Womens attitudes and knowledge about the climacteric period and its treatment. A Swedish population-based study

The aim of the study was to investigate womens knowledge and attitudes about the menopause and hormone replacement therapy (HRT).

Women aged 46, 50, 54, 58 and 62 years, born on uneven days, resident in Göteborg, Sweden (n = 5.990) were invited by letter to complete a questionnaire concerning the menopause and HRT.

The response rate was 76% (n = 4504). Current estrogen use was reported by 21%. Another 20% had stopped estrogen use e.g. because of a fear of cancer (9%) or other side-effects (14%). The most common reasons to refrain from HRT were minor climacteric symptoms (27%), fear of cancer (9%) or side-effects (15%) and the opinion that the menopause is a natural process (20%). A majority (67%) preferred HRT without withdrawal bleedings, especially elderly women (80%). Thirty-five per cent could accept life-long HRT if treatment was free from withdrawal bleedings. Almost 70% received their information about the menopause and HRT from a physician. Forty-five percent of the women considered the menopause to be a relief. Approximately 60% had a regular sex-life. The most common reasons for not having a regular sex-life were irrespective of the womans age, the absence of a partner (43%). Loss of sexual desire (29%) or partners loss of desire (12%), both of which showed an increase with age, were other reasons given. Only 8% of the total population had no sexual activity because of vaginal dryness but in the oldest cohort (62 years old) 32% gave this as a reason.

Physicians require more time for counselling of patients about the menopause and HRT. Many women refrain from therapy because of fear and misconceptions. To achieve better long-term compliance especially in elderly women the use of 'non-bleeding' regimes requires further attention.