The role of treatment intentions and concerns about side effects in women's decision to discontinue postmenopausal hormone therapy

Objectives: To investigate the factors that influence women's decisions about hormone therapy use and the duration of use, in particular the effect of women's reasons for initiating hormone therapy, the source of information about hormones, women's symptom experience, and their concerns about side effects from hormone therapy. Methods: Eight hundred and sixteen women aged 45–59 who began hormone therapy between July 1993 and June 1995 in a Massachusetts health maintenance organization were followed for two years from the day they received a prescription for estrogen. This cohort has been previously studied for health, treatment and demographic determinants of hormone therapy discontinuation. In March 1999, these women were mailed a questionnaire containing closed and open-ended questions. 449 women (55%) completed the survey. Discrete-time hazards models were used to identify determinants of discontinuation, controlling for medical predictors of survey nonresponse. Results: Women's assessment of the difficulty of their decision to use hormone therapy (RR=1.25 for each point on a 7-point scale, 95% CI: 1.16, 1.35) was associated with discontinuation. Women who described their decision as extremely difficult had the greatest likelihood of discontinuing. The importance placed on preventing osteoporosis (RR=0.93 for each point on a 7-point scale, 95% CI: 0.86, 0.99) and cardiovascular disease (RR=0.94 for each point on a 7-point scale, 95% CI: 0.88, 0.99) were also statistically significant predictors of discontinuation. Women for whom the prevention of osteoporosis and cardiovascular disease were extremely important in deciding to use hormone therapy were the most likely to continue using hormones. Concerns about the return of monthly bleeding (RR=3.00, 95% CI: 1.45, 6.17) and weight gain (RR=2.06, 95% CI: 1.16, 3.67) at the time hormone therapy was initiated, but not the actual experience of these side effects while using hormones, were associated with a higher rate of discontinuation. Symptoms around the time of initiating hormone therapy, including the perceived severity of the symptom, were not statistically associated with discontinuation. Conclusions: Discontinuation of hormone therapy is the result of a complex process of decision-making that is influenced by the value placed on the prevention of osteoporosis and cardiovascular disease at the time of initiation and women's perceptions and interpretations of side effects. Concerns about the potential side effects of hormone therapy, in particular weight gain and monthly bleeding, lead women to discontinue hormone therapy.