Menopause international最新文献

{"title":"HRT prescribing post WHI and MWS: What did you do? Would you do it again?","authors":"Edward Morris, Heather Currie","doi":"10.1258/mi.2012.012004","DOIUrl":"https://doi.org/10.1258/mi.2012.012004","url":null,"abstract":"As we write the editorial for this edition, a very public row has broken out over the principal findings of the Million Women Study (MWS). It was this study, in combination with the principal findings of the Women’s Health Initiative (WHI), that completely transformed the opinion of professionals and patients worldwide with regard to almost any hormone therapy. Various estimates of the quantitative effect on hormone-replacement therapy (HRT) prescribing exist depending on the markets examined but it is clear that the overall effect is a halving in the use of HRT globally. It is highly likely that most HRT prescribers reduced the numbers of prescriptions immediately after the publication of these studies. Thus, was what many of us did right? Before we changed our prescribing habits or advice to patients, did we look at the data with the same level of scrutiny we would apply were we personally to be the ones about to start or continue therapy? Did we follow the investigators’ conclusions, or worse the conclusions from the media to influence our actions? Most of us recall the frenzy of sensationalism that accompanied these publications. Newspaper front pages screamed about the dangers of HRT and interviews with lead investigators promulgated their conclusions further. It was all too easy to take the path of least resistance and accept the indirect recommendations from investigators and press and the more direct guidance from some regulatory authorities. What we all should have done right from the start is to make our own minds up, either sit down, read the papers in detail or discuss them in a practice or multiprofessional meeting. Following the herd may have been the safest thing to do from a purely professional point of view but did we do the right thing for our patients? Without a doubt there may have been patients taking HRT who were not being regularly assessed and having their risk profiles assessed yearly who should have considered stopping. The worrying thing is the number of patients who had their treatment stopped suddenly without an option to discuss things further. With this probably well-intentioned risk-reducing manoeuvre, many women were plunged suddenly into a hormone-free hell. Many women suffered a significant and sudden reduction in quality of life, seeking out alternatives such as phytoestrogens and other drugs that are largely less well researched than HRT. It was easy to see the immediate effects on quality of life but other unwanted effects of cessation such as bone loss, vulvovaginal atrophy and short-term cognitive effects would take longer to present. Thus, what should we do with the reawakened debate about the validity of the MWS? Firstly, it should be considered that the recent publication does not actually provide new factual challenge to the MWS, it provides challenges to the methodological processes that lead to the main conclusion that HRT causes breast cancer. This conclusion has been challenged in several publicatio","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.2012.012004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30463668","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":"Osteoporosis quality and outcomes framework.","authors":"Sarah Gray","doi":"10.1258/mi.2012.012002","DOIUrl":"https://doi.org/10.1258/mi.2012.012002","url":null,"abstract":"In November 2011 it was announced that osteoporosis would be included in the quality and outcomes framework (QOF) for general practice (GP) in the UK. Will this make any difference? For the international reader the answer is probably none at all but within the health system of the UK it just might. The reason being that it will financially encourage primary care to pay more attention to this disease area. Primary care funding within the national health service (NHS) is complex. For anyone who is not a GP the details are likely to baffle and bore in equal measure. Some explanation is however justified in order to determine whether this will be a mechanism for promoting better care of women at and beyond menopause. General practices are usually small to medium sized, independent businesses contracted to provide services to the NHS. Payment to practices has elements that recognize the numbers of registered patients with an adjustment for deprivation, payments for ‘enhanced services’ that are over and above the core job of the GP and quality payments for meeting targets in defined clinical or organizational areas. In April 2008 osteoporosis was included in the primary care funding envelope as a designated enhanced service (DES). This funding stream encouraged practices to do extra things that they would not have done before (a ‘carrot’ approach). In return for the additional money the regulation at the time stipulated that:","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.2012.012002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30463669","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":"Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management.","authors":"Sarah