Päivi Topo

Selection to postmenopausal therapy by women's characteristics.

Many surveys have shown that women using postmenopausal hormone therapy have a lower incidence of cardiovascular diseases and lower overall mortality. The purpose of this study was to compare past and non-users with current users of hormone therapy in regard to characteristics known to, or assumed to, predict poor subsequent health (indicators). The main data source was a survey in 1989 of a random sample (n = 2000, 86% response rate) of 45-64 year-old Finnish women. Among women with their uterus, after adjusting for age and urbanism, of the 21 indicators studied, 10 suggested a poorer and none a better health prognosis for the non-users than for current users. Many differences were greater among older women, suggesting a cohort effect or long-term users being an especially selected group. Among hysterectomized women, differences between users and non-users were similar or smaller than among women with uteri. The past users were more similar to non-users than current users. Our study suggests that women with a better health prognosis are selected or select themselves for hormone therapy, and that may impede interpretation of observational studies on hormone therapy and health.

Trends in the use of climacteric and postclimacteric hormones in Nordic countries

The extent of menopausal and postmenopausal hormone use in Denmark, Finland, Norway, and Sweden during 1981-1992 was studied by means of drug sales figures and associations between hormone use, education, employment and occupational status, by questionnaire surveys in each of the respective countries in the 1980s-90s. According to sales figures, hormone use has been different in each of the countries studied. In 1981 use was three times more common in Denmark than in Norway. In 1992 use had increased in all the other countries except Denmark, and was highest in Finland and Sweden. Based on 1981 data for Norway, on 1987 data for Denmark and on 1989 data for Finland, use of hormone therapy was related to education, employment or occupational status in Finland but not in Denmark or Norway. Differences in the phases of innovation diffusion between these countries may offer a partial explanation for these results.

Declining socioeconomic differences in the use of menopausal and postmenopausal hormone therapy in Finland

OBJECTIVE Sales figures for the use of menopausal and postmenopausal hormone therapy in Finland show a rapid increase during the 1980s continued into the first half of the 1990s. Hormone therapy use became very common in Finland compared to many other Western countries. The aim of our study was to investigate the sociodemographic distribution of hormone therapy among Finnish women aged 45-64 years. METHODS The study is based on population-based surveys conducted in 1989 and 1996 (response rates 87% and 78%). RESULTS Between 1989 and 1996 the current use of hormone therapy increased from 22% to 27%; in 1989 it was most common in the age group 50-54 years, but in 1996 among 55-59-year-olds. In 1989 it was significantly more common among women with longer education than other women in every age group, but in 1996 this difference was significant only in those 55 years and older. In 1989 the use was more common in the capital area than elsewhere and this difference decreased but remained significant in 1996. CONCLUSION Our results suggest that hormone therapy has become a routine treatment during the menopause in all educational groups and throughout the country. The lack of socioeconomic differences indicates that among women under 55 year of age the saturation point in short-term hormone use was reached in 1996. However, the persistence of socioeconomic differences among older women suggests that the use of long-term postmenopausal hormone therapy will continue to increase for some time.

Experience and opinions of climacterium by Finnish women

OBJECTIVE Literature on womens experiences with climacterium is mostly based on patients or on North American women. In this study, the experiences and opinions of Finnish women were investigated. STUDY DESIGN In 1989, a questionnaire was sent to a representative sample of 45-64-year-old Finnish women (n = 2000); 1713 (86%) responded, of which 1308 were postmenopausal. RESULTS Most women (87%) reported their health to be good or rather good. Symptoms were commonly experienced, but each symptom usually by a minority of women. Most subjective health problems were not related to climacterium as such, but were problems also encountered otherwise or related to aging. Some symptoms decreased with increased age, others increased or stayed the same. Comparing the symptoms reported in the past two weeks and womens own judgements suggests that hot flashes and irritability were specific to climacterium. Most women had a neutral or positive opinion of climacterium in general. CONCLUSION Our study challenges the view that climacterium is a time of big subjective health problems.

Hysterectomy among Finnish women: prevalence and women's own opinions

Hysterectomy among furnish women: Prevalence and Womens own Opinions. Luoto R., Hemminki E., Topo P., Uutela A. and Kangas I. University of Helsinki, Department of Public Health Helsinki, Finland This article describes the prevalence of hysterectomy, womens own opinions of it, and socioeconomic characteristics of hysterectomized women compared to non-hysterectomized ones. The questionnaire was sent in spring 1989 to 2000 45 to 64-year-old Finnish women picked randomly from the Population Census. After two reminders, 1713 (86%) had responded. One fifth of the women had had a hysterectomy and 5% had also had both ovaries removed. Among the highest educated there were less hysterectomized women than among the less educated. The largest differences in the prevalence of hysterectomy were between counties, not between socioeconomic groups. Fourtyone percent of the hysterectomized women had themselves wished hysterectomy, 25% did not have any specific opinion about the operation. Results raise further questions about clinical decision making and regional variation of hysterectomy.

Alternative drug use for the climacteric in Finland

OBJECTIVES To investigate the use of alternative drugs for the climacteric in Finland, which products are used, and who are the women using them. METHODS The study was based on a population-based survey conducted in 1989 among 2000 Finnish women aged 45-64 (response rate 86%). RESULTS 11% of the women reported the use of alternative drugs for the climacteric. Food supplements and bee products were the most common types of alternative drugs used. Some of them may have allergic or other side effects. Users differ little from other women judging by health habits and the utilization of health care services. The best predictors for alternative drug use were urban residence, more than 9 years of general education, and among 50 54-year olds, the use of prescription or OTC drugs for menopause. Over half of the users of alternative drugs had also used hormone therapy. CONCLUSIONS Women using alternative drugs during and after the climacteric represent a large group. More information is needed about the clinical effects of alternative drugs, and the characteristics of alternative drug users.

Is menopause withering away

Menopause (cessation of menstruation) and the period surrounding it (climacterium) are often defined retrospectively by asking a woman the date of her last menstrual period (LMP). Based on a survey of 2000 women aged 45-64 in 1989 in Finland, this study examines (1) the relation between these definitions and womens own definition of their climacteric status and of the cessation of menstruation and (2) the effect of menopausal and postmenopausal hormone therapy and hysterectomy on the definition of menopause and climacterium. Agreement of the womans own definition of her climacteric status and interval since LMP was 25% among current hormone users, 41% among hysterectomised women and 64% among those who were neither currently using hormones nor had been hysterectomised. Current hormone users defined the climacteric phase as longer than their LMP suggested. Current hormone use and hysterectomy had little effect on reported final cessation of menstrual periods. It is concluded that hysterectomy and hormone therapy shape womens thinking about the end of reproductive life, blur the concepts of menopause and postmenopause and confuse the measurement of age at menopause.