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Context: Initiation of hormone replacement therapy (HRT) has been shown to increase breast density. Evidence exists that increased breast density decreases mammographic sensitivity. The effects on breast density of discontinuing and continuing HRT have not been studied systematically., Objective: To examine the effects of initiation, discontinuation, and continued use of HRT on breast density in postmenopausal women., Design, Setting, and Participants: Observational cohort study of 5212 naturally postmenopausal women aged 40 to 96 years and enrolled in a large health maintenance organization in western Washington State who had 2 screening mammograms between 1996 and 1998., Main Outcome Measures: Breast density, assessed using the clinical radiologists' BI-RADS 4-point scale, compared among women who did not use HRT before either mammogram (nonusers); who used HRT before the first but not before the second mammogram (discontinuers); who used HRT before the second but not before the first mammogram (initiators); and who used HRT prior to both mammograms (continuing users)., Results: Relative to nonusers, women who initiated HRT were more likely to show increases in breast density (relative risk [RR], 2.57; 95% confidence interval [CI], 2.12-3.08), while women who discontinued HRT use were more likely to show decreases in density (RR, 1.81; 95% CI, 1.06-2.98) and women who continued to use HRT were more likely to show both increases in density (RR, 1.33; 95% CI, 1.13-1.55) and sustained high density (RR, 1.45; 95% CI, 1.33-1.58)., Conclusions: These results indicate that breast density changes associated with HRT are dynamic, increasing with initiation, and decreasing with discontinuation.

Objective: To ascertain the sources of information women use when making decisions about hormone replacement therapy (HRT)., Methods: A cross-sectional, population-based computer-assisted telephone survey of 1082 randomly selected women aged 50-80 years (80.3% response rate) was conducted at Group Health Cooperative of Puget Sound, a large staff-model health maintenance organization in Washington state., Results: Overall, 460 participants (42.5%) were current HRT users, 226 (20.9%) were past users, and 396 (36.6%) were never users. Discussions with physicians dominated as the major source of information used in decision making by current (83.4%) and past (65.5%) users, but were less often cited by never users (44.4%); printed material was used by 44.5% of women. Although 72.1% of current users reported that the amount of information received from their physician about the benefits of HRT was about right, only 48.2% of past users and 33.6% of never users shared this view (P < .001 current versus never), and 13.3% of current users, 32.6% of past users and 58% of never users reported receiving no information from their physician about HRT's benefits., Conclusion: Hormone replacement therapy use is strongly related to interactions between women and their physicians. Many women use written materials to make decisions about HRT. A large proportion of women feel inadequately informed about HRT's risks and benefits. Much work remains to be accomplished toward meeting the goal of the US Preventive Services Task Force that all perimenopausal and postmenopausal women be counseled about the potential benefits and risks of HRT.

To examine preventive health practices in older women, we conducted computer-assisted telephone interviews with 1082 women aged 50-80 who were enrollees of Group Health Cooperative of Puget Sound (June-November 1995; 80.3% response rate). We sought to describe the women's reasons for initiating, discontinuing, or not initiating hormone replacement therapy (HRT). HRT use was categorized as current (42.5%), past (20.9%), or never (36.6%) based on the interviews. The reasons most frequently cited by current users for initiating HRT were menopausal symptoms (47.3%), osteoporosis prevention (32.4%), and physician advice (30.3%). The most frequently cited reasons for quitting HRT were side effects (26.6%), physician's advice (22.9%), fear of cancer (15.4%), and not wanting menstrual periods or bleeding (15.2%). Of past users, 53.8% reported stopping HRT on their own, and 46.2% did so at their physician's advice. The reasons most commonly cited by never users for not initiating HRT were that hormones were not needed (49.9%) and that menopause is a natural event (17.9%). Among never users, 33.1% reported considering HRT, only 46.6% discussing it with their provider, and 5.0% being given an HRT prescription they did not fill. Many women made decisions about HRT independent of interactions with health care providers. Better understanding of the beliefs and decisions that influence women's choice to use or not use HRT is needed to develop more effective counseling strategies.