"I'm going to stay young":  Belief in anti-aging efficacy of menopausal hormone therapy drives prolonged use despite medical risks

Over a third of menopausal hormone therapy (HT) prescriptions in the US are written for women over age 60. Use of HT more than 5 years is associated with increased risk for cardiovascular disease; breast, ovarian, and endometrial cancers; thromboembolic stroke; gallbladder disease; dementia; and inc...

Full description

Saved in:
Bibliographic Details
Published in:PloS one 2020-05, Vol.15 (5), p.e0233703-e0233703
Main Authors: Hunter, Mary M, Huang, Alison J, Wallhagen, Margaret I
Format: Article
Language:English
Subjects:
Age
Aging
Aging (Biology)
Analysis
Biology and Life Sciences
Breast
Breast cancer
Cardiovascular diseases
Decision making
Decisions
Dementia disorders
Disease
Endocrine therapy
Endometrial cancer
Endometrium
Estrogens
Gallbladder
Gallbladder diseases
Health aspects
Health behavior
Health risk assessment
Health risks
Hormone replacement therapy
Hormones
Interviews
Medicine and Health Sciences
Menopause
Methods
Mountains
Nursing schools
Osteoporosis
Patient outcomes
Pharmaceutical industry
Physiology
Risk
Studies
Thromboembolism
Urban areas
Vagina
Womens health
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Over a third of menopausal hormone therapy (HT) prescriptions in the US are written for women over age 60. Use of HT more than 5 years is associated with increased risk for cardiovascular disease; breast, ovarian, and endometrial cancers; thromboembolic stroke; gallbladder disease; dementia; and incontinence. To explore older women's perceptions of the benefits and risks of long-term HT and examine factors influencing their decisions to use HT > 5 years despite medical risks. A qualitative approach was selected to broadly explore thought processes and social phenomena underlying long-term users' decisions not to discontinue HT. Interviews were conducted with 30 women over age 60 reporting use of systemic HT more than 5 years recruited from an urban area in California and a small city in the Rocky Mountain region. Transcripts of interviews were analyzed using conventional grounded theory methods. Women reported using HT to preserve youthful physical and mental function and prevent disease. Gynecologists had reassured participants regarding risk, about which all 30 expressed little concern. Participants, rather than providers, were the principal drivers of long-term use. Participants perceived estrogen to have anti-aging efficacy, and using HT imparted a sense of control over various aspects of aging. Maintaining this sense of control was prioritized over potential risk from prolonged use. Our findings provide an additional perspective on previous work suggesting the pharmaceutical industry has leveraged older women's self-esteem, vanity, and fear of aging to sell hormones through marketing practices designed to shape the beliefs of both clinicians and patients. Efforts are needed to: 1) address misconceptions among patients and providers about medically supported uses and risks of prolonged HT, and 2) examine commercial influences, such as medical ghostwriting, that may lead to distorted views of HT efficacy and risk.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0233703