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.

Physicians' gender and clinical opinions of reproductive health matters.

The purpose of this study was to investigate the effect of physicians' gender when sex-specific conditions are being treated in a country where almost half of the physicians are women. Five Finnish surveys originally conducted for other purposes were reanalyzed. Two surveys examined physicians' and medical students' views about hormone therapy during and after menopause, one survey examined medical students' attitudes about medicines, one survey examined physicians' obstetric practices, and one examined contraceptive counselling. All the surveys showed more similarities than differences in the clinical decision-making of women and men physicians. In opinions about menopause the physician's medical specialty was more important than gender. Physicians' obstetrical practices were also similar in five cases out of six, but in one situation where medical factors were not a deciding issue, women physicians acted differently. These results suggest that socialization into the medical profession makes physicians' practices more alike and diminishes gender differences.

PIP: To determine the effect of gender on the type of reproductive health treatment offered to women in a setting where half of the physicians are female, this study reanalyzed data collected from five surveys in Finland. The surveys were originally conducted to investigate the views of physicians (74% of 500 responding) and medical students (74% of 125 responding) about menopausal hormone replacement therapy, the attitudes of medical students about prescribing hormones, obstetric practices (83% of 90 responding), and contraceptive counseling (74% of 480 responding). It was found that the number of menopausal patients was highest for female gynecologists, followed by male gynecologists, female physicians, and male physicians. Female and male gynecologists offered similar recommendations for hormone replacement therapy, but female physicians were more likely to prescribe hormones for prevention only. Results for medical students were not influenced by gender. The only significant difference in obstetric practice was that female obstetricians were three times more likely than males to induce labor for convenience. While equal numbers of female and male physicians prescribed oral contraceptives and IUDs, females were more likely to prescribe condoms, implants, and diaphragms. It is concluded that professional identification among these physicians was stronger than gender influences.

Experience and opinions of climacterium by Finnish women.

OBJECTIVE: Literature on women's 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 women's 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.

Feedback for participants in a health survey: feasible and useful.

The use of quantitative methods has often limited the communication between researchers and research participants to being one-sided. Use of feedback in survey-oriented research is one possibility for creating a more communicative relationship. After doing a postal survey of 2000 Finnish 45 to 64-year-old women about their climacterium we produced a feedback leaflet about the main results of the study and about climacterium in general and sent it to all respondents (n = 1713). Later a postal questionnaire concerning the feedback leaflet was sent to a consecutive sample of every eighth (n = 200) woman, of whom 153 (76%) responded. Most of the women gave neutral or positive responses to the content of the leaflet. There was more interest in the feedback among the younger and pre-menopausal groups than among the older or postmenopausal women. Some women wanted more information about climacterium-related issues than was possible to give in the space of eight pages. According to this experiment, feedback offers fresh view-points and valuable critique for researchers as a result of being more in contact with respondents.

Physicians' views on hormone therapy around and after menopause.

Estrogens and progestins are commonly and increasingly used during and after menopause. We studied Finnish physicians' views of this hormone therapy based on their specialty. A questionnaire was sent to a stratified random sample of gynecologists, internists, general practitioners and nonspecialists (n = 500; response rate 74%). Reported prescription habits and opinions concerning benefits and harms of hormones were asked and compared to current literature. Combined therapy was much more popular than was estrogen alone. One fourth of the physicians said hormones should be preventively given to all or to all those at risk for osteoporosis. Long therapies were accepted by many and for our patient cases hormones were recommended much more commonly than were other medical therapies. Most considered prevention of osteoporosis to be a benefit of combined therapy, but opinions of other benefits and harms varied. Gynecologists had the most favourable opinions and most of them considered hormone therapy very useful; the other physicians' opinions were characterized by uncertainties about hormone therapy and its long term effects.

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

This article describes the prevalence of hysterectomy, women's 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. Fourty-one 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.