The European Menopause Survey 2005: Women's perceptions on the menopause and postmenopausal hormone therapy

Objectives.?To identify and describe current women's thoughts about the menopause, hormone treatment (HT) and perceptions about breast cancer.

Methods.?Between December 2004 and January 2005, 4201 postmenopausal women in seven European countries were interviewed via a standardized computer-aided telephone interview protocol.

Results.?Almost all women reported to have experienced climacteric symptoms, and 63% of the women rated them as being severe. Only 52% of women were aware of the benefits of HT for relief of climacteric symptoms. Although 84% felt that severe symptoms should be treated, only 40% had used HT at some point in time. Thirty-four percent of the women preferring treatment with natural products did so because of the risk of breast cancer associated with HT. HT was recognized by 59% of the women as one of the most important contributors to an increased breast cancer risk. Most women received their information about HT and breast cancer risk from the media.

Conclusions.?This European survey reveals that the majority of women experience climacteric symptoms but that their decision whether or not to use HT is highly dependent on their concern about breast cancer risk. An increase in knowledge of the benefits and risks of HT is required for women to make appropriate decisions about hormone use.     

Managing the menopause: British Menopause Society Council consensus statement on hormone replacement therapy

The British Menopause Society Council aims to help health professionals inform and advise women about the menopause. This guidance regarding estrogen-based hormone replacement therapy (HRT), including tibolone, which is classified in the British National Formulary as HRT, responds to the results and analysis of the randomized Women's Health Initiative studies and the observational Million Women Study. Treatment choice should be based on up-to-date information and targeted to individual women's needs. HRT still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.     

Managing the menopause - British Menopause Society Council consensus statement on hormone replacement therapy

The British Menopause Society Council aims to aid health professionals to inform and advise women about the menopause. The oestrogen plus progestogen arm of the Women's Health Initiative was stopped in July 2002. This guidance regarding hormone replacement therapy (HRT) use responds to the results and analysis that have been published since then. Because there are few effective alternatives to HRT for vasomotor and urogenital symptoms, oestrogen-based treatments still have a major role. HRT is also most effective for prevention of osteoporosis. Unopposed oestrogens are contraindicated in women with an intact uterus, and hence a range of oestrogen and progestogen combinations, with differing routes of delivery, now exists under the title of "HRT". Treatment choice should be based on up to date information and targeted to individual women's needs. Hormone replacement still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.     

绝经激素治疗与认知

阿尔茨海默病的发病存在性别差异,其机制复杂。绝经激素治疗对认知的影响尚不确定。从整体健康效益而言,绝经女性窗口期应用激素治疗的受益远大于风险,没有理由仅因未确定的风险而否定绝经激素治疗。     

Evidence-based practice in women's health: hormone therapy for women at menopause

Women's health providers, especially midwives, must take into account the known benefits and risks, as well as the "unknown," when recommending the use of hormone therapy for menopausal women, especially as it relates to heart disease, breast cancer, impaired cognition, and osteoporosis. The most recent evidence available from various studies about the benefits and risks of estrogen and hormone therapy at menopause suggests that, although hormone therapy may be protective in some women against heart disease and osteoporosis, evidence is less certain about the benefits of hormone protection against impaired cognition and the risks of breast cancer with use. The clinical approach used by midwives in which individualizing care based on each woman's health status history as well as preferences is highly appropriate for women in the perimenopausal and menopausal period.     

绝经激素治疗与动静脉血栓栓塞性疾病

绝经激素治疗（MHT）是缓解女性更年期症状的重要医疗措施,但MHT也存在一定风险,其中,动静脉血栓栓塞性疾病包括静脉栓塞、肺栓塞、卒中的风险有可能增加。不同种类、不同途径应用MHT对人体的凝血、纤溶系统可产生不同的影响。MHT的治疗剂量、启动时间、持续时间、给药途径、用药方案以及孕激素的种类等所导致的血栓栓塞性疾病的风险不同。合理采用个体化MHT方案,有助于预防或降低动静脉血栓栓塞性疾病的相关风险。     

Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy

OBJECTIVE: To examine whether women who were using postmenopausal hormone therapy (HT) before publication of Women's Health Initiative findings about risks associated with HT had been informed about the findings once published; and to estimate how knowledge of these findings was associated with their decision to discontinue HT. METHODS: We performed a telephone survey of 670 female members of a large health maintenance organization, aged 50-69 yr, who had regularly used HT from July 1, 2001, through June 30, 2002. RESULTS: Most women (93%) reported hearing about the new findings; however, only 57% considered the quality of this information to be good, regardless of its source: mass media (21%), the health plan (32%), or a health care practitioner (34%). Women's knowledge of Women's Health Initiative findings was generally poor; 64% did not know what the findings were, 7% were unsure of their knowledge, 6% had incorrect knowledge, and 23% had correct knowledge of Women's Health Initiative findings. On a simple, five-question, true-or-false quiz about HT risks, 30% of respondents answered four to five questions correctly. Although not well informed, 56% reported attempting to discontinue HT in the 6 to 8 months after July 2002. Our multivariable model included five statistically significant predictors of attempting to stop HT: having been sent a letter about Women's Health Initiative findings (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.8, 3.9), reporting good-quality information from media (OR 2.1; 95% CI 1.3, 3.3), having started HT for health promotion (OR 2.0; 95% CI 1.2, 3.3), using a lower-than-standard dosage of estrogen (OR 1.9; 95% CI 1.1, 3.1), and correctly answering four or more items on the HT quiz (OR 1.9; 95% CI 1.2, 2.8). CONCLUSION: During the 6-8 months after publication of Women's Health Initiative trial findings, most regular postmenopausal HT users tried to stop using HT, despite not being well informed about the Women's Health Initiative findings.     

Where are we with postmenopausal hormone therapy in 2005?

Recently, two large randomized placebo-controlled studies on long-term postmenopausal hormone replacement therapy, the Heart and Estrogen/progestin Replacement Study (HERS) and the Women's Health Initiative (WHI), have raise a lot of controversies, especially on the cardiovascular aspects. We briefly review these two trials and discuss what we know and do not know about postmenopausal hormone therapy, including the evidence on novel choices such as raloxifene and tibolone.     

The effect of hormone replacement therapy on postmenopausal bone loss.

Eighty-four postmenopausal women who were randomly allocated to one of four groups, completed a 1 year follow-up. The first group (n = 20) received 0.625 mg/day conjugated estrogens cyclically (CE; 25 days/month). The second (n = 23) received 0.625 mg/day of CE continuously, and the third (n = 17) received 50 micrograms/day of transdermal 17 beta-estradiol cyclically (24 days/month). All these groups also received 2.5 mg of medroxiprogesterone acetate sequentially for the last 12 days of hormone replacement therapy, while the fourth group (n = 24) constituted a treatment-free control group. Dual photon absorptiometry was carried out before therapy and was repeated after 1 year. Serum calcium, phosphate and osteocalcine levels, and the urinary calcium/creatinine and hydroxyproline/creatinine ratios, were measured prior to treatment and 6 and 12 months thereafter. All treatment groups showed an increase in bone mineral content. This increase was higher in the continuous CE treatment group (4.4%, P less than 0.05) and in transdermal group (7.1%, P less than 0.01). Concomitant biochemical effects at 6 and 12 months, reduction in urine calcium and hydroxyproline, reduction in blood calcium, phosphate and osteocalcine, were compatible with the observed effects on bone mineral.     

False alarm: postmenopausal hormone therapy and ovarian cancer.

BACKGROUND: In a follow-up study of 948,576 women, based on respective relative risk (RR) estimates of 1.23 and 1.20 for incident and fatal ovarian cancer among current users of postmenopausal hormone therapy (HT), the Million Women Study investigators have estimated that, since 1991, HT has resulted in 1300 additional cases and 1000 deaths. CRITIQUE: The association was almost entirely confined to hysterectomized women, some of whom would not have been at risk because their ovaries had been removed; the findings in that group were uninterpretable. Among non-hysterectomized women, the RR was 1.12 and compatible with chance. The response rate to a follow-up questionnaire was only 64%, and HT-exposed women who developed ovarian cancer may selectively have responded. The risk of ovarian cancer was no longer increased once women stopped using HT - an effect that was pathologically and clinically incompatible with causation. Symptoms of as yet undiagnosed ovarian cancer may have 'caused' HT use, rather than the reverse. The histological classification of the tumors was not centrally adjudicated. A meta-analysis of nine studies of current HT use, for which the aggregated RR was 1.28, was acknowledged by the investigators to be defective. CONCLUSIONS: Only the findings among non-hysterectomized women were to some limited extent interpretable and, among them, there was virtually no evidence to suggest that current HT use increases the risk of ovarian cancer. It follows that the estimated numbers of additional cases of incident and fatal ovarian cancer that were attributed to HT use were spurious, and arbitrary extrapolation back to 1991, which was many years before the Million Women Study, had no scientific rationale.     

