Menopausal Symptoms In Women Research Articles

F147 Control of menopausal symptoms in women denied oestrogen using unopposed megestrol acetate

F147 Control of menopausal symptoms in women denied oestrogen using unopposed megestrol acetate

Hormone replacement therapy in a risk-benefit perspective

The relative cost-effectiveness of different treatment strategies for hormone replacement therapy (HRT) was assessed within the framework of a computer model. Where data were lacking, it was necessary to make assumptions about the effects of HRT, particularly in relation to combined oestrogen-progestogen therapy and cardiovascular disease; however, sensitivity analyses were performed to assess the impact of changing these assumptions on the cost-effectiveness equation. It appears that net expenditure by the NHS will depend critically on the direct costs of treatment, rather than on any indirect costs incurred or saved as a result of side-effects. In terms of mortality, a reduction in cardiovascular disease risk would have greatest impact and would overshadow any small increase in breast cancer risk which may be associated with long-term use. If the cardioprotective effect of oestrogen is real, our results suggest that long-term prophylactic treatment of hysterectomised women would be relatively cost-effective. Treatment of symptomatic menopausal women for any period of time appears to offer very good value for money. The lack of data relating to combined oestrogen-progestogen therapy and cardioprotection, and the major importance of the latter in the equation of benefits and risks, make it more difficult to draw conclusions about the cost-effectiveness of treating non-hysterectomised asymptomatic women for prophylactic reasons.

Not All "Menopausal" Symptoms Are Caused by Menopause

A myriad of symptoms in menopausal women are ascribed to hormone deficiency. This British study surveyed a community-based sample of 8000 women aged 45-54 about menopausal status and symptoms and found that the two are not necessarily related. The 6096 respondents (78% of the sample) were classified …

A multifactorial approach to complaints during the climacteric

Abstract Besides somatic experiences such as vasomotor symptoms, and sexual difficulties related to atrophy of the vagina, the climacteric is frequently associated with psychological symptoms. However, no evidence exists that psychological symptoms are directly related to hormonal changes during the climacteric. Psychological and social factors not specifically related to the climacteric appear to be an important predictor of psychological complaints during this period. Menopause has for long been regarded as a deficiency disease, requiring medical attention and hormone replacement therapy. However, it may be concluded that oestrogen is only a specific treatment for hot flushes and dyspareunia, but has no clear role in the management of psychological symptoms in menopausal women. A multifactorial approach, paying attention simultaneously to biological, psychological and social factors supposed to influence complaints during the climacteric may be more appropriate. A description of an integration of medica...

Continuous Combined Piperazine Oestrone Sulphate and Medroxyprogesterone Acetate Hormone Replacement Therapy ‐ A Study of Bleeding Pattern, Endometrial Response, Serum Lipid and Bone Density Changes

This pilot study was conducted to establish the optimum oral dosage of medroxyprogesterone acetate (Provera) given daily in combination with a fixed dose of piperazine oestrone sulphate (Ogen), as hormone replacement therapy. A group of 32 nonhysterectomized, symptomatic menopausal women were randomly allocated to receive piperazine oestrone sulphate 1.25 mg daily and medroxyprogesterone acetate 2.5 mg, 5 mg or 10 mg daily for a 2-year period. This was an open study and the patients were reviewed at 3-monthly intervals for 2 years. Vaginal bleeding was reported by 58% of patients after the first 3 months of treatment. There was a gradual decline in the reported incidence of bleeding over the following 6 months particularly by women in the 5 mg and 10 mg Provera group. Only 10% of patients were still recording slight bleeding in the 10 mg group at 12 months. By 24 months all the women in the 5 mg and 10 mg Provera groups had ceased bleeding. There were 2 patients in the 2.5 mg Provera group with persistent proliferative endometrium at 24 months. All the remaining patients had atrophic endometrium. There was no significant difference in serum lipid changes between the 3 groups, but there was an overall reduction in total cholesterol, triglycerides and low density lipoprotein cholesterol in all women. There was no significant difference in bone mineral density changes between the groups over the 2-year period. Endometrial protection with increased incidence of amenorrhoea, without significant adverse effects, was seen with the use of 5 mg and 10 mg of provera.

