更年期婦女中斷荷爾蒙治療之原因探討──以中部某醫院為例

Discontinuation of Hormone Therapy by Post-Menopausal Women

目的：探討中部某醫院接受荷爾蒙療法之更年期婦女中斷治療（中斷服藥三個月以上）的原因。方法：本橫斷式研究以中部某區域教學醫院婦產科門診103年5月1日至6月30日，因為更年期症狀就診，兩次診斷相同但來院就診治療時間相隔三個月（含）以上的婦女作為研究對象，共完成訪談資料30份。研究人員在說明研究目的取得受訪者同意並填寫同意書後，與個案進行一對一質性訪談。訪談資料以質性資料分析軟體NVivo 10協助分析，再將分類後的內容歸納，得到四個主題。結果：本研究結果得到更年期婦女中斷荷爾蒙治療的原因為：（一）擔心藥物副作用：包括致癌、發胖、藥物成癮。（二）症狀緩解：自覺已無症狀或症狀減輕。（三）藥物無效或藥物太多。（四）與健康照護提供者間溝通不良。此外，〝被更年期症狀造成的不適所困擾〞是受訪者在三個月後又繼續接受治療的原因。結論：擔心藥物的副作用是更年期婦女中斷荷爾蒙治療最常見的原因，因此除了荷爾蒙的使用必須經過個別化的審慎的考量外，醫師需要在醫病關係良好的基礎上提供建議，使更年期婦女在得到正確知識的同時，減低藥物副作用的心理威脅，維持服藥的順從性，使荷爾蒙治療能正確發揮治療功能。建議日後婦科門診加強更年期與荷爾蒙使用的衛生教育，以建立正確的更年期保健知識。本研究的結果，可以作為日後提供更年期婦女用藥諮詢與醫療建議的參考。

Purposes: The aim of this study was to explore the reasons for discontinuation of menopausal hormone therapy (MHT) for up to three months by post-menopausal women. Methods: Thirty women qualified for this cross-sectional study. All hadhad menopausal symptoms but had discontinued medication for up to three months while being followed in a regional teaching hospital in central Taiwan between May 1 and June 30, 2014. In this qualitative study, the researcher explained the purpose of the study and provided the participants with informed consent before a one-on-one interview. The collected data were analyzed with Nvivo 10 software. Results: The reasons for discontinuation of MHT by these postmenopausal women were categorized into four themes: worry about the side effects of treatment, including the increased risks of cancer,obesity, and drug addiction, no sense of symptoms, no effect of the drug or too many medications, poor communication between patients and healthcare providers. The discomfort of menopausal symptoms resulted in many returning to treatment after three months. Conclusions:Worry about side effect was the most common reason for the discontinuation of MHT in post-menopause women in this hospital. In addition to careful individualized consideration of the need for MHT, physicians should provide suggestions based on the doctor-patient relationship. This may not only educate menopausal women, but also reduce their worry about suffering from the side effects of treatment, help obtain medication compliance, and allow for the appropriate therapeutic function of hormone therapy. We suggest that gynecology clinics enhance education about menopause and MHT.