Issues to debate on the Women's Health Initiative (WHI) study. Prescription attitudes among Belgian gynaecologists after premature discontinuation of the WHI study

Background: A survey was conducted in order to assess the attitude of Belgian practitioners toward HRT, after publication of the results of the 'Women's Health Initiative' (WHI) study. Methods: Using a single case of a 55-year-old woman (no particular medical history, no longer climacteric symptoms), eight clinical case records were constructed by modifying three variables: (i) the HRT type [either conjugated estrogens (CEE) 0.625 mg + medroxyprogesterone acetate (MPA) or tibolone 2.5 mg]; (ii) the HRT duration (2 years or 11 years); and (iii) the bone density result (T-score +0.5 or -1.5). One case (drawn at random) was sent to Belgian gynaecologists (n=1374), who were asked whether they would pursue, discontinue or modify the HRT regimen. Results: In total, 577 returns were obtained (42% response rate). Globally, 19.8% of the physicians would stop prescribing the CEE+MPA regimen, 19.5% would continue the same regimen, and 60.7% would prescribe another HRT type, while respectively 15.9% of them would discontinue tibolone, 76.1% would continue it and 8% would prescribe another regimen (P<0.001). After 2 years of use, 11.7% would discontinue HRT, while 23.5% would do so after 11 years (P<0.001). No differences in prescription rates or discontinuation rates were observed in relation to the bone density results. Conclusions: The results of this survey suggested that Belgian gynaecologists intend to continue prescribing HRT, despite the negative findings of the WHI study. When patients are using tibolone, physicians generally maintain the same regimen, but when using CEE+MPA physicians tend to prescribe another HRT regimen. Less than 25% of physicians will spontaneously discontinue HRT, even after 11 years of use.