Menopause

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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.

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.

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.”

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.

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.

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.

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.

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.