Climacteric Medicine Research Articles

4.更年期医療とサイコセラピー : 仏教的思想を盛り込んだ心理療法を中心に(シンポジウム 日本における女性心身医学の現況,2006年国際サイコセラピー会議イン・ジャパンおよび第3回アジア国際サイコセラピー会議)

4.更年期医療とサイコセラピー : 仏教的思想を盛り込んだ心理療法を中心に(シンポジウム 日本における女性心身医学の現況,2006年国際サイコセラピー会議イン・ジャパンおよび第3回アジア国際サイコセラピー会議)

Phytochemicals: Potential in Management of Climacteric Neurobiology.

Menopause jeopardizes the integrity of brain and makes it vulnerable to various diseases, both of psychiatric and degenerative nature. Exogenous estrogen supplementation confers neuroprotection but the results of Women's Health Initiative (WHI), Million Women Study (MWS) and incidence of endometrial cancer, breast cancer and venous thromboembolism reported with estrogen use have engendered doubts over its clinical translation for postmenopausal neurological disorders. Scientific community and general public have started recognizing the protective potential of phytochemicals in climacteric medicine. These phytochemicals are plant-derived, non-steroidal bioactive estrogenic compounds. Emerging preclinical studies have suggested that these phytochemicals display potential benefits in mitigating postmenopausal depression, anxiety, cerebral ischemia and cognitive dysfunction. Thus, the aim of present review is: a) to give an overview of neuroprotective action of estrogen, b) to address the chemical and pharmacological features of various classes of phytoestrogens, and c) to present preclinical and clinical evidence of effect of phytoestrogens on climacteric neurobiology with their possible mechanisms of action.

Effectiveness of phytoestrogens in climacteric medicine

The increased interest in phytoestrogens in the management of menopausal symptoms followed the publication of the Women's Health Initiative study. A wide-spread perception that these plant-derived compounds are equivalent to estrogen was established. These compounds evolved to fulfill the needs of plant physiological processes and are natural for the plant cells but not natural to the human cell. Epidemiological data suggest a possible protective effect of phytoestrogen if consumed during adolescence, but later on in life this effect is not clear. The utility of phytoestrogen as a "natural and safe" alternative to estrogen in alleviating vasomotor symptoms has failed the test in randomized clinical trials. Because many breast cancer sufferers seek in phytoestrogen a relief of estrogen deficiency symptoms, the possible interaction of such remedies with risk of recurrence of breast cancer or interference with tamoxifen action should not be overlooked.

I70 Climacteric medicine – where to go in the future? Psychosomatic challenge

I70 Climacteric medicine – where to go in the future? Psychosomatic challenge

Impact of recent studies on attitudes and use of hormone therapy among Scandinavian gynaecologists

Climacteric medicine has been in focus during the last 2 decades, and an intensive debate has been ongoing regarding the positive and negative aspects of postmenopausal hormone therapy (HT). Recent randomised controlled studies have been unable to confirm data from observational studies of primary or secondary preventive effects of HT on coronary heart disease, and other studies have indicated an increased risk of breast cancer, stroke and venous thromboembolism among HT users. In 2001, we reported on knowledge, attitudes, management strategies and use of HT among Scandinavian gynaecologists. The aim of the present study was to re-assess the same parameters concerning HT among Scandinavian gynaecologists in 2002-2003, and compare the results with the data collected in 1995-1997. All practicing gynaecologists in Denmark, Sweden and Norway were invited by letter to complete and return a questionnaire regarding their knowledge, attitudes and management strategies concerning HT. Female gynaecologists were questioned if they were currently using HT, and the same question was posed concerning spouses of male gynaecologists. The questionnaire was completed and returned by 60, 76 and 72%, respectively of gynaecologists in Denmark, Sweden and Norway. Of the 1,591 physicians who responded, 13% thought that all women should be offered HT provided there were no contraindications, while 86% recommended HT only to selected women after considering the individual advantages and disadvantages of the treatment. Of the gynaecologists, 37% considered HT to be without relevance in the primary prevention of osteoporosis in healthy women. As for duration of the treatment, 40% of the gynaecologists would recommend HT for <5 years for the treatment of climacteric complaints, and only 8% would recommend HT for >10 years. The prevalence of HT use among the menopausal female gynaecologists varied between 71 and 74%. Among the menopausal spouses of male gynaecologists, 68-72% were current users of HT. During the last years of ongoing debate, gynaecologists from Denmark, Sweden and Norway have become more modest in their recommendations of postmenopausal HT. Scandinavian specialists are more cautious in prescribing hormones for women with symptomatic CVD or previously treated for breast cancer, however, their personal use of HT has not changed dramatically and still reflects a positive attitude.

