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Physician Specialty Is Significantly Associated With Hormone Replacement Therapy Use

From the Department of Family Medicine, College of Medicine, and Departments of Biostatistics and Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.

Address reprint requests to: Barcey T. Levy, PhD, MD, University of Iowa, Department of Family Medicine, 01292 East Pomerantz Family Pavilion, Iowa City, IA 52242; E-mail: barcey-levy{at}uiowa.edu.

OBJECTIVE: To compare the characteristics of postmenopausal women seen by gynecologists versus family physicians and to determine factors associated with current hormone replacement therapy (HRT) use.

METHODS: We conducted a cross-sectional study of 426 postmenopausal women seen for their annual examination at university clinics. Logistic regression was used to identify predictors of current versus never HRT use.

RESULTS: Overall, 60% of women recruited in family practice clinics and 69% in gynecology clinics were current HRT users. Significant, positive, multivariable predictors of HRT use were gynecology versus family practice clinic attendance (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.4, 4.6), surgical menopause (OR 2.3, 95% CI 1.2, 4.6), history of depression (OR 2.3, 95% CI 1.2, 4.7), at least two live births (OR 2.1, 95% CI 1.1, 4.0), and current alcohol use (OR 1.8, 95% CI 1.04, 3.2). Significant, negative, multivariable predictors were increasing age (60–70 years versus less than 60 years, OR 0.4, 95% CI 0.2, 0.8; 70 years or older versus less than 60 years, OR 0.4, 95% CI 0.2, 0.9) and history of breast cancer (OR 0.04, 95% CI 0.01, 0.14). Sociodemographic factors, smoking status, number of self-reported medical conditions, number of prescription medications besides HRT, oral contraceptive use, history of hypertension, and exercise level were tested as covariates and did not enter the model.

CONCLUSION: Although current HRT use rates between clinics were similar and higher than national averages, we found that the adjusted odds of current HRT use among women receiving care from gynecologists was 2.6 times that among women receiving care from family physicians. This practice variation may reflect physicians’ uncertainty surrounding the preventive value of HRT.