The climacteric in the Netherlands: A review of Dutch studies on epidemiology, attitudes and use of hormone replacement therapy

The climacteric has been the subject of research in the Netherlands for several decades. The incidence of climacteric symptoms has not changed since the pioneerwork of Jaszmann in 1967; nevertheless the number of contacts with a physician decreased by a factor of three during the 1970s and early 1980s. A rise in the number of contacts has occurred since 1987-1988 and nowadays the same number is reached as was 20 years ago. In 1970 psychopharmacons were the first choice of therapy. Nowadays 90% of the prescriptions for climacteric complaints are hormones. Twelve percent of women aged 45-60 years are current users of HRT. The mean duration of HRT use is only 7 months. The positive attitude of most women towards the climacteric is an explanation for this very short duration of use. Women receive their information on HRT use mainly through women's magazines and TV programmes and not through physicians. The determinants of longer duration of use are a positive attitude to treatment, younger age and the support of the GP. Physicians claim that they prescribe progestogens for 51% of oestrogen users, but the data give a figure of only 20% of prescription of progestogens with oestrogens. One explanation for this difference is the practice of many doctors to prescribe progestogens only once in 3 months.