Characteristics of menopausal hormone therapy use in Russia: results of a large-scale survey of peri- and postmenopausal women

Menopause is accompanied by various symptoms that can reduce the quality of life of women and have an impact on society as a whole. The identification of factors that contribute and prevent the use of menopausal hormone therapy (MHT) can provide additional opportunities and perspectives for changing attitudes towards menopause and MHT. The article was prepared by the Russian Society of Gynecological Endocrinology and Menopause (ROSGEM)

Objective: To identify and systematize the causes of the low prevalence of MHT in Russia in terms of patient perception of the problem.

Materials and methods: The study was conducted by Ipsos Comcon through an online survey of 2,536 women aged 45–59 living in Russian cities with populations over 100,000 people. Among them, 1,743 were peri- and postmenopausal women. National representative quotas were established by gender, age, and federal district. All the respondents were divided into three groups: 45–49 years old (n=890), 50–54 years old (n=835) and 55–59 years old (n=811). In addition to the main sample, the survey included 200 women who had some experience in taking MHT over the past 12 months: 100 women took herbal medicines to relieve menopausal symptoms over the past 12 months, and 100 women previously took MHT but stopped using it less than 12 months after starting therapy.

Results: The study revealed that 97.5% of women aged 45–59 years who were in the peri- and post-menopausal stages experienced at least one symptom of menopausal syndrome. The symptoms of menopause were rated as moderate or severe by 74% of patients. The women agree that their quality of life should not deteriorate during peri- and postmenopause (90%). Endocrinological (55%) and vasomotor (56%) symptoms were often the cause for seeking medical help. Among all the medical professionals, the gynecologist was the primary source of knowledge (93%) about symptoms and therapy. However, gynecologists seldom initiated active discussions about menopause with their patients. Among women who went to the doctor at least once during menopause, only 19% of women reported that the doctor was the first to initiate a conversation about menopause. Women who were aware of the appropriate treatment method perceived MHT as a therapy that totally relieves peri- and postmenopausal symptoms (49%) compared with non-hormonal therapy (36%) and combined oral contraceptives (23%). Most Russian women (67%) aged 45–59 years who associate health changes with the approach/onset of menopause and do not deny hormone therapy in the future preferred the oral route of MHT administration and only 9% of women chose the transdermal gel. The need for information about menopause and MHT was reported by about 58% of women. The recommendation to discontinue MHT in 82% of cases (among all doctors) was given by the gynecologist. The lack of a doctor’s administration is also a significant barrier to MHT: the gynecologist did not prescribe MHT to women with severe menopausal symptoms in 21% of cases. Only 10% of women had at least one/combination of several unmodifiable absolute contraindications to MHT.

Conclusion: The level of MHT use in Russia increased from 1.3% to 6.5% but it remains low compared to developed countries. It is necessary to conduct educational events for gynecologists, other doctors, as well as patients. These events should provide information about menopause, its symptoms, potential long-term health consequences and they should also discuss current ideas about the safety and benefits of MHT.