The journal of the British Menopause Society最新文献

{"title":"Medicolegal pitfalls of prescribing hormone replacement therapy.","authors":"Gerard Panting","doi":"10.1258/136218006775997225","DOIUrl":"https://doi.org/10.1258/136218006775997225","url":null,"abstract":"<p><p>The prescribing of hormone replacement therapy can give rise to clinical negligence, just like any other area of medical practice -- keeping up to date, ensuring patients are properly informed and so able to consent, and avoiding prescribing pitfalls are the keys to successful risk management. Ultimately, good practice is defensible practice.</p>","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"12 1","pages":"34-5"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/136218006775997225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25885333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormone replacement therapy with estradiol and drospirenone: an overview of the clinical data.","authors":"Malcolm Whitehead","doi":"10.1258/136218006775992185","DOIUrl":"https://doi.org/10.1258/136218006775992185","url":null,"abstract":"<p><p>A new form of continuous combined hormone replacement therapy has become available that contains estradiol and drospirenone as the progestogen component. Drospirenone is a synthetic progestogen, the only one in hormone replacement therapy in the UK that possesses clinically relevant anti-mineralocorticoid activity. The combination of estradiol and drospirenone has been shown to provide relief from estrogen-deficiency symptoms of the menopause. It also helps to prevent osteoporosis in postmenopausal women by increasing bone density. Further, it has been shown to provide protection against endometrial hyperplasia associated with unopposed estrogen therapy.</p>","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"12 Suppl 1 ","pages":"4-7"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/136218006775992185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25885326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related macular degeneration.","authors":"G. Arden","doi":"10.1201/b13694-3","DOIUrl":"https://doi.org/10.1201/b13694-3","url":null,"abstract":"Age-related macular degeneration is a common cause of blindness. Its incidence is increasing, partly due to the advancing age of the population in North America and Europe, but there is no doubt that the age-adjusted rates are also increasing, which points to some environmental influence. The condition is characterized by the appearance of retinal deposits called drusen. These and other changes form a barrier between the retinal pigment epithelium and the choroidal circulation. As a result, new vessels may grow from the choroid and penetrate the retina. These new vessels are delicate and can leak or bleed. Such episodes occur in the \"wet\" form of age-related macular degeneration and cause the well known disciform degeneration, which in turn leads to distortion of the image and rapid loss of vision. Even when this does not happen, areas of retina may atrophy, probably due to anoxia: this is the \"dry\" form of the disease, also called geographic atrophy. In trials, scattered laser burns have been applied to the retina but the long-term benefits of this are as yet uncertain. New micro-pulse lasers are coming into use which may be more effective. Surgical treatments include translocation of the retina and photodynamic therapy. Medical therapies attracting attention are intraocular injections of anti-angiogenic drugs, such as ranibizumab. These need further evaluation, as does the role of diet. Within a few years blindness due to age-related macular degeneration may be reduced by combining dietary control, screening for visual loss, and medical and surgical methods of treatment.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"42 1","pages":"64-70"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90615575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premature menopause: management challenges after the Women's Health Initiative.","authors":"Julie Ayres","doi":"10.1258/136218005775544363","DOIUrl":"https://doi.org/10.1258/136218005775544363","url":null,"abstract":"Correspondence: Dr Julie Ayres, Hospital Practitioner, Menopause Clinic, Gynaecology Outpatient Department, Clarendon Wing, General Infirmary at Leeds, Belmont Grove, Leeds LS2 9NS, UK. Email: Julie.ayres@leedsth.nhs.uk If the media can twist official statements on the subject of hormone replacement therapy (HRT) and its safety (or otherwise), what chance does Josephine public have of really understanding the issues that she needs to cover before committing herself to taking something that she has been led to believe might kill her? Consultations, for menopausal women, take a great deal of time to equip patients with enough information to facilitate an informed decision. But one area that should really be quite straight forward is the woman who has undergone a premature menopause, for whom the advice from regulatory authorities such as the Committee on Safety of Medicines is to take HRT until the average of menopause (51 years), during which time there is no evidence of an increased risk of breast cancer or cardiovascular disease. But time and time again I am seeing referrals for women who have been told to stop HRT, by their primary care physician, because they have taken it for 5, 10 years, or whatever their doctor decides is time enough, despite them still being under 50. It is important to emphasize that both the Women’s Health Initiative and the Million Women study were undertaken in women aged 50 and over.1,2 Their findings cannot be extrapolated to younger women, who would normally be producing their own endogenous estrogen. Indeed, I would suggest that a case could be made to illustrate the apparent differences in risk by referring to HRT under the age of 50 as true hormone ‘replacement’ and that HRT in the over-50s be referred to as hormone ‘extension’ therapy, at least in counselling those with a premature menopause. It is always pleasing to see a confused and worried patient’s face light up with understanding and relief over this important subject when this point is made. It is essential to assess studies critically and not to generically extrapolate the results of a single study or trial to all menopausal women.