The journal of the British Menopause Society最新文献

{"title":"Breast cancer and menopausal hormone therapy: does the progestogen matter?","authors":"John C Stevenson","doi":"10.1258/mi.2008.008034","DOIUrl":"https://doi.org/10.1258/mi.2008.008034","url":null,"abstract":"It is established that the adjunction of a progestogen to the estrogenic component of menopausal hormone therapy (MHT) is not neutral regarding breast cancer risk, and even constitutes a central factor. Estrogen–progestogen MHT has now been classified as carcinogenic to the human breast. Should we thus conclude that there exists a class effect related to all progestogens? Or is there a possibility that different molecules or doses, for example, bear different risks? It is only quite recently that progestogens have become a key topic of investigation concerning the relation between breast cancer and MHT. Therefore, many aspects of this relation remain unresolved, some of them having been barely investigated. However, data exist suggesting that the choice of the progestogen molecule is able to impact the risk of breast cancer. In particular, in the French E3 N cohort, MHT-containing progesterone or its isomer, dydrogesterone, were associated with a lower risk than those containing other progestogens. The question of whether the number of days the progestogen is used per month modulates the risk produced so far divergent results. The observation that risk differences between sequential and continuous-combined regimens are generally more marked in studies conducted in Northern Europe than in the USA or in the UK is puzzling. This apparent discrepancy is resolved if the hypothesis that the cumulative monthly dose of progestogen is implicated in breast cancer risk holds true. Indeed, in Northern Europe, the daily dose of progestogen is often the same in both continuous-combined and sequential regimens, so that the total monthly dose in the former ismore elevated than in the latter, which is generally not the case in the USA or in the UK. Finally, the route of administration of the progestogen (oral, transdermal, vaginal, . . .) mayalso intervene regarding breast cancer risk, but there is so far no epidemiological data on this subject. By considering the available epidemiological evidence, it therefore seems likely that breast cancer risk varies according to the characteristics of the progestogen component of MHT. As it is the most effective treatment to alleviate climacteric symptoms, MHT remains widely used, and the administration of a progestogen is mandatory in hysterectomized women to protect the endometrium against the development of estrogen-induced hyperplasia. Therefore, for these women who need estrogen–progestogen MHT, the issue of progestogens must remain a very active area of research, aiming at identifying treatment modalities that have the least potential for exerting adverse effects. In particular, future studies should be designed to disentangle the effects of various progestogen-related parameters: the molecule, the dosage, the regimen and the route of administration.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"182 - 182"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2008.008034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66442600","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":"Nurse education in menopause: evaluation of learning in first cohort of a University accredited course in menopause and health","authors":"K. Abernethy, G. Bentley, L. Sievert, T. Sharmeen, K. Begum, O. Chowdhury, S. Muttukrishna, E. Kalu, N. Panay","doi":"10.1258/mi.2008.008043","DOIUrl":"https://doi.org/10.1258/mi.2008.008043","url":null,"abstract":"Introduction. Nurses in the UK advise menopausal women and make treatment recommendations, often prescribing hormone replacement therapy (HRT) and monitoring its safety and efficacy. However, there is no requirement for nurses to complete an accredited education programme in menopause and nurses’ knowledge can vary widely. This course was established to encourage nurses to achieve and demonstrate a level of competence in this field of nursing expertise. Content of the course was as follows: physiology and psychology of menopause; menopause symptomatology and long-term biological effects; osteoporosis; HRT pharmacology and prescribing; complementary therapies used in menopause; evaluation, assessment and monitoring; multidisciplinary working and team skills; cultural, social and psychological aspects of menopause. Methods. Fourteen nurses commenced the first course and completed an evaluation of their knowledge before the course, using a 10-point linear scale. Five were prescribing nurses and all were actively and independently advising women about menopause-related issues and discussing treatment options. Twelve completed the course and 11 completed the evaluation afterwards. The following criteria were measured: general menopause knowledge; physiology understanding; specific HRT-prescribing knowledge; confidence in prescribing HRT; knowledge of therapies other than HRT; understanding of risks and benefits of various therapies; confidence in teaching others about menopause. Results. The results indicated that there was a highly significant change in scores over time for all questions examined. In each case there was an increase in the scores from before to after. All nurses reported a significantly improved knowledge and understanding, with the areas of greatest improvement being HRT prescribing and understanding of risks and benefits of various therapies. Average scores for all items improved significantly and individually, some nurses described their knowledge moving from ‘poor’ prior to the course, to ‘excellent’ afterwards. Conclusions. Based on this small number of nurse evaluations, it would appear that some nurses are seeing and advising women with knowledge that they consider to be ‘poor’ and with little confidence. This course offers nurses the opportunity to improve their knowledge base and increase their confidence in menopause practice.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"188 - 192"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2008.008043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66443012","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":"Lower risk of MI associated with cyclical and transdermal hormone replacement therapies","authors":"S. Brown","doi":"10.1258/mi.2008.008045","DOIUrl":"https://doi.org/10.1258/mi.2008.008045","url":null,"abstract":"","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"140 - 143"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2008.008045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66443184","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":"The role of androgens","authors":"J. Rymer","doi":"10.1258/mi.2008.008041","DOIUrl":"https://doi.org/10.1258/mi.2008.008041","url":null,"abstract":"","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"185 - 186"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2008.008041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66442996","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":"Physiology of female sexual arousal","authors":"R. Levin","doi":"10.1258/mi.2008.008040","DOIUrl":"https://doi.org/10.1258/mi.2008.008040","url":null,"abstract":"gious rites. In other more westernized cultures, this transition is regarded more negatively. And what of those cultures in transition and the women uprooted into a new society? An understanding of these complex interactions is essential if we are to communicate as effective clinicians. Even a risk/benefit assessment for hormone replacement therapy must be tailored to the individual. The perceived risks in the west may have no relevance to an ethnic group where these diseases have low prevalence. Women need clearer and more focused practical information to aid their decision-making but it must be in a language they understand that is ethnically and culturally suitable.