Griffiths F, Convery B
Cleveland Medical Audit Advisory Group facilitator, Middlesbrough.
Br J Gen Pract. 1995 Jul;45(396):355-8.
Hormone replacement therapy is used for the relief of menopausal symptoms. In the United Kingdom, guidelines have been developed for the use of hormone replacement therapy in the prevention of osteoporosis, and in the United States of America its use has also been recommended for cardiovascular disease prevention. However, compliance has been found to be a problem, and rates of prescribing vary between general practitioners.
This study set out to describe the prescribing of hormone replacement therapy in one general practice, to enable doctors to plan future prescribing and promotion of hormone replacement therapy, taking into account constraints on its use.
The patient records of users of hormone replacement therapy were examined to collect data on menopausal status, reason for use, length of use, breaks from therapy and reasons for stopping therapy. Women with a history of hysterectomy and with risk factors for osteoporosis were identified from the practice morbidity register. Their use of hormone replacement therapy was recorded.
Of women aged 40-59 years on the practice list, 348 were taking hormone replacement therapy (20%). Of 107 women aged under 52 years who had had a hysterectomy and bilateral oophorectomy 76 were taking therapy (71%). Of 158 women under the age of 52 years who had had a hysterectomy with preservation of the ovaries 39 were taking therapy (25%). Among women taking hormone replacement therapy for the relief of menopausal symptoms, the highest rate of use was among those aged 50-54 years where 93 were on therapy (24% of women in that age group in the practice). Twenty out of 47 women with a recorded risk factor for osteoporosis were taking therapy. More than three quarters of women using hormone replacement therapy appeared to be taking it continuously.
The uptake of hormone replacement therapy was found to be high for women with a surgical menopause, the group most easily identifiable as at risk of osteoporosis. Women who decided to take therapy appeared to take it continuously, and therefore effectively for prevention. Rate of uptake, rather than compliance, is more likely to constrain its use in prevention.
激素替代疗法用于缓解更年期症状。在英国，已制定了关于使用激素替代疗法预防骨质疏松症的指南，在美国也推荐使用该疗法预防心血管疾病。然而，发现依从性是个问题，全科医生的开药率也各不相同。
本研究旨在描述一家全科诊所中激素替代疗法的开药情况，以便医生在考虑其使用限制的情况下，规划未来激素替代疗法的开药和推广。
检查激素替代疗法使用者的病历，收集有关更年期状态、使用原因、使用时长、治疗中断情况及停药原因的数据。从诊所发病率登记册中识别出有子宫切除史且有骨质疏松症风险因素的女性。记录她们使用激素替代疗法的情况。
在诊所名单上年龄在40至59岁的女性中，348人正在接受激素替代疗法（20%）。在107名年龄在52岁以下且已进行子宫切除和双侧卵巢切除的女性中，76人正在接受治疗（71%）。在158名年龄在52岁以下且已进行子宫切除并保留卵巢的女性中，39人正在接受治疗（25%）。在因缓解更年期症状而接受激素替代疗法的女性中，使用率最高的是年龄在50至54岁的女性，其中93人正在接受治疗（占该年龄组诊所女性的24%）。在记录有骨质疏松症风险因素的47名女性中，20人正在接受治疗。使用激素替代疗法的女性中，超过四分之三似乎在持续用药。
对于经历手术绝经的女性，激素替代疗法的使用率很高，这是最容易被认定为有骨质疏松症风险的群体。决定接受治疗的女性似乎在持续用药，因此能有效起到预防作用。在预防方面，更可能限制其使用的是接受率，而非依从性。