A Case-Control Study of Combined Continuous Estrogen???Progestin Replacement Therapy among Women with a Personal History of Breast Cancer

Abstract Our objective was to examine the effect on all-cause mortality and tumor recurrence rate of combined continuous estrogen-progestin therapy given to symptomatic menopausal women with a personal history of breast cancer. We performed a nested case-control study in a cohort of women with a personal history of breast cancer. The entire database comprised 901 women with surgically confirmed breast cancer attending one of three teaching hospitals in south-eastern Sydney, Australia. Ninety had taken estrogen for relief of severe menopausal symptoms after their diagnosis and treatment of breast cancer. Most were using combined continuous estrogen-progestin therapy, usually an oral estrogen with a moderate dosage progestin. Controls were matched subjects from the same database who had not taken sex steroids after their diagnosis of cancer. The main outcome measures were all-cause mortality and recurrence of breast cancer (or new contralateral breast cancer). Relative risks (RR) were then calculated comparing sex-hormone users with matched controls. Among the 90 estrogen users, there were no deaths and only 7% developed a recurrence, compared to 17% of the nonusers (using two matched controls); RR = 0.40 (95% CI 0.17–0.93). These results suggest that short-term usage of combined continuous hormone replacement therapy (HRT) by women with a personal history of breast cancer may be safe and might even reduce the risk of recurrence. A formal prospective double-blind controlled study is needed to confirm these results.

The prevalence of symptoms in menopausal women in the far east: Singapore segment

Questionnaires (4000) on experience of menopausal symptoms in Singaporean women aged 40–55 were distributed by students. In total, 524 envelopes were returned (13.1%) and of these 420 were analyzed. Of these, 366 were classified as either pre-, peri-or postmenopaual on the basis of their menstrual patterns. Menopausal symptoms in this sample of Singaporean women were, in general, similar to those experienced in the West though the prevalence was low compared to European studies. No significant differences in individual symptoms were found between the 3 groups but, taken together, symptoms were significantly highest in the perimenopausal and lowest in the other menopausal groups. In the postmenopausal group 50% had been menopausal for at least 1 year at 50.5 years.

Hormone replacement therapy in women treated for breast cancer

We must still maintain the conventional advice that unopposed low dosages of oestrogen should not be used for the treatment of menopausal symptoms in women treated previously for breast cancer. There is, however, epidemiological, laboratory and clinical evidence that certain combinations of oestrogen and progestogen are more likely to be beneficial than harmful, in respect to the risk of reactivating subclinical residual breast cancer or causing progression in premalignant lesions. It is no longer justifiable to deprive a woman with a history of breast cancer treatment of a hormonal therapy capable of safely relieving symptoms which are making her life intolerable. A clinical trial of such treatment is reported.

Oral discomfort at menopause

The relationship between oral discomfort and menopause was assessed in 149 women who were divided into three groups determined by response to a questionnaire. The groups consisted of 50 premenopausal women (30 to 43 years old), 47 menopausal women not receiving medical treatment for symptoms of menopause (37 to 66 years old), and 52 menopausal women attending a menopause clinic before and during treatment for menopausal symptoms (30 to 63 years old). The last group had a general medical assessment, including psychological and oral examinations with oral smears and cultures, and the following blood tests: full blood examination, follicle-stimulating hormone, oestradiol, folate, vitamin B 12, iron, and total iron binding capacity. Of this last group, 33% reported oral discomfort but had no obvious organic abnormalities that could account for this symptom. The prevalence of oral discomfort was found to be significantly higher in perimenopausal and postmenopausal women (43%) than in premenopausal women (6%). The results also showed an association between oral discomfort and psychological symptoms in menopausal women. Approximately two thirds of the menopausal women with oral discomfort, but without oral clinical signs, found that this symptom was relieved after hormone replacement therapy. The results indicated that oral discomfort is a common symptom of menopause, that it often occurs without overt clinical signs, and that it frequently resolves during appropriate hormone replacement therapy.

