Prescribing estrogen during menopause: physician survey of practices in 1974 and 1981

A physician survey was conducted in 13 counties surrounding Albany and Syracuse, N.Y., to determine estrogen prescribing patterns for treatment of problems associated with menopause. A case history of a 51-year-old woman was included in questionnaires sent to the physicians, who were asked how they would treat her in 1981 and how they would have treated her in 1974. Of the 717 questionnaires mailed to gynecologists, internists, and family practitioners, 584 were returned, a response rate of 81 percent. When asked how they would treat the woman, who was described as having frequent, severe hot flashes and other menopausal symptoms, 65 percent of the physicians practicing in both 1974 and 1981 would prescribe estrogen for the patient in 1981; 82 percent would have done so in 1974. Although 87 percent of the gynecologists would have prescribed estrogen both years, the gynecologists surveyed would have decreased daily estrogen doses of 1.25 mg by 72 percent and increased daily doses of .625 mg and .3 mg by 68 percent. Overall, 19 percent of the physicians surveyed would prescribe a daily estrogen dose of 1.25 mg or more for more than 6 months or .625 mg daily for 3 or more years in 1981, compared with 48 percent in 1974. These results suggest that many physicians have responded to the increasing evidence in the literature of a link between using estrogen to treat menopausal symptoms and endometrial cancer by switching from high doses of estrogen for long durations to smaller doses for shorter durations. Many physicians are also simply prescribing estrogens for fewer patients.