The Asian Menopause Survey: Knowledge, perceptions, hormone treatment and sexual function
Introduction
Postmenopausal hormone replacement therapy (HRT) with estrogen or estrogen plus progestogen is widely considered to be the therapeutic standard for treatment of vasomotor symptoms and protection from chronic diseases [1]. Yet with the publication of findings from studies such as the Heart and Estrogen/Progestin Replacement Study [2], the Women's Health Initiative (WHI) [3], and the Million Women Study [4], the assumptions underlying the putative effects of HRT (in particular, estrogen plus progestin therapy) have undergone a stringent paradigm shift, with radical public perception changes reflected in altered prescribing practices [5].
A study of HRT and menopause in Europe has revealed that while women appear to be well-informed regarding the issues (83%), 40–50% reported having negative feelings towards HRT, despite the high prevalence of postmenopausal symptoms [6]. Whereas some women opted for natural remedies, the majority did not opt for HRT because of the risks (breast cancer and side effects). Of the few post-WHI studies conducted in Asia, two recent retrospective studies evaluating changes in prescription use of HRT in Taiwan reported a pronounced decline in use [7], with college-educated women less likely to be prescribed HRT compared to lesser educated women [8]. Similar studies in Thailand revealed that 67% of Thai women knew about HRT, and that only 4% of these women were aware of the WHI, even though one-half of all previous users of HRT discontinued therapy following publication of the WHI results [9]. Several studies conducted in Hong Kong (following publication of the WHI) revealed that only 24% of women were familiar with HRT [10], while 76% had never used any form of therapy nor ever thought of using HRT prior to being interviewed [11]. Caution should be taken, however, in extrapolating from these results for the following reasons: (1) the studies reported by Huang's group [7], [8] relied on a retrospective review of the National Health Insurance database records; (2) the studies reported by Chaikittisilpa's group [9] employed an non-validated self-completed questionnaire; and (3) the participants of Ngai's study [11] were not randomized, and therefore not representative of a postmenopausal population sample. Finally, as of writing, there exists no large, post-WHI study of the perceptions of menopause or HRT in women from other regions in Asia, such as China and Malaysia.
The objective of this Asian Menopause Survey was to provide current insight into the opinions, attitudes, and knowledge of Asian (China, Hong Kong, Malaysia, Taiwan, and Thailand) menopausal women regarding menopause and HRT, with a focus on perceptions pertaining to breast cancer, breast cancer risks, and sexual function. Such information is clearly needed to facilitate the implementation of public health policies in these countries that focus on improving women's knowledge regarding the benefits and risks of HRT and the potential impact (both positive and negative) of this therapy on quality of life.
Section snippets
Participants
This cross-sectional survey was conducted between January 2006 and February 2006 in five Asian countries (China, Hong Kong, Malaysia, Taiwan, and Thailand). A total of 1000 women took part in the study (China, n = 300; Hong Kong, n = 100; Malaysia, n = 300; Taiwan, n = 150; Thailand, n = 150). Participants were interviewed face-to-face following street interception or door-to-door visits. Interviews were conducted by Synovate Healthcare (Kuala Lumpur, Malaysia), a specialist healthcare division of the
Demographics
Table 1 summarizes the demographic characteristics of the participating women. Statistical significance was observed between the five different countries with respect to education, marital status, number of children, medical history (osteoporosis, diabetes mellitus, hypertension) and sexual desire (P < 0.05 for all).
Breast discomfort and knowledge of breast cancer risk
Women generally replied negatively to having a history of breast discomfort (Table 1), with women from Hong Kong reporting the highest incidence of breast discomfort. Most women
Discussion
Parallel to the European Menopause Survey 2005 [6], the Asian Menopause Survey is the first large Asian study to investigate the opinions, attitudes, and knowledge of postmenopausal women regarding menopause and HRT, with a focus on perceptions of breast cancer, breast cancer risks, and sexual function in line with WHI [3] and the Million Women Study [4].
Findings from a previously published study indicated that almost all European women experience postmenopausal symptoms and are affected by the
Conclusions
The Asian Menopause Study revealed that many women experience postmenopausal symptoms that are often left untreated due to acceptance of menopause as a natural process of life or are treated with herbal/natural remedies due to a lack of knowledge of the treatment options available. The largest hurdle for these women preventing them from potentially taking HRT for postmenopausal symptoms was fear of increased breast cancer risk. It is essential that detailed information regarding the
Contributors
We declare that all the listed authors participated in supervising and serving as consultant of the interview, and also collecting and reviewing the data and that we have seen and approved the final version. In addition to the above, Dr. Ko-En Huang conducted in the writing and editing of the manuscript.
Competing interest
None.
Ethical approval
Ethical approval was obtained from local institutes and ethical committees.
Acknowledgement
This study was supported by a research grant from Organon, Schering Plough Co.
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