Transparent patch for hormone treatment.

Hormone treatments to relieve menopausal symptoms in women who have had a hysterectomy can now be delivered through the skin, rather than taking a tablet.

Vasomotor flushes and the release of peripheral immunoreactive luteinizing hormone-releasing hormone in postmenopausal women

The plasma concentrations of immunoreactive luteinizing hormone-releasing hormone (IR-LH-RH) and LH and the peripheral skin temperature of symptomatic menopausal women were recorded continuously and compared with those of asymptomatic menopausal women. These studies were performed by an intermittent withdrawal technique (n = 13) and a continuous withdrawal technique (n = 3). The mean plasma concentration of IR-LH-RH was much higher in symptomatic than in asymptomatic women by both methods of analysis. Large episodic secretory spikes of IR-LH-RH and a temporal correlation between the IR-LH-RH spikes and temperature elevations was found (P less than or equal to 0.025) only in symptomatic women.

OESTROGENS AND MENOPAUSAL AND POSTMENOPAUSAL WOMEN

The majority of women experience a variety of symptoms at the time of the menopause, but these are frequently regarded as being unworthy of management by their doctors. Recent reports of a possible association between exogenous oestrogens and endometrial carcinoma have increased professional reluctance to prescribe oestrogens for menopausal symptoms. This report describes the initial 50 patients who have attended a special clinic established to manage symptomatic menopausal women; common complaints included hot flushes, lack of energy, altered temperament, dyspareunia and headache. Oestrogen therapy was effective in the alleviation of symptoms and the practical aspects of oestrogen use are discussed. It is recommended that with due recognition of its potential complications, oestrogen therapy should be made available to symptomatic menopausal women, and that it requires further study in regard to its place in the long-term prophylaxis of osteoporosis.

The treatment of functional uterine hemorrhage

BNORMAL uterine bleeding is ascribed to a functional origin when A the pelvic organs are normal and when no constitutional disease or blood dyscrasia exists to account for it. The modern conception of its etiology recognizes an alteration from the normal functional relationship between the hypophysis, the thyroid, the ovaries and the endometrium. Functional bleeding occurs most commonly during the fifth decade of life, but it is encountered frequently in women of less mature years in whom preservation of the menstrual and procreative functions is of vital importance. In many of the milder forms, the blood loss is insufficient to require treatment, as is often the case in adolescence. The same may occur during the menopausal age, but here the more likely cause of irregular bleeding is a myoma or cancer and hopeful expectancy is warranted only when the possibility of these organic lesions has been eliminated. The wide age distribution of functional bleeding necessitates a variation in the objectives of its treatment. If we could devise an ideal therapeutic method, it would have for its result preservation of the normal menstrual and procreative functions in women under forty, and the return to normal periods or amenorrhea without severe menopausal symptoms in women beyond this age. Unfortunately, the methods at our disposal often fall short of this ideal, but in our choice of treatment, we should attempt to approach it as nearly as possible. Only too often methods are employed with the control of bleeding as the only objective and with entire disregard of the disastrous sequelae which may accompany the destruction of ovarian or reproductive function. Proof that the ideal treatment of functional bleeding has not been found is the large number of therapeutic procedures which have been and are still being introduced. These methods may be divided into seven groups: (1) Hygienic measures. (2) Uterine stimulants. (3) Means to increase the coagulability of the blood or to decrease the permeability of the capillaries. (4) Endocrine therapy. (5) Removal or ,destruction of the endometrium. (6) Roentgen or radium therapy. (‘7) Surgical procedures upon the ovaries or the uterus. Hygienic measures are of value when used in conjunction with appropriate medical and glandular therapy. Constitutional defects often