H.-U.
        • Schäfer-Korting M.
        Hormone replacement therapy in Germany: determinants and possible health-related outcomes results of national health surveys from 1984 to 1999.
        Maturitas. 2005; 52: 223-234
        • Gallicchio L.
        • Miller S.R.
        • Kiefer J.
        • Greene T.
        • Zacur H.A.
        • Flaws J.A.
        Change in body mass index, weight, and hot flushes: a longitudinal analysis from the midlife women‘s health study.
        J. Womens Health. 2014; 23: 231-237
        • Nappi R.E.
        • Lachowsky M.
        Menopause and sexuality: prevalence of symptoms and impact on quality of life.
        Maturitas. 2009; 63: 138-141
        • Griffiths A.
        • MacLennan S.
        • Hassard J.
        Menopause and work. An electronic survey of employeeś attitudes in the UK.
        Maturitas. 2013; 76: 155-159
        • Polo-Kantola P.
        Estrogeeni ja uni [Estrogen and sleep].
        Duodecim. 2000; 116: 1689-1695
        • Lampio L.
        • Polo-Kantola P.
        • Polo O.
        • Kauko T.
        • Aittokallio J.
        • Saaresranta T.
        Sleep in midlife women: effects of menopause, vasomotor symptoms, and depressive symptoms.
        Menopause. 2014; 21: 1217-1224
        • Kalleinen N.
        • Polo O.
        • Himanen S.-L.
        • Joutsen A.
        • Polo-Kantola P.
        The effect of estrogen plus progestin treatment on sleep: a randomized, placebo-controlled, double-blind trial in premenopausal and late postmenopausal women.
        Climacteric. 2008; 11: 233-243
        • Schmidt P.J.
        • Nieman L.
        • Danaceau M.A.
        • Tobin M.B.
        • Roca C.A.
        • Murphy J.H.
        • et al.
        Estrogen replacement in perimenopausal-related depression: a preliminary report.
        Am. J. Obstet. Gynecol. 2000; 183: 414-420
        • Sumanen M.
        • Rantala A.
        • Sillanmäki L.H.
        • Mattila K.J.
        Childhood adversities experienced by working-age migraine patients.
        J. Psychosom. Res. 2007; 62: 139-143