Menopause international最新文献

{"title":"When should surgical treatment be considered for premenstrual dysphoric disorder?","authors":"Robert L Reid","doi":"10.1258/mi.2012.012009","DOIUrl":"https://doi.org/10.1258/mi.2012.012009","url":null,"abstract":"<p><p>Premenstrual mood disorders afflict a substantial number of women of reproductive age. Medical treatments provide excellent symptomatic relief to many women but at times a poor therapeutic response or adverse effects attributable to these therapies lead women to seek alternative solutions. Oophorectomy (with concomitant hysterectomy) followed by low-dose estrogen therapy has been shown to be an effective alternative for such cases of menstrual-cycle-related mood disorder.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2012.012009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30631503","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":"Practice observed.","authors":"Sarah Gray","doi":"10.1258/mi.2012.012003","DOIUrl":"https://doi.org/10.1258/mi.2012.012003","url":null,"abstract":"Rachel was referred in 2006. She was only 35 but already had a chequered gynaecological history. She had delivered four children (with depression in both antenatal and postnatal periods) but lost one from a cot death. She had a long history of pain attributed to pelvic inflammatory disease with removal of first one ovary and then attempted vaginal hysterectomy. Due to bleeding from iliac vessels an abdominal incision was needed. The remaining ovary was then removed. Prior to referral she had been prescribed hormone replacement therapy (HRT). The initial hospital prescription was an estradiol 50 mg/24 hour weekly patch but this did not suppress sweating and she assumed that because of this the patches did not stick. She had improved with 100 mg/24 hour patches but continued to have problems with adhesion. Her general practitioner (GP) then tried estradiol valerate (branded as Progynova) with which she complained of mood swings and was then changed to generic estradiol 2 mg, which she was still taking when I first met her. ‘Failure to settle on standard regimens’ is one of the referral criteria for the specialist menopause service and Rachel certainly met this. She was hot during the day and sweating with subsequent chills at night. Nights were very disturbed, she was tossing and turning, woken by the sweating and would frequently need to get up to pass urine. She was itchy and described moods that swung but were predominantly low. She was tearful, irritable and snapping at the family. Her concentration and memory were both poor and she survived by writing lists. Her vagina was dry and uncomfortable. She explained that all sexual interest and her sense of femininity had evaporated. In addition to vaginal discomfort she was slow to arousal. Sexual difficulty was the feature that most distressed her as she perceived it as threatening her relationship. Her breasts had shrunk and though she had lost the scourge of her periods she was generally tired and unhappy. Rachel was slim and fit and her vascular and breast risk profile were unremarkable. The treatment recommendation at the end of a long discussion was to try non-oral delivery of estradiol once more but using a different patch in the hope that this would help adhesion. I asked her to try the 100 mg/24 hour dose again. In addition, we would add testosterone. Having lost her ovarian source of androgens, deficiency was a possibility and the symptoms described appeared consistent with this. At the time patches licensed for women were not available so testosterone 1% gel (Testogel) was prescribed with advice to subdivide each sachet and use 1/7 daily such that each would last a week. Four months later her sweats had reduced but not gone, sleep had improved but remained broken, she remained irritable though overall mood had lifted and concentration was not quite as bad. Sex had occurred on one occasion, which was not uncomfortable. Rachel felt that she was very slow to achieve arousal. There was still ","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2012.012003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30463671","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":"Qualitative inquiry into women's menopause experiences in southeastern Iran.","authors":"Kobra Alidoosti,&nbsp;Abbas Abbaszadeh,&nbsp;Ali Hosseininasab","doi":"10.1258/mi.2011.011117","DOIUrl":"https://doi.org/10.1258/mi.2011.011117","url":null,"abstract":"<p><p>Menopause is defined as amenorrhea for one year. Signs and symptoms are categorized as physical and psychological changes, including depression, hot flushes and ageing. Woman's responses to menopause are governed by lifestyle factors. The purpose of this study was to determine how Iranian women experience menopause and hormone therapy. A qualitative inquiry was conducted through semistructured, in-depth interviews to explore study questions in 11 menopausal women. Participants had positive and negative menopause experiences. Negative menopause experiences are due to severity of symptoms. Menopause can be facilitated by increasing women's knowledge about this phase and ways to cope with it.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30433624","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":"Menopause and schizophrenia.","authors":"Rina Gupta,&nbsp;Iyas Assalman,&nbsp;Ronald Bottlender","doi":"10.1258/mi.2012.011116","DOIUrl":"https://doi.org/10.1258/mi.2012.011116","url":null,"abstract":"<p><p>We have come a long way from our understanding of the menopause as it was described in the 11th century by Trotula of Salerno, a female gynaecologist who said 'there are older women who give forth blood matter especially as menopause approaches them'. Yet very little is known about the impact menopause has on the mental health of women especially severe and enduring illnesses like schizophrenia. A lot of research has shown that estrogen acts as a protective factor due to its antidopaminergic properties, thus providing an explanation for the increase in risk of a new psychotic disorder during the menopause. This has further led to the hypothesis of hormone replacement therapy providing benefits in the management of these disorders in menopausal women. This review article highlights the importance of a clear understanding of this phase of life in patients suffering from or who present with a risk of developing schizophrenia.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2012.011116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30439043","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":"Postmenopausal vaginal bleeding in women using hormone replacement therapy.","authors":"Nikolaos Burbos,&nbsp;Patrick Musonda,&nbsp;Timothy J Duncan,&nbsp;Simon G Crocker,&nbsp;Joaquin J Nieto,&nbsp;Edward P Morris","doi":"10.1258/mi.2011.011111","DOIUrl":"https://doi.org/10.1258/mi.2011.011111","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding using estrogen-progestogen hormone replacement therapy (HRT) regimens and to assess if the duration of HRT use has an effect on the risk of diagnosing endometrial cancer.