Attitudes of Women Who are Currently Using or Recently Stopped Estrogen Replacement Therapy with or without Progestins: Results of the Aware Survey

OBJECTIVE: To examine the level of awareness of the findings of the Women's Health Initiative (WHI) study among recent users of hormone therapy (HT). METHODS: A survey was conducted on Canadian women older than 45 years of age who had used either an oral, topical, or vaginal HT within the preceding 3 years. Questionnaires were mailed to a random sample of 210 eligible women within an academic subspecialty rheumatology/osteoporosis practice between April and June 2003. Questionnaires were also provided upon request to women attending tertiary care multidisciplinary clinics and 6 community pharmacies in Hamilton, Ontario. The 98 questions in the survey were either categorical in nature (yes or no response) or followed by a Likert scale. Using chi-square and Student t tests, the responses of women who used combination estrogen/progestin were compared to those who used estrogen alone. RESULTS: Of the 161 women who responded to the survey (128 from the osteoporosis practice, 33 from other clinics and pharmacies), 102 (63%) had used HT for more than 5 years. Ninety-one of 159 respondents (57%) discontinued HT, and 63% (57/91) of those stopped using HT after publication of the WHI principal findings. Sixty-four percent (33/52) of women on combination estrogen/progestin discontinued HT, compared to 50% (46/93) who were on estrogen only, and 5 other women who also discontinued HT but did not know what type of preparation they had been taking (P = .04 for the difference in rates between the 3 groups). Knowledge of the findings of the estrogen/progestin arm of the WHI study did not significantly differ among users of different types of hormone preparations. Of the women who indicated that they did not know if HT affected the risk of WHI-studied medical conditions, 44% (69/156) indicated being unaware of HT risks for stroke, 28% (44/157) for hip fracture, 39% (60/155) for myocardial infarction, 25% (39/155) for breast cancer, and 48% (73/152) for blood clots. Women who had recently taken HT generally did not regret their use of HT. CONCLUSION: Although many women discontinued HT following the publication of the principal findings of the estrogen/progestin arm of the WHI study, the majority of these women lacked a clear understanding of those findings.