Estrogen replacement therapy

1. Menopause, defined as the permanent cessation of menstruation resulting from loss of cyclic ovarian function, occurs spontaneously at a mean age of 51 years. More than 40 million American women are postmenopausal, and an additional 30 million are expected to join their ranks during the next decade. 2. The depletion of naturally occurring hormones that accompanies menopause and the issue of hormone replacement therapy have become fundamental concerns in women's health care. 3. Many experts now advise estrogen-progestin replacement therapy to prevent osteoporosis in all women at high risk for this disorder, and for vasomotor flushes, genitourinary symptoms, and mood changes in women who have no contraindication to this therapy. 4. Hormone replacement therapy plays a pivotal role in preserving good health and vitality, but it should be presented within the context of other health-promoting measures to be adopted by menopausal and postmenopausal women.     

Stress Tests in the Detection of Coronary Disease

Ovarian failure is the fundamental factor responsible for cessation of menstruation at the menopause. Uterine bleeding usually diminishes gradually over a period of several months. Irregular or increased bleeding may indicate cancer of the cervix or endometrium and should be investigated immediately. Most women have only minor symptoms of emotional origin, which may be controlled by psychotherapy. True climacteric symptoms, such as hot flushes, may be managed with ataraxic drugs or hormones.     

Struggling in silence

Women who have been treated for breast cancer can experience an early menopause or the return of symptoms such as hot flushes years after they have been through the menopause. Grateful to have survived cancer, they may be reluctant to seek help for menopausal symptoms. A breast cancer menopause clinic is providing tailored support.     

First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes

Background  

This trial aimed to assess the tolerability and efficacy of a fresh sage preparation in treating hot flushes and other menopausal complaints. Sage (Salvia officinalis) has been traditionally used to treat sweating and menopausal hot flushes, as well as to alleviate associated menopausal symptoms and as a general tonic. However, no clinical studies substantiating the use of sage in menopause have been published previously.     

Síntomas relacionados con el climaterio en mujeres residentes en la provincia de Zaragoza

ObjetiveThe aim of this study was to assess menopausal symptoms and related sociodemographic conditions in middle-aged women from the Spanish province of Zaragoza.MethodThis was a cross-sectional study in which 241 women (40-59 years old) from the Zaragoza province completed the Menopause Rating Scale (MRS) and a sociodemographic questionnaire containing personal and partner data to assess symptoms associated with the menopause.ResultsThe most prevalent symptoms were musculoskeletal, followed by hot flushes and perspiration. Somatic, psychological and urogenital symptoms were more severe in post-menopausal women. Somatic and urogenital symptoms worsen with age, body mass index, age at menopause, and partner age. Multiple linear regression analysis (MA) for somatic symptoms was related with the menopausal status, psychiatric treatment, problems with sexual relationships, and history of gender violence. The MA for psychological symptoms was associated with menopausal status, psychiatric treatment and a history of gender violence. The MA for urogenital symptoms was associated with menopausal status, problems with sexual relationships, urinary incontinence and partner alcohol abuse. A history of gender violence was reported by 11.6% of the women.ConclusionIn this sample of middle-aged women, menopausal symptoms were related to menopausal status, and other factors associated with their partner factors, including gender violence.     

Homeopathic treatment of hot flushes: a pilot study

Hot flushes are a common problem, especially for menopausal women for whom hormone replacement therapy (HRT) is contra-indicated or who prefer not to take it and patients receiving Tamoxifen. Some seek homeopathic treatment. We report an uncontrolled, pilot outcome study, conducted at the Tunbridge Wells Homeopathic Hospital (TWHH) in 1998-1999. The study was conducted in out-patient consultations booked in the usual way. Thirty-one patients referred to the Department for menopausal flushes and seen for an initial consultation and at least one follow-up review, were assessed in three groups: Hot flushes: No history of carcinoma of the breast. Hot flushes: Treatment for breast carcinoma, not receiving Tamoxifen. Hot flushes: Treatment for breast cancer including Tamoxifen. For all patients, the initial and follow-up assessments included review of hot flush frequency and severity. Patients also completed their own self-assessment rating after follow-up consultations. The results indicate useful symptomatic benefit for all three groups of patients.     

