Menopause

Five years ago this summer the National Institutes of Health’s stopped early a major portion of the Women’s Health Initiative (WHI), a large and ambitious study to address the most common causes of death, disability and impaired quality of life in postmenopausal women.

Recently there have been numerous references in the news about the new types of estrogens that do not cause an increased risk of breast cancer. While studies looking at an increased risk of breast cancer with traditional hormone replacement use still do not show a clear consensus, it is generally accepted that there may an increased, albeit small, risk of breast cancer with the use of traditional replacement hormones.

The HERS trial was the first study to put a damper on enthusiasm for hormone replacement therapy (HRT) as a preventive therapy for heart disease. A second trial called ERA (Estrogen Replacement and Atheriosclerosis trial), reported at the 49th Annual Meeting of the American College of Cardiology, held in Anaheim, California, March 12–15, 2000, provides additional evidence that HRT does not prevent heart disease.

Hysterectomy is one of the most common abdominal surgical procedures performed in women today with 600,000 hysterectomies in the USA annually, one in three women undergoing hysterectomy, and 6–20% in European countries.

The optimal surgical approach to treatment of stress urinary incontinence (SUI) in women continues to be a topic of controversy. This debate is fueled, in part, by the difficulty in comparing data on the different surgical procedures due to variations in patient selection, diagnostic methods, techniques, outcome criteria, and length of follow-up.

Interview with Steve Fleischman

Roberta Speyer: “This is Roberta Speyer and I’m reporting for OBGYN.net. I have the pleasure of talking to Dr. Fleischman who is an Assistant Clinical Professor at Yale University and in private practice with Gynecology & Infertility, PC. Today we are going to talk about urinary incontinence and how OBGYN physicians can fit this into their practice. As a practicing OBGYN yourself, this is something you have a great degree of specialization in. Tell us a little about your practice Dr. Fleischman.”

A study sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health found that postmenopausal women with heart disease who took hormone therapy and high dose antioxidant vitamins - either alone or in combination with hormones - did not have fewer heart attacks, deaths, or progression of coronary disease.

Perimenopause is a time of hormonal fluctuations where some perimenopausal women will experience psychological symptoms during this transition (Carter, 2001; Conboy, O’Connell, & Domar, 2000). Perimenopause may be connected with a new onset of psychiatric symptoms or exacerbation of pre-existing psychiatric problems in women (Simon, et. al., 1998).

Urinary incontinence (leakage) refers to the involuntary loss of urine from the bladder, which constitutes a social or hygienic problem for the individual. Bladder control problems affect about 17 million people in the United States.

Each year, about 180,000 women in the United States discover they have breast cancer. Those at greatest risk are women over the age of 50. Nevertheless, it is important to keep in mind that younger women account for up to 30% of cases.

Many women experience vasomotor symptoms at or around the time of menopause. Hot flushes and night sweats are considered primary menopausal symptoms that may also be associated with sleep and mood disturbances, as well as decreased cognitive function.

The average age of natural menopause in Western societies is estimated to be 51 years; women in Canada can therefore expect to live, on average, a third of their lives in post-menopausal years. During these years women are at increased risk of chronic diseases such as osteoporosis and cardiovascular disease.

Researchers from Italy have found that premenopausal breast cancer patients treated with triptorelin and chemotherapy were less likely to experience early menopause and were more likely to resume menses than patients who received chemotherapy alone.

Thanks to innovative treatments like in vitro fertilization and egg donation, we are able to help thousands of infertile patients build their families.

Results from a new study by doctors at the University of Michigan Hospitals and Health Centers indicate that long-term estrogen replacement has a beneficial effect on postmenopausal women's non-verbal memory and attention span.

The Editorial: Timing is Everything…  - A. R. Genazzani, MD., Ph.D., FRCOG, President, The International Society of Gynecological Endocrinology (ISGE)

Dr. John Collins presented a thorough review of the literature concerning the interaction of hormone replacement and breast cancer entitled "HRT and Breast Cancer: The Evidence and the Issues" with the following general conclusions

To review, the recent article in the Lancet that he discussed showed that there was a very small increased risk of breast cancer by taking hormones over a prolonged length of time. However, certainly this risk should be viewed in the overall context of risks and benefits.

Today, Putting Women's Health First launched a national campaign to educate women about cervical cancer, the role of human papillomavirus (HPV) role in its development, and the importance of effective screening in preventing the disease.

The use of chemotherapy for the treatment of breast cancer can result in transient or permanent amenorrhea, and research indicates that each month of chemotherapy translates into 1.5 year of lost reproductive life. This is especially significant for women younger than 40 years, which accounts for 6% of the population diagnosed with breast cancer.

Commercial Calcium Carbonate Vs. Commercial Calcium Citrate

This is the exercise which, when done faithfully and correctly, can help decrease the urgency a patient may have and help with both urge incontinence and stress incontinence. The pelvic floor muscle is like a hammock that stretches from the pubic bone in the front to the tailbone in the back.

It is easier to understand uterine and vaginal wall relaxation (prolapse) if one has a working knowledge of normal anatomy. The support system of the uterus, urethra, bladder and to some degree the rectum is the vagina, specifically the "fascia".

Lower Doses of Hormone Replacement Therapy Shown to be as Effective, Possibly Safer

This depends on the types and the severity of the prolapse. Generally, most women are not aware of the presence of mild prolapse. When prolapse is moderate or severe, symptoms may include sensation of a lump inside the vagina or disturbance in the function of the affected organs, such as: Bladder: stress incontinence, urgency, frequency, incomplete emptying, dribbling, recurrent urine infections.

Articles from Millennium Medical Communications, Inc.

Symptoms related to menopause, including insomnia, nervousness, melancholia, vertigo, weakness, fatigue, hot flashes, vaginal dryness, and urinary incontinence, denote a decline in a woman's quality of life. Further, the symptoms a woman may experience vary according to age.

With a number of clinical studies now completed, the launch of drospirenone/ethinyl estradiol (Yasmin®) in the United States and Europe is expected in the near future. An international panel of physicians involved with the development of drospirenone/ethinyl estradiol recently described the potential benefits of the new oral contraceptive (OC) to clinicians attending an industry-sponsored symposium held during the XVI FIGO World Congress of Gynecology and Obstetrics.

There has been an explosion of hormone replacement therapy research over the past few years. The task of wading through the data to determine what is best for a particular patient, however, can be daunting at best and confusing at worst, said Dr. Karen Carlson, Massachusetts General Hospital, Boston, to delegates at the Pri-Med East in Boston.