Perceptions of menopausal stage and patterns of hormone replacement therapy use

In 1994, as part of their participation in the University of North Carolina Alumni Heart Study, 1101 women aged 45-51 years answered questions about their menopausal status and current use of hormone replacement therapy (HRT). Little is known about the use of HRT in younger women. We were interested in determining both patterns of HRT use and patient characteristics associated with HRT use in this cohort of women approaching the average age of menopause. After excluding women with breast, endometrial, and ovarian cancer, we studied 1080 women. These women identified themselves as: "There is no indication that I am near menopause" (stage 1, n = 326), "I think I may be close to or in the beginning stages of menopause but am not sure" (stage 2, n = 410), "I have begun menopause" (stage 3, n = 202), and "I have been through menopause" (stage 4, n = 142). The overall rate of HRT use was 22% (0% in stage 1, 8% in stage 2, 52% in stage 3, and 76% in stage 4). Both patterns of HRT use and patient characteristics associated with HRT use differed based on the woman's perception of her menopausal stage. In logistic regression models, where HRT use was the outcome variable, independent predictors of HRT use included stage of menopause, having had a hysterectomy, having had a bilateral oophorectomy, no family history of breast cancer, having had a pelvic examination in the last year, being married, and not participating regularly in physical exercise. A woman's perception of her stage in the process of reproductive aging correlates with her use of HRT. Informed decision making about HRT use should be tailored to the individual's perception of her menopausal stage.