During the 1990s there was a strong increase in the use of estrogen to alleviate symptoms of menopause in Sweden and many other countries. The increase was prompted by the many studies published in the 1980s and 1990s showing that different types of estrogen treatment improved the quality of life and at the same time decreased the risk of cardiovascular diseases and osteoporosis. Around the turn of the new century, two major American studies were published that could not confirm that estrogen treatment had any effect in preventing cardiovascular disease. The studies also showed, just as others had done before, that the risk of breast cancer and blood clots increased somewhat during estrogen treatment. This had led to a drop in the use of estrogen in recent years.
In her dissertation, Louise Thunell, M.D., compares the attitudes of Swedish gynecologists to prescribing estrogen preparations for menopause problems between the years 1996 and 2003, in other words before and after the American studies. The gynecologists were more cautious in their recommendations about prescriptions in 2003 compared with 1996. In 1996, 44 percent of gynecologists maintained that virtually all women should be offered estrogen treatment, compared with 11 percent in 2003. The proportion of gynecologists who regarded the prevention of osteoporosis and cardiovascular diseases as reasons for estrogen treatment declined considerably between 1996 and 2003. More gynecologists pointed out in 2003 that estrogen treatment increased the risk of breast cancer and blood clots than in 1996.
The use of estrogen during menopause among gynecologists themselves went down between 1996 and 2003, but remained high in comparison with the general public. In 1998 over 30 percent of Swedish middle-aged women were taking some type of estrogen. In 2003 this share had dropped to about 20 percent. Among female gynecologists during or after menopause, 88 percent were being treated with estrogen, and among partners of male gynecologists 86 percent were being treated in 1996. The corresponding figures for 2003 were 71 and 68 percent respectively.
“Gynecologists in Sweden appear to be well informed about the latest findings in the scientific literature and have changed have changed their practice and prescribing of estrogen to their patients, but they themselves still use estrogen to a greater extent,” says Louise Thunell.