Menopause hormone therapy,migraines, and thromboembolism

Migraine, a common form of headache, is a highly prevalent and disabling condition with a predilection for females. Migraines are neurovascular diseases. The two main types of migraines are migraines with and without aura, and several subtypes exist. There is a strong link between sex steroids and migraines. In women, migraine remissions are associated with stable and critical oestrogen levels. The literature reveals an association between migraine with aura and stroke, with a higher incidence in the young compared with that in the old. The absolute risk of stroke is low; tobacco use and a high dose of oral oestrogens may increase the risk. Early diagnosis, follow-up, and nonhormonal symptomatic and preventive treatments address the neglected area of migraines. Judicious use of hormones throughout the lifespan as needed would improve the quality of life.     

Sex hormone binding globulin capacity and postmenopausal hormone replacement therapy.

The sex hormone binding globulin (SHBG) capacity was measured in 26 normal untreated postmenopausal women and 10 postmenopausal women taking different types of hormone replacement therapy. The patients on hormone replacement therapy had significantly higher levels of SHBG than postmenopausal women (p less than 0.001) and also significantly higher levels than 52 normal ovulating women studied previously (Pogmore and Jequier, 1979; p less than 0.02). This suggests that postmenopausal women on hormone therapy are being overtreated.     

Cost-effectiveness of hormone replacement therapy in the menopause

Costs, risks, and benefits of estrogen-progestin therapy in the menopause were compared with those for estrogen alone, using techniques of cost-effectiveness analysis. With the progestin added, reduced costs of endometrial monitoring and treatment of endometrial lesions more than offset the increased cost of the drug regimen with a net saving of $230-$430 per patient, depending on the duration of treatment. An estimated gain in life expectancy with estrogen-progestin compared to estrogen alone may be partly offset by a perceived reduction in the quality of life owing to the prolongation of menstruation in women receiving progestin. Overall, based on currently available evidence, estrogen-progestin therapy appears to be cost-effective, except in women who consider the adverse effects of continued menstruation to offset the relief of menopausal symptoms. These conclusions must be viewed as tentative, pending further clarification of the roles of estrogens and progestins in cardiovascular disease and breast cancer.     

The health-promoting behaviors and attitude towards menopause and hormone replacement therapy among women on dialysis.

The aim of this study was to assess the health-related behaviors, knowledge and attitude towards menopause and hormone replacement therapy (HRT) among women receiving dialysis treatment. The study population consisted of 44 women aged 55-75 years attending the dialysis unit. All women completed a 20-item questionnaire, which covered information on personal health-care habits, life style and attitude regarding menopause and HRT. The majority of participants were of desirable weight (body mass index < 25 kg/m2) and had a positive body image. About 80% had never smoked, and did not engage in regular physical activity. Over half underwent annual Pap smear, mammography, breast examination by a physician, and only a small minority performed breast self-examination. Surprisingly, 45% had used HRT in the past, but only 5% were current users. Although we expected postmenopausal women with a life-threatening disease to be more aware of personal health care than the general population, only a relatively small percentage of the study population safeguarded their health care, and used HRT. Stronger educational efforts may be needed to promote health-related behaviors and a positive attitude to health care, aging and menopause in this subgroup of patients.     

绝经激素治疗新进展

2002年美国妇女健康干预（Women’s Health Initiative,WHI）的发表使绝经激素治疗进入了一个低谷。近10年来该领域取得了重大进展,目前的观点已经有很大的不同。该文在具体介绍WHI 研究后,着重介绍了该领域10年来的最重要研究,包括WHI再分析、丹麦的DOPS研究、欧洲的EURAS-HRT研究等,突出了这10年来最重要的进展为“窗口期”理论和孕激素选择。最后介绍了2013年关于绝经激素治疗（menopausal hormone therapy,MHT）的国际共识要点。