Contraception in the perimenopause

Most clinicians advise women to continue using contraception for 12 months after menstruation has ceased. Some recommend that women less than 45 years old continue contraception for 2 years after menstruation has ceased. A fertility specialist says that women can stop taking nonhormonal methods after 6 months of amenorrhea if women experience hot flushes. If there are no classic menopausal symptoms, however, they should wait for 12 months before stopping contraception use. Hormonal methods may mask menopausal signs. If a woman has no contraindications, she can use them safely until age 50, however. Women should still use contraception after menopause because irregular ovulation may occur. In older women, the most useful measure of ovarian history is perhaps a good menstrual history rather than a high level of follicle stimulating hormone. A woman needs to consider her age, health status, menstrual history, sexuality, risk of sexually transmitted diseases, past contraception use, lifestyle, obstetric history, and attitude toward abortion when choosing a contraceptive method during the perimenopausal years. Options may include male or female sterilization, combined oral contraceptives, the progestogen-only pill, Depo-Provera, IUD, female barrier methods (diaphragm, cervical cap, contraceptive sponge, and female condom), condoms, spermicides, and postcoital contraception. Assuming the mucus signs can be reliably determined, natural family planning is an alternative for some older women. Depending on coitus interruptus can be stressful for older women because it is not easy to distinguish between a possible pregnancy and an irregular menses.     

Can acupuncture ease the symptoms of menopause?

In a randomized, 2-group clinical study, acupuncture was used for the relief of menopausal hot flushes, sleep disturbances, and mood changes. The experimental acupuncture treatment consisted of specific acupuncture body points related to menopausal symptoms. The comparison acupuncture treatment consisted of a treatment designated as a general tonic specifically designed to benefit the flow of Ch'i (energy). Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity for site-specific acupuncture. The comparison acupuncture treatment group had no significant change in severity from baseline over the treatment phase. Sleep disturbances in the experimental acupuncture treatment group declined over the study. Mood changes in both the experimental acupuncture treatment group and the comparison acupuncture treatment group showed a significant difference between the baseline and the third month of the study. Acupuncture using menopausal-specific sites holds promise for nonhormonal relief of hot flushes and sleep disturbances.     

Protocol for estrogen replacement therapy in menopausal women

The hormonal changes of menopause may produce a variety of symptoms, including hot flushes, atrophic vaginal changes and osteoporosis. For some women these symptoms may be so pronounced that estrogen replacement with opposing progesterone becomes a suitable therapy. Before instituting this therapy, the nurse practitioner must carefully assess the woman and obtain necessary information on the risks and benefits of this regimen. Clinical guidelines for initiating oral estrogen replacement therapy in menopausal women are presented and patient education topics, including additional measures the woman can employ to relieve her menopausal symptoms, are reviewed. The value of diet, calcium and fluoride supplements and exercise in decreasing the risk of osteoporosis is also discussed.     

Health maintenance for postmenopausal women

Menopause is the permanent cessation of menstruation resulting from the loss of ovarian and follicular activity. It usually occurs when women reach their early 50s. Vasomotor symptoms and vaginal dryness are frequently reported during menopause. Estrogen is the most effective treatment for management of hot flashes and night sweats. Local estrogen is preferred for vulvovaginal symptoms because of its excellent therapeutic response. Bone mineral density screening should be performed in all women older than 65 years, and should begin sooner in women with additional risk factors for osteoporotic fractures. Adequate intake of calcium and vitamin D should be encouraged for all postmenopausal women to reduce bone loss. Coronary artery disease is the leading cause of death in women. Postmenopausal women should be counseled regarding lifestyle modification, including smoking cessation and regular physical activity. All women should receive periodic measurement of blood pressure and lipids. Appropriate pharmacotherapy should be initiated when indicated. Women should receive breast cancer screening every one to two years beginning at age 40, as well as colorectal cancer screening beginning at age 50. Women younger than 65 years who are sexually active and have a cervix should receive routine cervical cancer screening with Papanicolaou smear. Recommended immunizations for menopausal women include an annual influenza vaccine, a tetanus and diphtheria toxoid booster every 10 years, and a one-time pneumococcal vaccine after age 65 years.     

