更年期症狀絕大部分是由於體內女性荷爾蒙降低所致。既然如此，更年期的問題應該可以用補充女性荷爾蒙來解決，但實際上是否有預期的效果？其機轉如何？可能發生的副作用及適宜的用藥方法等等都值得探討與評估。本研究主要的目的是想了解婦產科醫生對賀爾蒙補充療法(Hormone Replacement Therapy --HRT)的認知程度，以期知道更年期婦女在接受賀爾蒙補充療法時，有無得到良好的醫療資訊與服務。 本研究是描述性的問卷調查研究。本次問卷一共設計了十二個題目。包含二個大主題 (1)婦產科醫師對荷爾蒙補充治療的禁忌與藥物作用的認知；(2) 臨床施用荷爾蒙補充治療的過程與經驗。 本次問卷是依附在台灣婦產科醫學會會刊寄發給2646名中華民國婦產科醫學會登記的婦產科專科醫師。我們主要分析以下幾項樣本資料： 1. 總答對率 2. 各題答對率 3. 服務單位與答對率 4. 醫師年齡與答對率 本次問卷一共回收470份問卷，其中有24份為無效問卷，所以有效問卷為446份，有效回收率只有16.86％。在回收的446份有效問卷中，有18份來自醫學中心；143份來自非醫學中心醫院(包括地區醫院與區域醫院)；285份來自基層診所。所有有效問卷中，其年齡分佈為：70-80歲─20人，60-69歲─47人，50-59歲─151人，40-49歲─164人，30-39歲─64人。在寄發問卷之前，我們曾對中山醫學大學附設醫院的12位婦產科住院醫師做過前測，他們的平均答對率為8.33題，故我們期望以8題當做合理的基本認知。這與本次問卷調查的結果大致吻合--大多數醫師答對7題(23.54%)或8題(29.37%)。各年層的醫師仍以答對8題的人最多；而不論合種工作地點，醫師們仍以答對8題的人最多。可以答對7題以上的總人數與比例為349 (78.25%);可以答對8題以上的總人數與比例為244 (54.71%); 可以答對9題以上的總人數與比例為113 (25.33%) 。90.13%的醫師知道在對患者使用HRT前要先收集患者的詳細病史與身體健康狀況資料，但卻只有三分之一的醫師在實際臨床上會完全執行正確的步驟。而且不管醫師的服務地點為何，只有約三分之一的醫師會落實要求患者在使用HRT前一定要做全身健康檢查。賀爾蒙補充療法對血中脂肪組成的影響是學者專家推論賀爾蒙補充療法可以預防心臟血管疾病的重要依據。問卷中詢問賀爾蒙補充療法對血中脂肪組成的影響，是本問卷一個相當重要的題目，我們可以把它當做一個醫師對HRT的基本認知的程度的指標。當我們詢問醫師賀爾蒙補充療法對血中脂肪組成的影響時，令人沮喪的，我們發現只有32.74%的醫師答對。我們進一步發現在診所服務的醫師答對的情形最差(25.96)；而非醫學中心醫院的醫師也只有42.11%的答對率；若以年齡來分析此一回答的情況，30-39歲的醫師答對率最高。這是否意味著年齡較長且在診所服務的醫師的更年期知識有所不足？所以台灣更年期婦女在就醫時能否得知醫師得到正確的指導，實在是很有疑問？我們的醫療監督單位應該慎重思考醫師對更年期認知的再教育的問題。 我們希望由本篇研究的結果，提醒我國的醫療決策單位，能召集各方專家，仿照美國做法，收集世界各國最新的報告，每年訂出適合台灣醫療社會的原則，擬出一個患者衛教與追蹤格式，以便醫師能依循一個基本原則來與患者溝通。這樣不僅更能夠得保障病人的權益，也較能夠統一台灣醫界對HRT的各種不同看法，使得醫師因為不同或不完整的治療行為，而引發潛在醫療糾紛的機會降到最低，這樣才能達到使用HRT的最大好處。 The purpose of this study was to investigate whether menopause women received proper supplement through the cognition of hormone replacement therapy by gynecologist-obstetrician. According to the medical reports that estrogen content reducing plays the major role of climacteric symptoms which happening to menopause female’s body. Nevertheless, the outcome through supplement of estrogen to solve the climacteric symptoms seems not as it expected. It revival the concern about the side effects and outcomes of hormone replacement therapy, and how to take hormone treatment’s medicine become an attractive strategy. In this study of conducting survey by open-ended describe questionnaire is investigated. Two of the major questionnaires: the first subject of the question is “Menopause women received proper supplement through the cognition of hormone replacement therapy by gynecologist-obstetrician” The second subject of the question is ”Process and experience of clinical supplement through the cognition of hormone replacement therapy.” Twelve sub-questions come to those two major subjects. Surveys were distributed to two thousand and six hundred forty six members of Taiwan Association of Obstetrics and Gynecology through the attachment mail of Taiwanese Journal of Obstetrics and Gynecology. Analysis is fundamental based on the idea of specific information topics as listed below: 1. Total rate of right answer. 2. Right answer rate for each question. 3. Right answer rate comes with specific service units. 4. Right answer rate comes with age of physician. Total four hundred and seventy completed surveys were returned, resulting in a 16.68% response rate which eighteen surveys are coming from medical centers, total one hundred and forty three surveys are coming from regional and district hospitals (hospitals otherwise medical center) and total two hundred and eighty five number of doctors’ survey are coming from basic level clinics. The age distribution described as following: the age from seventy to eighty total number is twenty people; the age from sixty to sixty nine total number total number is forty seven people; the age from fifty to fifty nine total number is one hundred and fifty one people; the age from forty to forty nine total number is one hundred and sixty four people and the age from thirty to thirty nine total number is sixty four people. As we expect from the result from the implement of the survey that average rate of 8 right answers out of 8.33 comes from the average right answer of twelve resident doctors in Chung Shan Medical University Hospital as the reasonable basic cognition. The majority of the doctors achieve seven right answers (equal to 23.54% of doctors) or eight right answers (equal to 29.37% of doctors) is mostly match the result of survey under the condition of no matter where they are working or how old they are. The number of doctor who achieves seven right answers is two hundred forty four people (equal to 54.71% of doctors) and the number of doctor who achieves nine right answers is one hundred and thirty three people (equal to 25.37% of doctors). About 90.13% of doctors understand that to collect the detail information and medical history of patients before implement HRT to patients, however only one of third of doctors ever request the patient to take entire physical examination before to take HRT. According to the ratiocinations from scholar and specialist that influences of taking HRT to composition of blood lipid may prevent cardiovascular disease. The influences of composition of blood lipid that taking HRT as a basic cognition index of HRT for doctor. Beyond understanding of us that only 32.74% of doctors achieve right answer of the questions. The further analysis on the reply that the doctors who are working for the clinic only achieve 25.96% compare to the right answer. Either the doctors who are working for the hospitals otherwise medical center receive only 42.1% of right answer rate; besides, the most right answer rate is coming from the age of thirty to thirty nine doctors. Does it supposed to present the shortage of cognition of HRT in older age doctor Doubtfully to receive right consult for climacteric women as they request the proper advice from doctors. Reeducation of climacteric for obstetrics and gynecology should supervise under the official medical department. According to the methods of medical system in United States of America and through collecting update reports from foreign countries to revise the suitable medical environment for Taiwan government in each year. Not only by built up hygiene education and follow up system for patients to achieve the best benefit from the implement of HRT through educated gynecologist-obstetrician treatment, but also reduce the happening of medical treatment disputation caused by imperfect treatment or different physician.