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"185 - 185"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2008.008040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66442339","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":"Handling media: what should clinicians know?","authors":"S. Brown","doi":"10.1258/MI.2008.008032","DOIUrl":"https://doi.org/10.1258/MI.2008.008032","url":null,"abstract":"","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"181 - 181"},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/MI.2008.008032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66442414","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":"Notes from the journals","authors":"J. Mcgarry","doi":"10.1258/mi.2008.008023","DOIUrl":"https://doi.org/10.1258/mi.2008.008023","url":null,"abstract":"ST A R PA PE R Efficacy and safety of tarenflurbil in mild to moderate Alzheimer’s disease: a randomized phase II trial Wilcock GK, Black SE, Hendrix SB, et al; on behalf of the Tarenflurbil Phase II Study investigators Lancet Neurol 2008;7:483–93 Background. Amyloid-beta peptide Abeta(42) has been implicated in the pathogenesis of Alzheimer’s disease (AD). The aim of this study is to test the effects of tarenflurbil, a selective Abeta(42)-lowering agent, on cognition and function in patients with mild to moderate AD. Method. Two hundred and ten patients who had a mini-mental state examination score of 15–26 were randomly assigned to receive tarenflurbil twice per day, 400 or 800 mg or placebo for 12 months. Results. Patients with mild AD in the 800 mg tarenflurbil group had lower rates of decline in their daily activities than of those in the placebo group. In patients with moderate AD, 800 mg of tarenflurbil twice per day had no significant effects. Adverse events included diarrhoea, nausea and dizziness. Conclusion. Eight hundred milligrams of tarenflurbil twice per day was well-tolerated and helped those with mild AD.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"138 - 138"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2008.008023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66442526","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":"Risk of VTE found lower in those using transdermal hormone replacement therapy","authors":"S. Brown","doi":"10.1258/mi.2008.008025","DOIUrl":"https://doi.org/10.1258/mi.2008.008025","url":null,"abstract":"","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"14 1","pages":"94 - 95"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2008.008025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66442301","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":"Screening for a healthy future","authors":"G. Remington","doi":"10.1258/175404507783004050","DOIUrl":"https://doi.org/10.1258/175404507783004050","url":null,"abstract":"Osteoporosis is a serious problem associated with fractures in up to one in two women over the age of 50 and the costs of the fractures to the UK exchequer are over £1.7 billion per annum. Preventing osteoporosis therefore is a significant challenge and could be highly cost-effective. While there are some lifestyle determinants of osteoporosis as defined by bone mineral density (BMD), as yet few interventional studies have shown substantial improvements in BMD by changing lifestyle. Exercise may have a role at specific bone sites, but maintaining improvement over a long time frame may be problematic. Similarly, while there are dietary factors associated with low BMD, with the exception of calcium and vitamin D there is a lack of data showing significant improvements in BMD after alterations in dietary habits. It is therefore valuable to consider pharmaceutical approaches to prevention and up until recently hormone replacement therapy (HRT) was the mainstay of such intervention. The recent concern about the adverse effects of long-term HRT have significantly affected its use for this indication. While alternative treatment, such as bisphosphonates, may be effective in maintaining bone density, their use may well be restricted in the UK by the National Institute for Health and Clinical Excellence, and will in part depend on the absolute risk of fracture. The World Health Organization will shortly release a 10-year fracture risk assessment tool, and this is likely to prove useful to clinicians in determining which individuals are at highest risk of osteoporotic fractures, who, even in the immediate postmenopausal time frame, will benefit from cost-effective intervention.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"13 1","pages":"198 - 198"},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/175404507783004050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66394877","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":"L. Cordingley, M. Towey, C. Bundy, S. Doshi, P. Gupta, M. Hunter, A. Papitsch-Clark, D. Sturdee","doi":"10.1258/175404507783004014","DOIUrl":"https://doi.org/10.1258/175404507783004014","url":null,"abstract":"In this way, programmes of food derivatives can be implemented, which, in contrast to the targeted, monotherapeutic and pharmaceutical approach, act on a series of parallel processes. For example, in treating coronary artery disease, it is possible to assemble a pharmaconutritional support programme which will normalize both blood chemistry and vascular physiology. In summary, the pharmaco-nutritional approach allows the physician to combine agents which reduce excessive inflammatory, oxidative, nitrosative and glycative stress, and reduce or reverse cross-link formation. As these core processes underlie much degenerative disease, this approach holds out the prospects of achieving considerable delays in the onset of age-related morbidities. This presentation will review the causes of type B malnutrition, analyse some of its effects on disease processes and outline the pharmaco-nutritional approaches to the management and prevention of coronary artery disease and osteoporosis.","PeriodicalId":85745,"journal":{"name":"The journal of the British Menopause Society","volume":"13 1","pages":"200 - 206"},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/175404507783004014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66395187","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}