Physicians' views and practices concerning menopausal hormone therapy

To examine physicians' views and practices concerning estrogen+progestogen therapy (EPT).

Questionnaires were mailed to a random sample of physicians in the United States (US) in 2003. A total of 1614 (53.8%) surveys were returned (633 obstetricians and gynecologists (Ob/Gyns), 571 family practitioners, and 410 internists).

Only a minority of the physicians (16%) would offer EPT to menopausal women in the absence of menopausal symptoms (26% Ob/Gyn, 11% family practitioners, 6% internists, p<0.0001). However, many physicians (62%) believed that EPT could be offered "short term" to menopausal women with menopausal symptoms assuming no contraindications (82% Ob/Gyn, 54% family practitioners, 42% internists; p<0.0001). Irrespective of specialty, the strongest contraindications to EPT use reported by these physicians were personal history of breast cancer (93%), thrombosis (92%), cerebrovascular disease (84%), ischemic heart disease (74%), uterine cancer (73%), as well as women's subjective "concern" about breast cancer (57%). Procedures reported as always required by physicians for continuing women on EPT were breast examination (97%), mammogram (96%), blood pressure measurement (94%), and pelvic examination (91%).

Internists and family practitioners address more contraindications to EPT use than Ob-Gyns. Although many physicians appear to be accepting of short-term use of EPT for menopausal indications in the absence of contraindications, the majority would not prescribe it for prophylactic purposes.