Elizabeth Machin,&nbsp;Sambit Mukhopadhyay","doi":"10.1258/mi.2011.011108","DOIUrl":"https://doi.org/10.1258/mi.2011.011108","url":null,"abstract":"<p><p>Pelvic organ prolapse is a common condition affecting a large number of women. Incidence increases after the menopause. Age, parity and obesity are the most consistently reported risk factors. Many women can be asymptomatic of prolapse but common symptoms include a sensation of a bulge or fullness in the vagina or urinary, bowel or sexual dysfunction. Management depends upon symptoms and the type and grade of the prolapse as well as any associated medical co-morbidities. Management options include expectant, conservative or surgical approaches. Up to 10% of women having a surgical procedure for prolapse will require a second procedure. It is, therefore, important to consider lifestyle modifications such as weight loss and conservative measures including pelvic floor muscle training, topical estrogens and pessaries as initial management options.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30285056","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":"Informed choice: is it achievable?","authors":"Edward Morris,&nbsp;Heather Currie","doi":"10.1258/mi.2011.011115","DOIUrl":"https://doi.org/10.1258/mi.2011.011115","url":null,"abstract":"It is clear that an essential aspect of menopause management is the provision of accurate, unbiased information so that women can make informed choices about the management of their own menopause. As outlined in our editorial in a previous issue of Menopause International, provision of this information is currently poor and must improve, yet we live in hope that this will improve and informed choices can be made. But will this ever be possible? There are several issues to be explored that currently throw this idealistic ambition into doubt. Most of the readership of this journal will be aware that with the international decline in enthusiasm for management of the menopause with hormones, there has been a decline generally in the management of the menopause. Think about where you live, was there a menopause clinic that no longer happens, or happens less often? Are you seeing fewer patients with menopausal problems in your clinic? Are more women being unilaterally advised to stop hormone replacement therapy (HRT)? All of these are symptoms of a decline in interest of management of the menopause. This does not mean that there are fewer menopausal women. In fact, the converse is true – it means more women are likely to be suffering. Is this right? With the best will in the world, not all health-care professionals, let alone women, can have access to the most up to date, accurate, unbiased information, which is understandable. Cumming et al. reported that 56.4% of women who stopped HRT following publication of the WHI trial, were influenced by the media and that overall, 46.5% of women who stopped HRT, would not have done so had they been given information of the current understanding of risks of HRT – they did not make an informed choice. Women are frequently exposed to information about the benefits of alternative therapies and yet there continues to be a lack of evidence confirming both effectiveness and safety of such therapies. It is clear that women choosing to purchase alternative therapies are not making fully informed choices. The common symptoms of vaginal atrophy continue to be hugely under-reported and under-treated, with an international survey of 4246 women aged 55–65 reporting that overall 77% believed that women were uncomfortable discussing vaginal atrophy and 42% did not know that local treatment was available. Women continue to suffer from distressing symptoms of urogenital atrophy and do not make informed choices about treatments of this almost inevitable consequence of estrogen deficiency. Over recent years, particularly in the UK, there has been withdrawal of various types of hormone therapy: estrogen nasal spray, preparations of estradiol and dydrogestrone, and most recently estradiol implants, while there has been a dearth in the introduction of new lower dose preparations and combinations. With reduced options available and lack of new options, health-care professionals are less able to make informed choices about the most app","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30293697","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":"Prevention of osteoporosis: one step forward, two steps back.","authors":"John C Stevenson","doi":"10.1258/mi.2011.011112","DOIUrl":"https://doi.org/10.1258/mi.2011.011112","url":null,"abstract":"<p><p>For many years, hormone replacement therapy (HRT) was the mainstay for osteoporosis prevention in postmenopausal women until a large randomized clinical trial raised serious safety concerns. This resulted in a big drop in HRT use and its demotion by regulatory authorities to second-line treatment. Many clinicians now feel that HRT is not safe to use, and recommend various alternatives for the treatment of osteoporosis. But how effective are these alternative therapies, are they any safer than HRT, and how do their costs compare? This review questions the validity of the safety concerns about HRT, and highlights the safety concerns about alternative therapies. It concludes that HRT is as safe as the other treatment options, and its efficacy and low cost demand that it be restored as a first-line treatment for the prevention of postmenopausal osteoporosis. Other therapies are available for use in osteoporosis, and the bisphosphonates are particularly effective for the treatment of the established disease. However, they must be used selectively and with caution, and are best restricted to those patients who are elderly or have severe disease. New treatments are emerging, but again caution must be taken until any long-term adverse effects have been identified.