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Hormone Therapy a Matter of Doctor Specialty

Family practitioners less likely to prescribe it for menopausal women

TUESDAY, Jan. 7, 2003 (HealthDayNews) -- Whether doctors continue to recommend hormone replacement therapy may have more to do with what they learned back in medical school than what they read in medical journals today.

At least that's the word from a new study in the January issue of Obstetrics and Gynecology.

Researchers report that physicians who specialize in gynecology are nearly three times more likely to prescribe hormone replacement therapy (HRT) than family practitioners -- even when they see the same number of menopausal patients.

"When we compared the two groups we found that family practice doctors were prescribing HRT less frequently than gynecologists, perhaps because they were less certain of the benefits of HRT," says study author Dr. Barcey Levy, an associate professor of family medicine at the University of Iowa School of Medicine.

This time last year the hesitancy of family doctors to prescribe HRT might have been interpreted as a deficit in women's health care. However, in light of the recent findings by the Women's Health Initiative -- studies that seriously question the benefits of HRT -- the balance of power has clearly shifted, landing smack in the lap of the family doctor.

"Our study was conducted and ultimately completed long before the current news on HRT was known, but certainly family doctors may have been prescribing HRT less often because they were intuitively less confidant about the use of these drugs," Levy says.

That is something the statistical information in the study seems to support: The women who saw family doctors were far more likely to cite uncertainty about the safety of HRT as their reason for not taking hormones. And it's a conclusion that Levy admits may have been influenced by their doctors.

For gynecologist Dr. Isaac Schiff, however, the data may represent a slightly different finding.

"Generally speaking, gynecologists are usually more familiar with these drugs. So ultimately they are likely to be more comfortable prescribing them -- which is one reason why women may be more comfortable taking the drug from them," says Schiff, chief of the Vincent Memorial Obstetrics and Gynecology Service at Massachusetts General Hospital and a spokesman for the American College of Obstetricians and Gynecologists.

However, Schiff says, it's also important to note that women themselves play an important role in the decision whether or not to take HRT.

"Women who actively seek out a gynecologist for their annual exam may be women who are experiencing more troubling menopausal symptoms and they may also be women who are more open to the idea of taking hormones, and both factors can influence how often these medications are prescribed," he says.

The new study involved a small group of 426 postmenopausal women, all of whom attended one of two clinics run by the University of Iowa School of Medicine. Roughly half the women attend the gynecology clinic for their annual exam, while the other half received their annual physical at the family practice clinic.

Overall, 60 percent of the women attending the family clinic and 69 percent attending the gynecology clinic were already users of HRT.

However, after examining the medical records as well as patient questionnaire data on all 426 women, the doctors found the difference in prescribing habits.

"Although the number of women using HRT in both groups was higher than that of the national average, in the final analysis we found the women who were seeing the gynecologists, as compared to those seeing the family doctors, were 2.6 percent more likely to be on HRT," Levy says.

An interesting sidebar to the study -- and one worthy of further research, Levy says -- was that women who reported a history of depression were nearly three times more likely to be using HRT, regardless of which doctor they saw.

"Perhaps these women were experiencing more severe symptoms, or they may have been in closer contact with their health-care provider, or perhaps the chemistry of depression itself is in some way linked to menopausal symptoms. We just don't know, and won't know until further research is conducted in this area," Levy says.

What To Do

To learn the very latest on the safety and effectiveness of hormone therapy, visit the Women's Health Initiative.

To learn more about family practice medicine, visit The American Academy of Family Physicians.

SOURCES: Barcey Levy, M.D., associate professor, family medicine, University of Iowa School of Medicine, Iowa City; Isaac Schiff, M.D., chief, Vincent Memorial Obstetrics and Gynecology Service, Massachusetts General Hospital, and spokesman, American College of Obstetricians and Gynecologists; January 2003 Obstetrics and Gynecology
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