The promotion of menopausal hormone therapy might be determined by the attitude of health-care professionals

Amongst the critical factors threatening the development of human society in this century are an aging population and declining fertility. Whilst this is a problem of varying severity for individual countries, it is also a severe challenge for the whole world.

As life expectancy has increased, the menopause transition and postmenopausal stages of life have expanded to occupy almost 50% of a woman’s life span [1]. Accordingly, the World Health Organization (WHO) has identified improving the quality of life in old age as one of its three health promotion themes [2]. Advances in medical technology have positively affected the length of the human life span, while menopausal specialists have taken on the responsibility of improving the quality of women’s lives.

The essence of menopause is the disturbance of reproductive endocrine hormones caused by ovarian failure, rooted in the lack of estrogen. There is no essential difference between the supplement of estrogen as a therapeutic regimen for menopause-related problems caused by ovarian failure and the other medical treatments to alleviate somatic dysfunction caused by the failure of other organs. However, the use of menopausal hormone therapy (MHT) has, almost from the outset, been beset by controversy, typically characterized by the release of positive and reassuring data followed shortly after by other reports of negative outcomes. MHT has been a treatment option for alleviation of vasomotor menopausal symptoms (VMS) for some 60 years and our understanding of its place in therapy is now becoming mature and rational. When initially released in the 1940s and 1950s, the public and the media were all carried away by the significant effects of MHT, with the highest utilization rate of MHT in European and American countries reaching as high as 40–50%. However, there were setbacks, including the reports of an increased risk of endometrial cancer associated with the use of unopposed estrogens in women with an intact uterus, inappropriate prescribing, and sensationalized release of initial data from the Women's Health Initiative (WHI) [3] and the Million Women Study [4]. This led to concerns amongst health-care workers about the real role of MHT and a consequent sharp fall in the utilization rate of MHT all over the world. This negative attitude of health-care professionals toward MHT and inaccurate publicity in the media caused a rapid decline in acceptance of MHT in Australia and America by 55% and 47%, respectively [5,6]. In addition, some deep-rooted traditional beliefs have further complicated the situation. Both the general public and many medical workers had a limited understanding of menopause, properly considering it as a natural aging process but without any understanding of the potential pathological consequences of this usually physiological process [7,8]. A further complication was that the Asian, and particularly the Chinese, population (which collectively constitutes almost 60% of the population of the world) has an inherent fear of hormones, and the utilization rate of MHT in Chinese menopausal women was only 1–3% [9,10] by the end of the last century.

The impact of inappropriately negative reporting of many studies of MHT also made younger doctors less likely to receive proper training in menopausal management. As a result, a generation of younger doctors was ill equipped to give proper advice to women who sought advice about relief from troublesome menopause-related symptoms [11]. It is worth noting that the current utilization rate of MHT worldwide is still much lower than that in the pre-WHI era and there is little doubt that this is significantly influenced by health-care professionals’ attitudes [12]. For example, the rate of acceptance of MHT approaches 80% among female gynecologists and spouses of male gynecologists who have in-depth knowledge of MHT [13], whilst the acceptance rate of patients treated by gynecologists with a positive attitude toward MHT approaches 50%, and increases with the doctor’s age and professionalism [14].

Following the re-analysis of the WHI data and a series of newly published research, it is now considered that, besides maintaining a healthy lifestyle, such as quitting smoking, a low-sugar and low-fat diet, regular physical exercise, and weight management, MHT should occupy at least part of the overall health strategy for postmenopausal women. A recent survey that investigated the attitude of medical staff in various countries toward menopausal management found it was relatively positive and many of them shared a strong passion for further education despite limited opportunities [7,14]. Unfortunately, there are still significant numbers of health-care professionals who lack a basic understanding of the place of MHT in the 21st century. This must be overcome by education and training. Opportunities exist including the International Menopause Society Professional Activity for Refresher Training (IMPART) [www.imsociety.org) and similar [11,13]. Studies have shown that such training leads to positive results and enhanced health care for women [15].

The attitude of health-care professionals has always influenced any therapeutic intervention in medicine but the situation in menopausal medicine is dire, with too many doctors, nurses, and other health-care workers poorly informed regarding the most up-to-date data on MHT and its proper role in the management of women moving through the menopausal transition and into the postmenopausal stage of their lives. For our mothers, our sisters, our wives, and our daughters it is time we corrected this oversight by improving undergraduate and postgraduate training to overcome ignorance and misconception in this important area of women’s health.

Potential conflict of interest

The authors report no conflict of interest.

Source of funding

Nil.