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30285054","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":"Tales from the menopause clinic: practice observed.","authors":"Sarah Gray","doi":"10.1258/mi.2011.011032","DOIUrl":"https://doi.org/10.1258/mi.2011.011032","url":null,"abstract":"Helen was 36 when she was referred on to the menopause clinic by a hospital gynaecologist. She had daytime flushes, mood changes and breast tenderness, all of which had worsened since stopping co-cyprindiol on account of migraine. She had been diagnosed with polycystic ovaries at the age of 17 and had not had a period in the six months since the last withdrawal bleed. The letter suggested that her ongoing management would be better served by the holistic approach of the menopause clinic. Helen had two children aged 15 and 10 who had been conceived spontaneously and her husband had had a vasectomy. Contraception was not a problem we needed to address. The co-cyprindiol had been used purely to manage the polycystic ovarian syndrome (PCOS). Migraine had been occurring weekly when taking the co-cyprindiol with flashing lights but no scotoma or neurological loss to constitute aura. Its frequency had progressively increased and had worsened in the pill-free week. Since stopping, there had been no migraine, though headache had continued. Discussion revealed a further disadvantage in that Helen was increasingly having to wax her upper lip and had had electrolysis to the linea alba. Helen described her mood change as hideous being tearful, irrational and depressed. This was endorsed by her mother. To Helen this was the most troublesome of her symptoms. As she had no periods there was no premenstrual exacerbation but she could clearly identify her mood being worse at the times when both the hot flushes and breast tenderness were most pronounced. The working hypothesis was that these correlated with a degree of estrogen deficiency. Helen worked hard to maintain her BMI of 27.5 and exercised regularly; she was aware of the recommendation for a low glycaemic index diet and had already been prescribed metformin at 500 mg twice daily. Our starting tactic after much discussion was to use low-level transdermal estrogen to address the apparent estrogen deficiency symptoms with continuous cyproterone acetate (CPA) in the lowest available daily dose (25 mg – half of a 50 mg tablet). Cyproterone is structurally a progestogen with potent antiandrogen receptor activity. It is not licensed for this indication but potentially this would address both a need for endometrial opposition and the androgen excess of the PCOS. Continuous use was intended to avoid changing progestogen levels and avert bleeding. It was vital to avoid fetal exposure as the drug could prevent virilization, the vasectomy achieved this. Three months later, Helen reported having been well when using one measure of estradiol gel along with the CPA. She had no flushes and her breast tenderness disappeared. Following instruction she had increased to two measures of gel and had then developed migraine. She therefore stopped both and had a painful, heavy and prolonged withdrawal bleed. However, since then her flushes and breast tenderness had resolved and mood remained good. We wondered if she had in fact o","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30285665","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":"Mental health around and after the menopause.","authors":"Malarvizhi Babu Sandilyan,&nbsp;Tom Dening","doi":"10.1258/mi.2011.011102","DOIUrl":"https://doi.org/10.1258/mi.2011.011102","url":null,"abstract":"<p><p>The menopause is a time in a woman's life when it is recognized that biological and social changes can impact upon mental wellbeing. Several studies have investigated the relationship between menopause and psychological symptoms, especially depression, with mixed results. In part, this is due to a considerable overlap between depressive symptoms and those due to declining estrogen levels, causing challenges in assessment. However it appears that vulnerable women are at a higher risk of succumbing to depression during menopausal transition. Antidepressants remain the mainstay of treating depressive symptoms, with little conclusive evidence for hormone replacement therapy. Memory problems during menopause are a common complaint, but there is no demonstrated link to subsequent dementia. This paper also reviews considerations of diagnosis and treatment of postmenopausal depression.