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"11 4","pages":"157"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/136218005775544363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25750786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited papers: putting risk into perspective","authors":"Tony Parsons, William L Ledger","doi":"10.1258/136218005775544246","DOIUrl":"https://doi.org/10.1258/136218005775544246","url":null,"abstract":"The main focus in relation to the menopause over the last two or three years has been the issue of benefit and harm. Uncritical reading, and often inappropriate extrapolation, from the Women’s Health Initiative (WHI) and the Million Women Study (MWS), fuelled by the media and some of the licensing authorities, has led to many women losing the benefits of hormone replacement therapy (HRT). Prescribing figures in many countries, including the UK, have dropped sharply and are currently showing little sign of recovery. The dangers of responding to published research while it is still hot off the press are clear. This paper briefly reviews some of the more recent publications that may help us develop a perspective on how best to prescribe for the patients we see. Numerous experiments carried out by Clarkson’s team in North Carolina, using the macaque monkey as an animal model, have predicted much of what we have subsequently found in relation to the benefit and harm of HRT in women, and particularly the findings of the WHI.1 There clearly are distinctions, as the WHI has shown, between the initiation of HRT for the perimenopausal or early postmenopausal woman and its use for long-term health protection starting many years after the menopause.2,3 Further evidence has been provided from more detailed analysis of observational studies and trials. The MWS was widely criticized when it first published data on the association between HRT and breast cancer, in 2003. At the end of April 2005 the authors and others published findings on the association with different types of HRT, including tibolone.4,5 Progestogens have been added to HRT regimens for good reason but there is accumulating evidence that the combination of estrogen and progestogen is associated with a higher level of breast cancer risk than is associated with the use of estrogen alone. Some recent data also support the WHI finding that the risk of thrombosis may be higher with combined preparations.6 In order to gain the benefits of HRT with the minimum of risk, two main strategies are being developed by many clinicians: the use of systemic estrogen with intrauterine progestogen; and the use of lower doses of estrogen, in some cases in unopposed form.7 Good-quality trials of these strategies are urgently needed to guide our clinical practice.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"26 1","pages":"173 - 175"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90899473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diet and healthy ageing.","authors":"Brigid McKevith","doi":"10.1258/136218005775544309","DOIUrl":"https://doi.org/10.1258/136218005775544309","url":null,"abstract":"<p><p>In the future there will be more people aged 65 years and over ('older adults'). Although the exact mechanisms underlying normal ageing are not fully understood, ageing is generally associated with an increase in chronic diseases, such as cardiovascular disease, diabetes, cancer and osteoporosis. It is becoming clear that it is possible to prevent, slow or reverse the onset of many these by modifying lifestyle factors such as diet. Studies of older adults in a range of countries have highlighted a number of areas in which dietary quality could be improved. It is important to identify dietary patterns in addition to specific dietary components that offer protection against chronic disease. The challenge in the area of diet and healthy ageing is twofold: first, there is a need to improve the diet of older adults; and second, as most chronic diseases begin earlier in life, there is a need to encourage other age groups to adapt their diet so they can enter old age in better health.</p>","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"11 4","pages":"121-5"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/136218005775544309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25750870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproduction and ovarian ageing.","authors":"Alexander Swanton,&nbsp;Tim Child","doi":"10.1258/136218005775544200","DOIUrl":"https://doi.org/10.1258/136218005775544200","url":null,"abstract":"<p><p>Female fertility rates are inherently linked to a woman's age, which is in turn related to ovarian function. Reproductive potential declines gradually until 37-38 years of age, from when the rate of decline hastens. Approximately 1% of women suffer from premature ovarian ageing, and many may not have completed their families. This paper reviews the physiology and fertility consequences of ovarian ageing, premature ovarian failure, measures of ovarian reserve and methods of fertility preservation.