HRT Counseling for Every Woman

Every woman who approaches menopause ought to be counseled about HRT (Figure 11) and the benefits it offers. Despite the fact that women seek healthcare more frequently than men, perimenopausal healthcare remains fragmented. In part, this is because menopause is a normal transition, and symptom control and disease prevention can be approached in a number of ways. But it is also because the majority of women do not seek help for this transition. Moreover, only a fraction of those women who would benefit from HRT take advantage of such therapy.

Efforts to increase awareness about postmenopausal disease prevention are influenced by cultural differences. There is very little literature on whether ethnicity alters the physical and biological experience of menopause. One survey found that reporting of hot flushes and night sweats was significantly lower among Japanese women.(36) It also is well established that Japan has a lower incidence of heart disease, osteoporosis, and breast cancer. Other studies suggest that not only are attitudes towards menopause influenced by ethnicity, but they are also altered by social factors. This was apparent in 2 studies, one among recent Korean immigrants and another involving Filipina Americans.(37,38) The studies suggest that role conflicts (such as transition from housewife to working status), recent immigration, and social status can influence whether women see this time as a natural healthy transition.

Such differences are also hard to quantify among the largest minority group in the United States. One study found significant racial differences in estrogen use among menopausal black women (Table 5),(39) while another did not.(40) Given the fact that African American women are at higher risk for developing coronary artery disease than white women, nurses must begin to address the counseling gap. What is apparent is that cultural differences abound,(41,42) and that they deter women from seeing menopause as a time to plan preventive health measures. The time of the perimenopause offers a unique opportunity for nurses who are aware of cultural influences to provide, direct, and encourage a program of preventive healthcare.

Table 5

Whether or not HRT is chosen as an option by every menopausal woman, it offers benefits that every woman should know about. Such a counseling discussion sets the stage for a review of each woman's health profile. Even though women with menopausal symptoms or increased risk of chronic disease may have the most obvious need for counseling, women without apparent symptoms or health risks can also benefit (Figure 11). However, counseling women about HRT cannot occur in a vacuum. It must be combined with discussions about the importance of the complementary lifestyles changes listed in (Figure 11.)

Figure 11

An emphasis on lifestyle changes is a critical part of a health assessment for menopausal woman. The ill effects of long-standing, unhealthy habits may begin to surface around the time of menopause, and such effects will surely progress with age. Although smoking cessation may be the single most important factor that can enhance life expectancy, moderation in other areas (diet and alcohol) and regular participation in exercise can significantly alter quality of life.

At the time of menopause, a woman's risk for developing several conditions can serve as a focal point for a review of her health. Routine HRT counseling should go beyond simple symptom control and include both short-term and long-term benefits (Figure 12), known contraindications, and common patient concerns and misconceptions. Figures on compliance suggest that such counseling is needed. A recent study found high noncompliance (54%) among women 1 year after HRT was initiated.(43)

Figure 12

This monograph addresses the short-term benefits of HRT in detail. However, in-depth discussions of the long-term benefits, as well as cutting-edge research data, will be included in monographs 2 and 3.

Short-term HRT Benefits