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Menopause
Current Obstetrics & Gynaecology (1997) 7, 189 © 1997 Harcourt Brace & Co. Ltd
Editorial
Menopause
R . W. S h a w
Most women, with the increased life expectancy achieved in this century, might expect to spend upwards of one-third of their life beyond the menopause and in a state of oestrogen deficiency, if not on treatment. The onset of the menopause is often accompanied with a wide range of symptoms. However, it is not only the cessation of oestrogen synthesis by the ovary that occurs at this time in a woman's life, with many other changes in domestic and family commitments often coinciding. What symptoms occur and which may be expected to be relieved by hormone replacement therapy (HRT) are explored in the first section of the mini-symposium. Oestrogen replacement, predominantly by the oral route, remains the mainstay of HRT. Natural oestrogens, as opposed to synthetic ethinyl oestradiol or mestranol, are now preferred and in recent years a complete range of administration modalities, from cutaneous gels, slow-release depot implants and transcutaneous patches, provides a choice of methods likely to suit each individual. Compliance with HRT preparations, however, is not always achieved, and newer continuous-combined
preparations aimed at reducing the likelihood of regular withdrawal bleeds are amongst the issues discussed in the middle section of the symposium, reviewing advantages and disadvantages of HRT preparations. Whilst HRT has been extremely helpful in relieving the acute symptoms of oestrogen deficiency, it is perhaps its long-term effects that have attracted so much attention in recent years. These include effects on bone mineral density, potential cardiovascular protective effects via lipid changes, and recent claims of benefits in terms of cerebral perfusion and Alzheimer's disease. Disadvantages of long-term usage being evaluated are those related to venous thromboembolism and breast-cancer risk as reviewed in the final part of the mini-symposium. In the final section, the problems and impact of osteoporosis in later life and the screening techniques are reviewed. It also discusses those with an increased risk of osteoporosis and the potential for HRT to influence the major burden on healthcare budgets. The mini-symposium gives, I believe, a well-balanced overview of the menopause and HRT, and our management options as we approach the next millennium.
189
Editorial
Menopause
R . W. S h a w
Most women, with the increased life expectancy achieved in this century, might expect to spend upwards of one-third of their life beyond the menopause and in a state of oestrogen deficiency, if not on treatment. The onset of the menopause is often accompanied with a wide range of symptoms. However, it is not only the cessation of oestrogen synthesis by the ovary that occurs at this time in a woman's life, with many other changes in domestic and family commitments often coinciding. What symptoms occur and which may be expected to be relieved by hormone replacement therapy (HRT) are explored in the first section of the mini-symposium. Oestrogen replacement, predominantly by the oral route, remains the mainstay of HRT. Natural oestrogens, as opposed to synthetic ethinyl oestradiol or mestranol, are now preferred and in recent years a complete range of administration modalities, from cutaneous gels, slow-release depot implants and transcutaneous patches, provides a choice of methods likely to suit each individual. Compliance with HRT preparations, however, is not always achieved, and newer continuous-combined
preparations aimed at reducing the likelihood of regular withdrawal bleeds are amongst the issues discussed in the middle section of the symposium, reviewing advantages and disadvantages of HRT preparations. Whilst HRT has been extremely helpful in relieving the acute symptoms of oestrogen deficiency, it is perhaps its long-term effects that have attracted so much attention in recent years. These include effects on bone mineral density, potential cardiovascular protective effects via lipid changes, and recent claims of benefits in terms of cerebral perfusion and Alzheimer's disease. Disadvantages of long-term usage being evaluated are those related to venous thromboembolism and breast-cancer risk as reviewed in the final part of the mini-symposium. In the final section, the problems and impact of osteoporosis in later life and the screening techniques are reviewed. It also discusses those with an increased risk of osteoporosis and the potential for HRT to influence the major burden on healthcare budgets. The mini-symposium gives, I believe, a well-balanced overview of the menopause and HRT, and our management options as we approach the next millennium.
189