</p>","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"11 4","pages":"126-31"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/136218005775544200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25750871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing the menopause: British Menopause Society Council consensus statement on hormone replacement therapy.","authors":"Joan Pitkin,&nbsp;Margaret C P Rees,&nbsp;Sarah Gray,&nbsp;Mary Ann Lumsden,&nbsp;Jo Marsden,&nbsp;John Stevenson,&nbsp;Jennifer Williamson","doi":"10.1258/136218005775544354","DOIUrl":"https://doi.org/10.1258/136218005775544354","url":null,"abstract":"<p><p>The British Menopause Society Council aims to help health professionals inform and advise women about the menopause. This guidance regarding estrogen-based hormone replacement therapy (HRT), including tibolone, which is classified in the British National Formulary as HRT, responds to the results and analysis of the randomized Women's Health Initiative studies and the observational Million Women Study. Treatment choice should be based on up-to-date information and targeted to individual women's needs. HRT still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.</p>","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"11 4","pages":"152-6"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/136218005775544354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25750785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decade-long use of continuous combined hormone replacement therapy is associated with better health-related quality of life in postmenopausal women, as measured by the generic 15D instrument.","authors":"Stiina Ylikangas,&nbsp;Harri Sintonen,&nbsp;Jorma Heikkinen","doi":"10.1258/136218005775544291","DOIUrl":"https://doi.org/10.1258/136218005775544291","url":null,"abstract":"<p><strong>Objective: </strong>To examine quality of life after a decade of continuous combined hormone replacement therapy.</p><p><strong>Study design: </strong>The 15D, a generic health-related quality-of-life (HRQoL) instrument, was used to evaluate trends in HRQoL in women who used continuous combined hormone replacement therapy (ccHRT; Indivina, Orion Pharma, Finland) for up to nine years. These women had a mean age of 56 years of age at the start of therapy. Control data on HRQoL were obtained from age-matched women participating in Finnish population health surveys.</p><p><strong>Results: </strong>Relative to controls, ccHRT was associated with significantly better HRQoL after six and nine years of treatment. Dose minimization at 8.5 years was not associated with a decline in HRQoL in the ensuing six months. One year after discontinuation of ccHRT there was evidence of a decline in HRQoL in women who discontinued ccHRT as planned, whereas HRQoL was maintained in women who had continued or resumed ccHRT during the one-year post-study follow-up. The benefits of ccHRT were apparent in multiple dimensions of the 15D, being largest and most robustly reproduced in the dimension 'discomfort and symptoms'. It is conjectured that the effectiveness of ccHRT in relieving symptoms of menopause may have contributed to the improved HRQoL scores registered in other dimensions, in addition to any direct effects of ccHRT on specific aspects of those other dimensions.</p><p><strong>Conclusions: </strong>These data indicate that up to 10 years of low-dose ccHRT has sustained value in the enhancement of HRQoL when used by women for whom relief of symptoms of menopause and control of bleeding are primary objectives of treatment.</p>","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"11 4","pages":"145-51"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/136218005775544291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25750784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poster presentations","authors":"W. McCullough, G. Pearson, P. Taylor, S. Shore, Cooper, R. Schiff, N. Panay, C. Bulpitt, C. Rajkumar","doi":"10.1258/136218005775544219","DOIUrl":"https://doi.org/10.1258/136218005775544219","url":null,"abstract":"Nurses play a pivotal role in caring for women around the time of menopause and in the years beyond. In both primary and secondary care, nurses are increasingly involved in assessing women for suitable treatments, including hormone replacement therapy (HRT) and in the ongoing support and monitoring of women on therapies. They advise women about risk of osteoporosis, interpret investigations and often have an in-depth understanding of the risks and benefits of HRT and other therapies. Within this specialist field of practice, some nurses will have a basic level of knowledge while others will be practising to a high degree of expertise – often described as ‘nurse specialists’. In 2002, a survey was carried out to evaluate common practice of nurses working in menopause and consider the educational needs of such nurses. This survey revealed that there were wide differences in clinical practice among nurses of all levels and that the experience and training of menopause nurses were hugely diverse. Of those nurses who described themselves as ‘specialist’, few had completed any formal education in menopause and yet most considered this an important aspect of specialist practice. With the Nursing and Midwifery Council currently consulting on the area of specialist practice in nursing, it is becoming increasingly important that nurses are able to demonstrate levels of competence within the field in which they work. In the light of this, the Royal College of Nursing (RCN) National Menopause Nurse Group was established. Its aims are:","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"340 1","pages":"181 - 184"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81972051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}