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30267491","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":"Unpredictable endocrinology of the menopause transition: clinical, diagnostic and management implications.","authors":"Henry G Burger","doi":"10.1258/mi.2011.011026","DOIUrl":"https://doi.org/10.1258/mi.2011.011026","url":null,"abstract":"<p><p>The approach to menopause can be divided into the early (E) and late (L) menopausal transitions (MT) on the basis of menstrual irregularity (EMT) and subsequent observation of at least one episode of 60 or more days amenorrhoea (LMT). In total, 40-60% of cycles in the LMT are anovulatory, often with low oestradiol (E2) and high follicle-stimulating hormone concentrations. The ovulatory cycles have variable endocrine characteristics, none of which is specific to EMT or LMT. Hormonal measurements of FSH and E2 are thus of little diagnostic value because of their unpredictable variability. Symptoms during the transitions may result from high or low E2 and can often be satisfactorily managed with low-dose oral contraceptives, which suppress pituitary-ovarian function.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30285664","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":"Exploring the breast cancer patient journey: do breast cancer survivors need menopause management support?","authors":"Nuttan Tanna,&nbsp;Helene Buijs,&nbsp;Joan Pitkin","doi":"10.1258/mi.2011.011101","DOIUrl":"https://doi.org/10.1258/mi.2011.011101","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer survivors can be expected to suffer from menopause symptoms with estrogen deprivation due to cancer treatments, in addition to natural menopause-related estrogen loss.</p><p><strong>Objective: </strong>To gain an understanding of what support breast cancer patients have when they suffer from menopausal symptoms, and utilize findings to further inform National Health Service (NHS) care provision for breast cancer survivors.</p><p><strong>Study design: </strong>Qualitative study with focus group sessions targeting Caucasian and Asian women with breast cancer.</p><p><strong>Methods: </strong>Patient stories, with women describing their breast cancer journey and speaking about support received for any menopausal symptoms. Thematic data analysis of transcription.</p><p><strong>Results: </strong>Breast cancer patients were not sure if they had menopausal symptoms or whether this was due to their breast cancer condition or treatment. Patients had an attitude of acceptance of menopausal symptoms and reported trying to cope with these by themselves.</p><p><strong>Conclusions: </strong>This research identifies a need for more information that is culturally sensitive on managing menopause symptoms, both as side-effects of breast cancer treatments as well as for affect on quality of life during the survivorship phase. Our work also gives insight into cultural remedies used for hot flushes by Asian patients, which they consider as 'cooling' foods. Breast cancer patients want to know whether side-effects of cancer treatment persist long term and how these can be managed. There is a need for improved patient support within any new NHS service models that are developed along breast cancer patient pathways, and inclusion of personalized advice for menopause symptoms.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30285663","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":"Estrogen treatment affects brain functioning after menopause.","authors":"Ulrike Bayer,&nbsp;Markus Hausmann","doi":"10.1258/mi.2011.011105","DOIUrl":"https://doi.org/10.1258/mi.2011.011105","url":null,"abstract":"<p><p>Sex hormones have powerful neuromodulatory effects on functional brain organization and cognitive functioning. This paper reviews findings from studies investigating the influence of sex hormones in postmenopausal women with and without hormone therapy (HT). Functional brain organization was investigated using different behavioural tasks in postmenopausal women using either estrogen therapy or combined estrogen plus gestagen therapy and age- and IQ-matched postmenopausal women not taking HT. The results revealed HT-related modulations in specific aspects of functional brain organization including functional cerebral asymmetries and interhemispheric interaction. In contrast to younger women during the menstrual cycle, however, it seems that HT, and especially estrogen therapy, after menopause affects intrahemispheric processing rather than interhemispheric interaction. This might be explained by a faster and more pronounced age-related decline in intrahemispheric relative to interhemispheric functioning, which might be associated with higher sensitivity to HT. Taken together, the findings suggest that the female brain retains its plasticity even after reproductive age and remains susceptible to the effects of sex hormones throughout the lifetime, which might help to discover new clinical approaches in the hormonal treatment of neurological and psychiatric disorders.</p>","PeriodicalId":87478,"journal":{"name":"Menopause international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1258/mi.2011.011105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30285053","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}