Estrogen replacement therapy. A survey of older women's attitudes

To understand the low prevalence of estrogen use among older women. To examine the reasons for the use and nonuse of estrogen replacement therapy.

Nonblack women (n = 7667), aged 65 years or older, who participated in the Multicenter Study of Osteoporotic Fractures completed an estrogen questionnaire.

Of the subjects, 1335 (17.4%) were currently using oral estrogens, 2084 (27.2%) were past users, and 4248 (55.4%) had never used oral estrogen therapy. The self-reported primary reasons for current users to have initiated therapy included hysterectomy (43.5%), menopausal symptoms (39.3%), prescribed by a physician (38.7%), or prevention or treatment of osteoporosis (33.6%). Of the 2084 former estrogen users (27.2%), the main reasons for starting therapy included prescribed by a physician (44.7%), menopausal symptoms (49.2%), and hysterectomy (28.5%). Approximately 30% of past estrogen users reported the primary reason for discontinuing therapy as "feeling that they didn't need it," whereas 16.4% reported undesirable side effects with bleeding as the most common (45.0%). The main reason women never started estrogen therapy (55.4%) was they feared that the medication was harmful (38.1%) or they felt they did not need it (29.5%).

We conclude that older women in the United States remain skeptical about long-term estrogen use despite its potential for protection against 2 major chronic diseases, osteoporosis and cardiovascular disease. Greater understanding about the barriers to estrogen replacement therapy and improved knowledge of its risks and benefits may reduce the skepticism surrounding estrogen replacement therapy among older women.