“我要保持年轻”：尽管存在医学风险，但对绝经激素治疗抗衰老功效的信念促使其长期使用。
"I'm going to stay young": Belief in anti-aging efficacy of menopausal hormone therapy drives prolonged use despite medical risks.
机构信息
Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America.
Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, United States of America.
出版信息
PLoS One. 2020 May 29;15(5):e0233703. doi: 10.1371/journal.pone.0233703. eCollection 2020.
BACKGROUND
Over a third of menopausal hormone therapy (HT) prescriptions in the US are written for women over age 60. Use of HT more than 5 years is associated with increased risk for cardiovascular disease; breast, ovarian, and endometrial cancers; thromboembolic stroke; gallbladder disease; dementia; and incontinence.
OBJECTIVES
To explore older women's perceptions of the benefits and risks of long-term HT and examine factors influencing their decisions to use HT > 5 years despite medical risks.
METHODS
A qualitative approach was selected to broadly explore thought processes and social phenomena underlying long-term users' decisions not to discontinue HT. Interviews were conducted with 30 women over age 60 reporting use of systemic HT more than 5 years recruited from an urban area in California and a small city in the Rocky Mountain region. Transcripts of interviews were analyzed using conventional grounded theory methods.
RESULTS
Women reported using HT to preserve youthful physical and mental function and prevent disease. Gynecologists had reassured participants regarding risk, about which all 30 expressed little concern. Participants, rather than providers, were the principal drivers of long-term use.
CONCLUSIONS
Participants perceived estrogen to have anti-aging efficacy, and using HT imparted a sense of control over various aspects of aging. Maintaining this sense of control was prioritized over potential risk from prolonged use. Our findings provide an additional perspective on previous work suggesting the pharmaceutical industry has leveraged older women's self-esteem, vanity, and fear of aging to sell hormones through marketing practices designed to shape the beliefs of both clinicians and patients. Efforts are needed to: 1) address misconceptions among patients and providers about medically supported uses and risks of prolonged HT, and 2) examine commercial influences, such as medical ghostwriting, that may lead to distorted views of HT efficacy and risk.
背景
在美国，超过三分之一的绝经激素治疗 (HT) 处方是为 60 岁以上的女性开具的。超过 5 年的 HT 使用与心血管疾病风险增加、乳腺癌、卵巢癌和子宫内膜癌、血栓栓塞性中风、胆囊疾病、痴呆和尿失禁有关。
目的
探讨老年女性对长期 HT 的益处和风险的看法，并研究影响她们决定尽管存在医疗风险仍使用 HT 超过 5 年的因素。
方法
选择定性方法广泛探索长期使用者不停止 HT 的决策背后的思维过程和社会现象。从加利福尼亚州的一个城市和落基山脉地区的一个小城市招募了 30 名报告使用超过 5 年的系统性 HT 的 60 岁以上的女性进行访谈。使用常规扎根理论方法分析访谈记录的转录本。
结果
女性报告使用 HT 来保持年轻的身体和精神功能并预防疾病。妇科医生已经让参与者放心有关风险的问题，所有 30 名参与者都对此表示关注。参与者而不是提供者是长期使用的主要驱动因素。
结论
参与者认为雌激素具有抗衰老作用，使用 HT 赋予了他们对衰老各个方面的控制感。保持这种控制感优先于长期使用的潜在风险。我们的研究结果为之前的研究提供了另一个视角，表明制药业利用老年女性的自尊心、虚荣心和对衰老的恐惧，通过旨在塑造医生和患者观念的营销手段来推销荷尔蒙。需要努力：1）解决患者和提供者对延长 HT 的医学支持用途和风险的误解，2）检查可能导致 HT 疗效和风险观点扭曲的商业影响，如医学代写。
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