Climacteric medicine: European Menopause and Andropause Society (EMAS) 2004/2005 position statements on peri- and postmenopausal hormone replacement therapy

In women experiencing distressing climacteric symptoms during the peri- and postmenopause there is conclusive evidence from abundant randomised controlled trials that systemic hormone replacement therapy (HRT) of any type affords symptom relief, with no alternative treatment producing similar effect. Though this evidence is accumulating, the question of how to provide best clinical practice in an attempt to both alleviate the menopausal symptoms and prevent the more long-term postmenopausal degenerative diseases is still under debate. When providing climacteric medicine, the dose and regimen of HRT needs to be individualised based on the principle of choosing the lowest appropriate dose in relation to severity of symptoms and on the menopausal age. However, few long-term data on different HRT formulations exist in symptomatic women, which also account for baseline risk of cardiovascular disease (CVD), breast cancer and osteoporosis. In most cases, an individualized prescription together with life-style management will sustain possibilities for net beneficial effects on climacteric symptoms, quality of life (QoL), sexuality and osteoporosis, with only rare risk of severe adverse effects. With the perspective provided by recent epidemiological findings, not least from the estrogen only arm of the Women's Health Initiative Study (WHI), European Menopause and Andropause Society (EMAS) supports research activities in symptomatic women with new HRT formulations in order to affect positively the balance of clinical benefit and risk, including specific information on QoL and also account for the traditional differences in treatment modalities between the US and Europe, and the difference in BMI, life-style and diet. In women experiencing an early menopause (<45 year) current data support a specific overall benefit of HRT. At present, more long-term systemic HRT may be considered in women at high risk of osteoporotic fractures, in particular when alternate therapies are either inappropriate or insufficiently effective, as benefits will outweigh any risks. In contrast, urogenital symptoms may be addressed efficiently and safely with long-term local estrogen therapy.

Clinical position of empty nest syndrome with undefined symptoms in the climacteric medicine

Clinical position of empty nest syndrome with undefined symptoms in the climacteric medicine

Guidelines for the hormone treatment of women in the menopausal transition and beyond: Position Statement by the Executive Committee of the International Menopause Society

Guidelines for the hormone treatment of women in the menopausal transition and beyond: Position Statement by the Executive Committee of the International Menopause Society

“Controversial Issues in Climacteric Medicine” Series 3rd Pisa Workshop: HRT in climacteric and aging brain Position paper under the auspices of The International Menopause Society, Pisa, Italy, 15–18 March 2003

“Controversial Issues in Climacteric Medicine” Series 3rd Pisa Workshop: HRT in climacteric and aging brain Position paper under the auspices of The International Menopause Society, Pisa, Italy, 15–18 March 2003

"Controversial Issues in Climacteric Medicine" Series 3rd Pisa Workshop “HRT in Climacteric and Aging Brain”: Under the Auspices of the International Menopause Society, Pisa, Italy, 15–18 March 2003

"Controversial Issues in Climacteric Medicine" Series 3rd Pisa Workshop “HRT in Climacteric and Aging Brain”: Under the Auspices of the International Menopause Society, Pisa, Italy, 15–18 March 2003

Controversial issues in climacteric medicine III: Hormone replacement therapy in climacteric and aging brain

(2003). Hormone replacement therapy in climacteric and aging brain. Climacteric: Vol. 6, No. 3, pp. 188-203.

