Management of hormone replacement therapy. The Italian experience

Objectives: To review the characteristics of users and prescribers of hormone replacement therapy (HRT) in Italy, to attempt to explain the low uptake of this therapy. Methods: A review of the published literature and prescription data. Results: As in many other Western countries, gynaecologists are the main prescribers of HRT in terms of the number of prescriptions/physician/year. However, because general practitioners renew specialists' prescriptions several times a year, they are responsible for the greatest prescription volume. Overall GPs are responsible for 77.6% of HRT prescriptions while gynaecologists account for 20.7%. The attitude of gynaecologists and GPs to HRT is still equivocal and this may be a major factor in the low uptake. The percentage uptake is higher in northern and central Italy than in the south and it has been suggested that women in the hotter southern areas may suffer less from hot flushes. The evidence for this, however, is anecdotal. A recent study in Milan showed that the use of HRT was strongly correlated to social class and level of education. Women with 12 years of education or more were three times more likely to use HRT than those with less than 7 years education. There seemed to be no relationship between marital status and HRT use but fewer parous women used it and use decreased with an increasing number of children. In addition postmenopausal osteoporosis is not yet a registered indication for transdermal HRT, the major route of HRT administration in Italy. Conclusions: An increased uptake is expected in the future due to increased media interest and the greater availability and steady increase of transdermal HRT use over the last 5 years.