A Johns Hopkins study of more than 200 low-income African American women suggests that their low use rate of potentially heart and life-saving hormone replacement therapy after menopause is closely linked to their health care providers' failure to bring up the subject. Only one in five of the women reported using HRT, and those women who said their providers never discussed menopause issues with them were 91 percent less likely to use replacement therapy. Results of the study were published in the December issue of Women's Health Issues.

"While we don't want to imply that all women should be on hormone replacement therapy, African American women are at greater risk for cardiovascular disease and other health problems that HRT might be able to prevent," says Jerilyn Allen, associate professor at the School of Nursing and lead author of the study.

Allen says previous studies have shown hormone replacement therapy may decrease the risk of developing heart disease by 20 to 50 percent. Less than half of the women in the study were aware that the risk for heart disease increases after menopause.

Allen found that women who had a hysterectomy were almost three times as likely to be on HRT, and women who had more knowledge about menopause were 31 percent more likely to be taking HRT. According to Allen, a surprising finding of the study was that 37 percent of the women experienced some level of urinary incontinence, a symptom of menopause that may be relieved by HRT.

"Women are significantly more likely to use HRT if their health care provider has discussed the therapy with them," says Allen. "Information about menopause needs to be provided by anyone who is delivering health care to women. This type of education is not just a gynecologist's role; it is the responsibility of all health care providers. Women cannot make educated decisions unless they have the proper information."

Allen says information about menopause and HRT should be available at community sites frequented by low-income women, including churches, beauty salons and neighborhood community centers.

"It is important for health care providers to consider the impact of HRT on heart disease risk reduction in this vulnerable population," says Allen. "This study and previous ones show low-income African American women lack knowledge about menopause but have a high interest in learning more about it. It is our job as providers to teach them."

The study was supported by the Johns Hopkins Fund for Geriatric Medicine and Nursing. Other authors include Michele Bellantoni, School of Medicine; and Susan E. Appling, Rosemarie Brager, Jule Hallerdin, Sharon Olsen, Shirley VanZandt, Jean Gaines and Kendra L. Young, School of Nursing.