Attitude of German gynecologists towards prescribing HRT before and after the WHI study

Objective The publication of the Women's Health Initiative (WHI) randomized, controlled trial in 2002 resulted in a critical discussion on the risks and benefits of hormone replacement therapy (HRT). The present study aims to evaluate the attitude of German gynecologists regarding changes in the prescription of HRT over recent years.

Method A questionnaire was sent to all 9589 German gynecologists in private practice in November 2010.

Results The response rate was 2548 (26.6%). Whereas 82.2% of the responders stated that their advice for primary hormone therapy and alternative agents depended on the severity of symptoms, 9.1% of the responders would recommend HRT in the first place (male: 14.3%; female: 6.1%; p <0.001). An age limit for hormone prescription was stated by 26.2%, with a mean age limit of 63 +/- 5.3 years. An increasing number of patients and becoming more critical about HRT after the WHI was mentioned by 79.8%. Of the responding doctors, 43.9% found that their patients were badly informed by the media, 44.5% stated they were moderately or well (10.1%) informed, whereas only 1% considered their patients to be very well informed. HRT was prescribed for the relief of vasomotor symptoms by 97.4% of responders, making this the primary indication. This percentage decreased slightly to 92.6% between 2003 and 2008 (p <0.001) and increased again to a similar level at the beginning of 2010 (96.7%, p <0.05).

Conclusion German gynecologists generally have a positive attitude towards HRT, but find it important to focus on the evaluation of the risk-benefit ratio. The major barriers to prescription are multiple concerns of the patients resulting from non-objective media.