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Date of release: 14 July, 2014

Use of hormone therapy by Chinese ob-gyns

In a recent survey study by Wang and colleagues [1], a total of 2000 self-administered questionnaires were sent to female obstetricians-gynecologists (ob-gyns) attending the Gynecological Endocrinology workshops held from February to May 2013 in 15 provinces and cities in China. A total of 904 eligible questionnaires were collected (response rate, 45.2%). The majority of the responders knew that hormone therapy (HT) could relieve menopausal symptoms (97.7%) and prevent osteoporosis (93.5%). Most (69.4%) of the responders thought that HT would increase the risk of breast cancer, and 52.9% thought that HT would increase the risk of endometrial cancer. The most common concern about the side-effects of HT was the risk of breast cancer, followed by risks of endometrial cancer, venous thrombosis and weight gain. A total of 123 of the 324 symptomatic responders (38.0%) reported HT use, and a further 28 (8.6%) had tried transdermal and vaginal estrogen cream.

Comment

Menopausal HT is the most effective treatment for menopausal symptoms and, as we know, it also has many other benefits [2], but the use of HT remains very low in the Chinese population. Deng and colleagues [3] published in 2002 an epidemiological survey of perimenopausal women in Beijing and found that only 7.9% of the women knew that HT is effective in protecting and treating the climacteric syndrome, and only 4.4% of menopausal women had used HT once or had been using it. The rates were lower in rural areas than in urban areas. A study in Guangdong province published in 2008 showed that 0.8% and 1.3% of menopausal women had ever used or were currently using HT, respectively [4].
 
In 2003 a study about climacteric symptoms and knowledge about HT among Hong Kong Chinese women found that 23.5% of women realized that HT could relieve menopausal symptoms, and only 3.4% women were aware that HT was protective against osteoporosis [5]. Another study conducted in 2006 on HT knowledge and use in Asian countries showed that almost all women reported experiencing postmenopausal symptoms, but only a minority knew about treatment options [6]. The corresponding data for China (300 women) were: two-thirds lack any knowledge about HT; previous use of HT was recorded only in 9%; and the rate of current use was 2%. As could be expected, Wang’s findings showed a better knowledge of HT among Chinese ob-gyns compared to the general postmenopausal Chinese population [1]. Also, the rate of HT use was much higher among the ob-gyns. Still, the use of HT was relatively low compared to that of Western ob-gyns; possibly Chinese ob-gyns also fear the risks of HT side-effects, especially the risks of breast cancer and endometrial cancer. 
 
Thus education on HT for Chinese ob-gyns is strongly recommended so as to enhance its proper use by perimenopausal women, but the general population also needs much more education.
 
Knowledge of the possible important risks regarding arterial cardiovascular diseases like stroke and myocardial infarction has not been questioned or discussed in this survey. The possibility of cardiovascular prevention if HT is started early in the 'window of opportunity' is not discussed, especially using estrogen-only therapy in hysterectomized women. Neither has the knowledge of the ob-gyns of the difference between estrogen-only and combined estrogen + progestogen therapy for breast cancer risk been sought and discussed.

Xiangyan Ruan
Beijing Obstetrics & Gynecology Hospital, Capital Medical University, Beijing, China

    References

  1. Wang Y, Yang X, Li X, et al. Knowledge and personal use of menopausal hormone therapy among Chinese obstetrician-gynecologists: results of a survey. Menopause 2014 Apr 14. Epub ahead of print
    http://www.ncbi.nlm.nih.gov/pubmed/24736196

  2. de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Climacteric 2013;16:203-4
    http://www.ncbi.nlm.nih.gov/pubmed/23488524

  3. Deng XH, Zhang SW. The epidemiological survey of perimenopausal women in Beijing. Beijing Medicine 2002;24(4):235-8 [published in Chinese]


  4. Yang D, Haines CJ, Pan P, et al. Menopausal symptoms in mid-life women in southern China. Climacteric 2008;11:329-36
    http://www.ncbi.nlm.nih.gov/pubmed/18645699

  5. Lam PM, Leung TN, Haines C, et al. Climacteric symptoms and knowledge about hormone replacement therapy among Hong Kong Chinese women aged 4060 years. Maturitas 2003;45:99-107
    http://www.ncbi.nlm.nih.gov/pubmed/12787968

  6. Huang KE, Xu L, I NN, Jaisamrarn U. The Asian Menopause Survey: knowledge, perceptions, hormone treatment and sexual function. Maturitas 2010;65:276-83
    http://www.ncbi.nlm.nih.gov/pubmed/20018469