Aromatherapy massage affects menopausal symptoms in korean climacteric women: a pilot-controlled clinical trial

This study investigated the effects of aromatherapy massage on menopausal symptoms in Korean climacteric women. Kupperman's menopausal index was used to compare an experimental group of 25 climacteric women with a wait-listed control group of 27 climacteric women. Aromatherapy was applied topically to subjects in the experimental group in the form of massage on the abdomen, back and arms using lavender, rose geranium, rose and jasmine in almond and primrose oils once a week for 8 weeks (eight times in total). The experimental group reported a significantly lower total menopausal index than wait-listed controls (P < 0.05). There were also significant intergroup differences in subcategories such as vasomotor, melancholia, arthralgia and myalgia (all P < 0.05). These findings suggest that aromatherapy massage may be an effective treatment of menopausal symptoms such as hot flushes, depression and pain in climacteric women. However, it could not be verified whether the positive effects were from the aromatherapy, the massage or both. Further rigorous studies should be done with more objective measures.     

Care of the menopausal patient: a nurse practitioner's view

PURPOSE: To evaluate the benefits and risks of hormone therapy (HT) and other treatment options for early postmenopausal women. DATA SOURCES: Published clinical trials, selected peer-reviewed literature, and recent clinical practice guidelines. CONCLUSIONS: Results of the Women's Health Initiative (WHI) studies on HT may not be directly applicable to healthy, early postmenopausal women suffering from hot flushes. HT is the most effective treatment for menopausal symptoms. The benefits of HT in relieving menopausal symptoms are likely to exceed the risks in this population. IMPLICATIONS FOR PRACTICE: The results of the WHI reinforce the importance of individualized care based on a woman's medical history, medical needs, and desired outcomes. Nurse practitioners can help their patients put recent results into perspective. When HT is used, nurse practitioners should consider using lower doses and reevaluate the need for therapy annually.     

20. Oral contraceptives,hormone replacement therapy and breast cancer

Both oral contraceptives (OCs) and hormone replacement therapy (HRT) are widely used by healthy women, so that any increase in breast cancer has to be considered in relation to the avoidance of either pregnancy or menopausal symptoms. Use of OCs for more than four years before first full term pregnancy leads to a small but significant increase in risk of breast cancer (6.5 extra cases per 10,000 women aged 20-29) that persists for 10 years after cessation. Risk is not amplified by a positive family history and OC-induced breast cancers are more likely to be localised to the breast. For those taking HRT there is an increased relative risk of breast cancer of 2.3% per year, similar to the increase in risk for each extra year spent in a premenopausal state. The increase in risk disappears five years after cessation. HRT does not lead to any increase in risk of dying of breast cancer. Some breast cancer patients can safely take HRT, and it is possible that some formulations may reduce the subsequent risk of relapse.     

Estrogen replacement therapy: current recommendations

Estrogen replacement therapy is effective for the prevention and treatment of postmenopausal osteoporosis and should be offered to all women at high risk for osteoporosis. Such therapy is particularly beneficial for prevention of spinal compression fractures; in addition, it alleviates menopausal symptoms (hot flushes, genitourinary symptoms, and changes in mood). In each patient, these benefits must be weighted against the potential risks of endometrial hyperplasia and carcinoma, breast tenderness, hypertension, vascular headaches, and the inconvenience of menstrual bleeding if the uterus is intact. The risk of endometrial cancer associated with estrogen replacement therapy can be considerably reduced by the addition of a progestin, and other side effects can be diminished or eliminated by use of the new transdermal estrogen preparations. Thus, estrogen replacement therapy should be considered in all women who have experienced natural or surgically induced menopause, and it is advisable in women who have osteoporosis or an increased risk for this disorder and no contra-indications to its use. Estrogen replacement therapy should be instituted as soon after menopause as possible and seems to be well tolerated until at least 75 years of age.     

