Enhancing patient compliance with hormone replacement therapy at menopause

Article Abstract:

Menopausal patients for whom estrogen replacement therapy is prescribed may fail to comply with the treatment because of their beliefs regarding the negative effects of hormone therapy. Compliance was evaluated in 220 middle-class private patients who underwent estrogen and progestogen combination therapy for menopausal symptoms. After one year, only seven percent of the women had stopped taking the medication, the majority because of episodes of vaginal bleeding. In general, the most compliant patients are those who understand the reasons for hormone therapy. Benefits include relief of hot flashes, prevention of osteoporosis (loss of bone density), and positive effects on lipid (fat) metabolism, which may be associated with better cardiovascular health. Women worry particularly about whether the hormone therapy will cause endometrial cancer (of the uterine lining). They should be advised that this disease is rarely fatal, since the irregular bleeding that is its main symptom usually motivates the patient to visit the doctor. In fact, hip fracture as a result of osteoporosis causes more deaths than endometrial cancer. The addition of a progestogen as part of the hormone therapy protects against the effects of pure estrogen on the endometrium. In spite of common beliefs, it has not been shown that progestogens reverse the positive effects of estrogen on cardiovascular disease. Finally, the incidence of breast cancer is not increased in menopausal women who take hormone replacement therapy. Patients should be informed about these facts, and encouraged to put the ''nuisance'' side effects of hormone replacement therapy (breakthrough bleeding, headaches, breast tenderness, nausea) into an appropriate perspective. To increase compliance, information about estrogen therapy can be supplied by books, booklets, videos, and physicians. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Evaluation, Physiological aspects, Drug therapy, Patient compliance, Hormone therapy, Patient education, Menopause

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Environmental and familial contributions to insulin levels and change in insulin levels in middle-aged women

Article Abstract:

Women who are overweight, have a large amount of body fat and have a family history of diabetes or hypertension have a higher risk of having elevated blood glucose and insulin concentrations. A group of 518 women were interviewed for family history and had their blood glucose and insulin measured during the fasting state and after a glucose tolerance test. Blood glucose and insulin were higher in women who were overweight or had gained weight and in those who had increased amounts of body fat. A family history of diabetes or hypertension was also associated with increased concentrations of blood glucose and insulin. Women who got little exercise tended to have increased concentrations of blood glucose and insulin. At the three-year follow-up, six women had developed diabetes; four had a family history of diabetes and five had a family history of hypertension. Increased blood insulin levels may be a risk factor for cardiovascular disease.

Measurement, Genetic aspects, Type 2 diabetes, Insulin resistance, Insulin

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