- Menopause is a critical life-cycle transition for women, and is associated with osteoporosis and cardiovascular disease, leading causes of morbidity and mortality in US women. Efforts to curb symptoms of menopause include HRT and ERT, although conflicting evidence exists linking ERT and HRT with the risk of breast cancer. Physicians attitudes and preferred mode of treatment have been extensively studied, but with the increased utilization of nurse practitioners in the field, a new paradigm is being established. The overall goal of this study was to assess the nurse practitioners knowledge and attitudes about menopause, hormone replacement therapy and estrogen replacement therapy. More specifically, the objectives include to: 1) determine methods of patient education for menopausal women; 2) examine whether attitudes of menopause are predictors of preferred modes of treatment; and 3) determine whether demographic factors of nurse practitioners are predictors of preferred modes of treatment.
A random selection of nurse practitioners from the state of Oregon were mailed a self-administered survey along with a stamped, addressed envelope. The questionnaire focused on knowledge of menopausal treatments, attitudes of menopause, continuing education in the menopause research, and methods of patient education. Follow-up surveys were mailed to non-responders at two and four-week intervals following the first mailing. Response rate was 60% with a sample size of 192.
Results describe the management practices of nurse practitioners and what influenced their prescribing and management practices. The influences included the following factors: perceptions about adequacy of formal education, continuing education and attitudes about menopause and managing menopause. Only 47.4% of the respondents felt that their formal education in menopause treatment and protocols was adequate. When asked how they treated women, a majority (64.6%) of the nurse practitioners depended on the women and her beliefs about menopause, HRT, and ERT when they considered how they cared for a menopausal women. Sixty-one percent were very likely to take time during a visit to discuss the changes a woman was going through, while 23.7% were most likely to answer questions if the client had any, otherwise leave the introduction of menopause to the client. When contraindications were present, all nurse practitioners were less likely to prescribe both ERT and HRT. A surprising trend was the high number of participants who were uncertain about how they would prescribe when contraindications were present.
In summary, this study describes Oregon nurse practitioners attitudes about menopause, the perceived adequacy of their formal education, and likelihood of prescribing ERT and HRT. Since almost 50% of the nurse practitioners felt their education was inadequate in menopause, a systematic analysis of masters level nurse practitioner programs in the area of menopause and menopausal treatments is needed. Ideally, a nationwide survey comparing physicians and nurse practitioners prescribing practices would help quantify differences between the two types of health care providers.