</p><p><strong>Study design: </strong>Cross-sectional study of consecutive women presenting with postmenopausal vaginal bleeding at a gynaecological oncology centre in the UK. Main outcome measures Endometrial cancer diagnosis.</p><p><strong>Results: </strong>Over a 62-month period, 4847 women were investigated for postmenopausal vaginal bleeding. The majority of women (4097, 84.5%) did not use any HRT preparation at the time of initial referral and 750 (15.5%) women were using combined HRT preparations. A total of 298 (6.1%) women were diagnosed with endometrial carcinoma. Women using HRT preparations were significantly less likely to be diagnosed with endometrial cancer compared with women not using HRT (adjusted odds ratio = 0.229, 95% CI 0.116-0.452; P < 0.0001). The longer duration of HRT use did increase the risk of diagnosing endometrial cancer in women presenting with postmenopausal vaginal bleeding, but this was not statistically significant.</p><p><strong>Conclusions: </strong>Postmenopausal women presenting with vaginal bleeding and using combined HRT preparations have significantly lower risk of being diagnosed with endometrial cancer when compared with women not using HRT.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30450464","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 and breast cancer: causation and epidemiology.","authors":"Simon Brown","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30567716","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":"Commentary regarding recent Million Women Study critique and subsequent publicity.","authors":"Nick Panay","doi":"10.1258/mi.2012.012006","DOIUrl":"https://doi.org/10.1258/mi.2012.012006","url":null,"abstract":"of critique The Million Women Study (MWS) was one of the major studies that raised concerns over the long-term safety of hormone replacement therapy (HRT). Shapiro et al. applied causal criteria, such as biases and biological plausibility, to assess the MWS findings. Their analysis highlighted several design flaws that would potentially have skewed the findings; the key criticisms of the MWS design were as follows:","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2012.012006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40142529","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":"Treatment of postmenopausal vaginal atrophy with 10-μg estradiol vaginal tablets.","authors":"Nick Panay,&nbsp;Ricardo Maamari","doi":"10.1258/mi.2012.011120","DOIUrl":"https://doi.org/10.1258/mi.2012.011120","url":null,"abstract":"<p><p>Postmenopausal estrogen deficiency can lead to symptoms of urogenital atrophy. Individuals with urogenital atrophy have symptoms that include vaginal dryness, vaginal and vulval irritation, vaginal soreness, pain and burning during urination (dysuria), increased vaginal discharge, vaginal odour, vaginal infections, recurrent urinary tract infections, pain associated with sexual activity (dyspareunia) and vaginal bleeding associated with sexual activity. Despite the frequency and effects of vaginal atrophy symptoms, they are often under-reported and, consequently, under-treated. Therefore, care of a menopausal woman should include a physical assessment of vaginal atrophy and a dialogue between the physician and the patient that explores existing symptoms and their effect on vulvovaginal health, sexuality and quality-of-life issues. The development of the ultra-low-dose 10-µg estradiol vaginal tablets is in line with the requirements of regulatory agencies and women's health societies regarding the use of the lowest effective hormonal dose. Because of its effectiveness and safety profiles, in addition to its minimal systemic absorption, the 10-µg estradiol vaginal tablet can offer greater reassurance to health-care providers and postmenopausal women with an annual estradiol administration of only 1.14 mg.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2012.011120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40142527","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":"Alternative and complementary therapies for the menopause.","authors":"Joan Pitkin","doi":"10.1258/mi.2012.012001","DOIUrl":"https://doi.org/10.1258/mi.2012.012001","url":null,"abstract":"<p><p>Despite a re-evaluation of risks in recent years, hormone replacement therapy is still surrounded by controversy. Almost 30% of women in a recent survey sought a natural approach to combat climacteric symptoms. Nevertheless, a large proportion of patients felt that they wanted a good safety profile and strong evidence base for treatment. This article seeks to review the evidence supporting non-hormonal approaches to treatment. There is only conflicting evidence at best to support alpha-2 agonists, e.g. clonidine and limited evidence for dihydroepiandrosterone and natural progesterones. There is limited randomized controlled trial data for gabapentin, selective norepinephrine re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs), many of these studies being related to breast cancer patients. Of the herbal medicinal products, the largest evidence base rests with phytoestrogens. A Cochrane Database review looking at all types of phytoestrogens, e.g. red clover extracts, dietary soya and soya extracts concluded that there was no evidence to support improvement in climacteric symptoms and the meta-analysis of a 178 studies on soy products was inconsistent. Nevertheless, other studies disagree. Mammographic density is not affected by soy or phytoestrogen products and recent in vitro work shows only a weakly proliferative effect of soy isoflavone on breast cancer cells and evidence that soy isoflavone blocks the proliferative effect of estradiol on these cells. There are no studies looking at clinical outcome measures for cardiovascular disease but a number of studies looking at biochemical markers including arterial wall stiffness and apolipo protein B. Recent studies have also looked at the effects of red clover isoflavone on mood and depression, using specific depression rating scales. Finally, it is important to note that herbal medicinal products should not be used without caution. Some may produce quite marked side-effects in high doses and others can interact with pre-existing medication. A strategy for which patients are suitable for herbal medicinal products is reviewed.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2012.012001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40142528","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":"Statins in postmenopausal women linked to ‘increased diabetes risk’.","authors":"Simon Brown","doi":"10.1258/mi.2012.012005","DOIUrl":"https://doi.org/10.1258/mi.2012.012005","url":null,"abstract":"","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2012.012005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30463670","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}