An exploratory pilot study of acupuncture on the quality of life and reproductive hormone secretion in menopausal women

The majority of menopausal women suffer from climacteric symptoms. The purpose of this study was to assess the effects of acupuncture on the quality of life and reproductive hormones secretion in menopausal women. Eleven (11) menopausal women with climacteric symptoms entered this prospective study. The Menopause Specific Quality of life Questionnaire was filled out by the patients before the first acupuncture session, after the last one (5 weeks later), and 3 months after the last acupuncture session. Reproductive hormones including follicular-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and prolactin were measured before and after treatment. Acupuncture significantly improved menopausal vasomotor symptoms (p = 0.001 and p = 0.003 for the end of treatment and 3 months later, respectively) and physical symptoms (p = 0.014 at the end of treatment and p = 0.046 3 months later). It did not change psychosocial or sexual symptoms, nor did it change the measured reproductive hormones. In conclusion, acupuncture is shown to be effective in relieving vasomotor and physical disturbances of menopausal women with effects lasting at least up to 3 months after termination of the treatment. Acupuncture may be a useful treatment alternative for women who are unable or do not want to receive hormone replacement therapy. A prospective study with larger sample sizes will be needed to define the role of acupuncture in the management of menopausal symptoms.     

Missed symptoms of menopause

OBJECTIVE: This review examines the available data on the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) for treating the commonly missed climacteric symptoms of menopause. DISCUSSION: Although some women may pass through the menopausal transition phase with few or no symptoms, the majority experience one or more symptoms serious enough to be disruptive to their lives. The most common are vasomotor symptoms (VMS; hot flushes and night sweats), but they are not the only climacteric symptoms that can negatively affect quality of life. The 'missed symptoms' of menopause -- symptoms with high prevalence and an impact on quality of life that nonetheless receive less attention than do VMS -- include mood changes, sleep disturbances and somatic complaints. These symptoms are reported by approximately half of menopausal women, with numbers varying by region and ethnic background. As with VMS, the effects of declining oestrogen levels on serotonin/noradrenaline pathways could play a role in their development. CONCLUSIONS: Results from pilot studies of several SSRIs and SNRIs suggest that they may improve menopausal mood and sleep symptoms, but few studies have demonstrated significant improvement compared with placebo. One SNRI (venlafaxine) improved menopausal mood symptoms and two SSRIs (citalopram and paroxetine) improved sleep, each in a single placebo-controlled trial of women with VMS. Additional placebo-controlled trials are needed to determine whether SSRIs or SNRIs are effective treatment options for women who cannot or choose not to use hormone therapy.     

Longitudinal study of a health education program for Japanese women in menopause

In this longitudinal intervention study, a 6 week health education program consisting of lectures and exercises was implemented for 39 Japanese menopausal women. The effects of the program were assessed by measuring their exercise participation, climacteric symptoms, and quality of life immediately before, 6 weeks after, and 1 year after the program. The Simplified Menopausal Index was used to assess the climacteric symptoms and the Medical Outcomes Study 36-Item Short-Form Health (SF-36) Survey was used to assess the quality of life. Significant improvements were observed in the subscale score for general health perception and the summary score for the physical component summary in the SF-36 Survey. Favorable results also were found for women without a previous exercise habit before the program but who participated in regular exercise 1 year after the program. No improvements were observed in the climacteric symptoms. We concluded that our program was effective for menopausal women in spite of the intervention period being relatively short.