Book Review Hormone Replacement Therapy and Cancer: The Current Status of Research and Practice (Controversial Issues in Climacteric Medicine Series.) Edited by Andrea R. Genazzani. 281 pp., illustrated. New York, Parthenon, 2002. $79.95. 1-84214-079-5

Book Review Hormone Replacement Therapy and Cancer: The Current Status of Research and Practice (Controversial Issues in Climacteric Medicine Series.) Edited by Andrea R. Genazzani. 281 pp., illustrated. New York, Parthenon, 2002. $79.95. 1-84214-079-5

Hormone Replacement Therapy and Cardiovascular Disease: A Statement for Healthcare Professionals From the American Heart Association

To the Editor: I was personally disturbed by the American Heart Association (AHA) statement on hormone therapy and cardiovascular disease that recently was published in Circulation .1 Two different medical journals, Climacteric 2 and Maturitas ,3 recently published a position paper from the Workshop on Controversial Issues in Climacteric Medicine: Hormone Replacement Therapy (HRT) and Cardiovascular Diseases, which was organized in October 2000 by the International Menopause Society (IMS). All persons interested in the health care of postmenopausal women should read it. Menopause experts, including internists and cardiologists, see the cardiovascular issue from a perspective different from that of American cardiologists, although they are interpreting the same database and research articles and, ultimately, are reaching similar conclusions. The authors of the AHA statement report that the biological basis of estrogen benefits the cardiovascular apparatus and mention epidemiological data showing a 35% reduction of cardiovascular events in normal women using hormones after menopause. However, their conclusions and final messages are different, referring mainly to the secondary prevention trial named the Heart and Estrogen/Progestin Replacement Study (HERS). The term HRT , as it is used in the article, includes treatment with estrogen alone or in combination with different progestins and using different schedules of administration. At the end of the article, the authors say that their conclusions are based primarily on a fixed dose of oral conjugated …

Controversial issues in climacteric medicine II: Hormone replacement therapy and cancer

Hormone replacement therapy (HRT) offers well-established clinical benefits for the relief of menopausal symptoms, improving quality of life, and may reduce the likelihood of osteoporosis and cardiovascular disease. However, some physicians are still hesitant in prescribing HRT, fearful that this hormone treatment may increase the risk of developing certain malignancies, and, in particular, breast and gynecologic cancers. The understanding of the biological events involved in carcinogenesis is essential to investigate the mechanisms by which sex steroid hormones may influence the risk of developing a malignancy. Estrogens may be involved in tumor development and progression by enhancing mitosis, inducing the expression of estrogen receptors (ER), as well as progesterone receptors (PgR), and promoting vascularization. However, estrogens do not cause DNA mutations directly, but stimulate cell proliferation and thus increase the likelihood that a DNA replication error will escape repair.

Controversial issues in climacteric medicine (I) Cardiovascular disease and hormone replacement therapy. International Menopause Society Expert Workshop, 13–16 October 2000, Royal Society of Medicine, London, UK

W.W. Kim, Korea A. Salvetti, Italy F. Al-Azzawi, UK H.P.G. Schneider, Germany D. Barlow, UK E. Lakatta, USA B.-M. Landgren, Sweden M. Birkhaeuser, Switzerland R. Sitruk-Ware, USA P. Mannuccio Mannucci, Italy S.O. Skouby, Denmark M. Boulet, Belgium M.E. Mendelsohn, USA H. Burger, Australia J.C. Stevenson, UK J.W.W. Studd, UK L.J. Mosca, USA P. Collins, UK D.W. Sturdee, UK D. Crook, UK E. Moscarelli, Italy M. Tikkanen, Finland S. Curtis Hewitt, USA M. Neves-e-Castro, Portugal B. O’Malley, USA P. de Vane, USA Y. Tsouderos, France S. O’Neill, Australia W.H. Utian, USA K. Friday, USA C. Varas, Spain M. Gambacciani, Italy F. Parazzini, Italy A. Pines, Israel A.R. Genazzani, Italy M. Whitehead, UK G.M. Rosano, Italy K. Williams, USA F. Grodstein, USA J.A. Gustafsson, Sweden J. Rosing, The Netherlands

At Third Meeting, Menopause Experts Make the Most of Insufficient Data

SOME CREDIT the aging of the baby boomers for the recent explosion of interest in menopause, a subject formerly treated with intense neglect. The large number of women who were born in the decade following World War II are now approaching the age of last menses. In the next two decades, approximately 40 million American women will pass through menopause and have to deal with the problems and increased health risks that often follow the end of a woman's reproductive years. These large numbers, as well as the recent awareness that medical research has neglected many women's health issues, have moved menopause under public and scientific spotlights. Climacteric Medicine Evidence of the rapid growth of interest in menopausal or climacteric medicine is reflected by the jump in attendance from approximately 300 clinicians, researchers, and educators who attended the first annual meeting of the North American Menopause Society (NAMS) in 1989,