January 1, 1997

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Women doctors who have undergone menopause use hormone replacement therapy (HRT) at nearly twice the rate of other postmenopausal women, report Emory University researchers in this week's Annals of Internal Medicine. The study is the first to evaluate women physicians' use of HRT.

The team found that 47 percent of 1,466 postmenopausal women doctors were using HRT when they were surveyed in 1993-94. Though prevalence rates of HRT vary among postmenopausal women in the general population (from eight percent in Massachusetts to more than 40 percent in western states), the national prevalence rate has previously been estimated at 24 percent.

"Women doctors are more likely to use HRT perhaps because they are most likely to be aware of the benefits and risks of HRT," says lead author Sally E. McNagny, M.D., assistant professor of Medicine, Emory University School of Medicine. "In patient surveys, (non-physician) patients who are better educated, wealthier and live in the Pacific states are also more likely to use HRT; whereas, women with a low income, are in a minority group and less educated are less likely to choose HRT."

Usage rates were highest among physicians soon after menopause. The researchers report that 60 percent of subjects aged 40-49 used HRT compared with 49 percent of subjects aged 50-59 and 36 percent of subjects aged 60-70.

The postmenopausal physicians who reported using HRT were more likely than their peers to be gynecologists (three times more likely to use HRT), younger, Caucasian, and sexually active (twice as likely).

Physician HRT users were also more likely to have used oral contraceptives in the past (twice as likely to use HRT), be inhabitants of the Pacific and Mountain states (doctors in the North Atlantic states had the lowest rates), have had a hysterectomy and have no personal or family history of breast cancer.

Even though many scientists believe that HRT may protect against heart disease, women doctors with risk factors for heart disease such as being a smoker, having diabetes or having a family history of heart disease were not more likely to choose HRT.

Data come from the Women Physicians' Health Study, a sample of 4501 female doctors that serves as a nationally representative sample of all women physicians. Current study co-author Erica Frank, M.D., assistant professor in Emory's Departments of Medicine as well as Family and Preventive Medicine, is principal investigator of the Women Physicians' Health Study.

"Every woman who is postmenopausal should discuss with her doctor her own individual risks and benefits of HRT," Dr. McNagny says. "HRT has been shown to relieve hot flashes, decrease a woman's risk of getting osteoporosis and possibly lower her risk of heart disease and Alzheimer's disease. However, HRT may increase the risk of breast cancer if used for more than five-10 years and it does have some side effects. Thus, by talking with her doctor, each woman can decide what is best for her."

Nanette Kass Wenger, M.D., professor of Medicine (Cardiology) at Emory also co-authored the current paper.

The study was supported in part by grants from the American Medical Association's Education and Research Foundation, the American Heart Association, a National Institutes of Health (National Heart, Lung and Blood Institute) institutional National Research Service Award, Emory Medical Care Foundation and unrestricted grants from Wyeth-Ayerst and Solvay Pharmaceuticals.


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