By Martin Birkhauser, David Barlow, Morris Notelovitz, Margaret Rees
Released below the auspices of the foreign Menopause Society, this ebook offers definitive and professional suggestions to clinicians at the administration of the menopause. Compiled with the help and enter of a workforce of overseas specialists, directions: future health Plan for the grownup lady presents a transparent and functional viewpoint that non-experts can seek advice from for all key matters on the topic of the care in their ladies sufferers. It explores the appliance of fundamental preventative modalities which aren't simply powerful in combating a lot of the morbidity in later existence, yet which are uniformly and cost-effectively utilized to the vast majority of ladies in so much societies.
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The risks, however, must be weighed against the benefits offered by estrogen therapy. The four major risks are: (1) Breast cancer; (2) Endometrial cancer; (3) Venous thromboembolic disease; General principles for clinical practice 29 (4) Stroke. KEY CONCEPTS • Endogenous premenopausal estrogen is essential for the health and well-being of women. This is true for target tissues throughout the body and not only those associated with reproductive function • Peri- and postmenopausal women have well-defined estrogen-dependent and estroegenrelated conditions that respond to exogenous estrogen therapy • Individuals respond differently to estrogen deficiency-related conditions due to variations in the amount of postmenpausal endogenous estrogen synthesis, polymorphism in estrogen receptor distribution and activity, and differing ‘tissue hormone thresholds’ needed for normal hoemone function • The net result that the individual need(s) for estrogen therapy including dose, route of administration, estrogen bioavailability, and age are variable • Progestogens are only required for endomaterial protection • The alternative agents, SERMS (raloxifene) and tissue-specific drugs (tibolone), have clearly defined indications for clinical use as altenatives to estrogen/hormonal therapy • Postmenopausal estrogen/hormonal therapy, as with other drug treatment, has welldefined benefits and risks.
Peripheral ultrasound methods have been shown in studies to provide a useful prediction of fracture risk in populations of women but this should not, on current knowledge, be extrapolated to use in diagnosis of osteoporosis or assessment of treatment response. Biochemical marker methods are continually developing and provide an insight into bone turnover responses not provided by Table 4 Some information about bone density measurements • Gold standard: DEXA (DPX) • DEXA of the hip is currently the gold standard for bone density measurements • Bone density results should be used in conjunction with information obtained in clinical risk assessment • SPX/ultrasound (less effective, but less costly and more available) DEXA, dual energy X-ray absorptiometry; SPX, single X-ray absorptiometry other techniques.
3) Mental tonic effect Women who do not have a mood disorder (depressive illness) report an increased sense of well-being and confidence with HRT, especially if they have had a surgical menopause. (4) Antidepressant effect In one study, estrogen relieved the depressive symptoms of a group of severely depressed psychiatric inpatients to a significant extent. This was not related to menopausal status; although other studies do not indicate benefit of estrogens alone in clinically depressed women, there are data suggesting that a simultaneous estrogen administration allows a reduction in the dosage of classical antidepressants.