Medical Decisions, Estrogen and Aging

The decision-making process that underlies ovarian hormone therapy (HT) is a fallible one. The question is whether or not physicians should prescribe HT to menopausal women, who are at a time in their lives when they are factoring various concerns into their decision to take (or not take) HT. Not only is it difficult to determine whether or not to prescribe HT, but what kind; should physicians recommend estrogen or progestin, or another combination of related hormones? The decision of whether or not to use HT has affected, and will continue to affect, many women in the United States and throughout the world and is an important model elucidating the forces that influence medical decision-making. §Two recent large-scale studies, one conducted here in the United States (the Women s Health Initiative) and the other in Great Britain (the Million Women Study), were highly publicized and cast a negative light on the use of HT. Since HT s inception, views have oscillated, due in part to expectations of benefits extending over the course of long-term use beyond the peri-menopausal period, and perhaps due to the overselling of research investigating the efficacy of HT. Thus, the decision for women to go on HT remains a controversial issue, and the decision-making process is undermined further by overzealous advertising and an exaggerated understanding of the research results (both positive and negative).§This book is unique in that it integrates core findings from within the Decision Sciences and Evidence Based Medicine in light of the research that has been done on HT. Medical Decisions, Estrogen and Aging integrates the various components that go into medical decision making in the context of understanding the dilemmas that surround HT. Therefore this book is intended for both specialists and generalists in the field, and it is ideally suited for use by graduate and medical students, medical health care professionals, behavioral scientists, medical ethicists, gerontologists, historians of science, and endocrinologists.The decision making process that underlies ovarian hormone therapy (HT) is fallible. Thus, the decision for women to go on HT remains controversial. At a time when confusion still permeates the decision making with regard to HT, this book bridges diverse features that surround the decision making concerning HT. The book is written for both specialists and generalists in the field.The decision making process that underlies ovarian hormone therapy (HT) is fallible. The question is whether or not physicians should suggest; should one take estrogen or progestin or some other combination of related hormones to women during the menopausal period, when women are deciding about whether to go on hormone therapy for diverse reasons. This decision affects many women in this country and around the world, and is an important factor serving to show what forces influence medical decision-making.§Two recent large-scale studies, one here (Women s Health Initiative or WHI) and the other in Great Britain, cast a negative light on the use of hormone therapy. Both have received considerable attention in the media. Thus, the decision for women to go on hormone therapy (HT) remains controversial. There is an historical oscillation of beliefs related in part to expectations of the medicinal value of HT over longer-term use beyond the initial peri-menonpausal period. Studies thought to resolve issues surrounding the efficacy of HT were perhaps over-stated. Confusion still permeates the decision making with regard to HT. Over zealous advertising, and exaggerated understanding of the results (negative or positive) undermines patient and physician decision making.