Progress in the Management of the Menopause: Proceedings of the 8th International Congress on the Menopause, Sydney, Australia

508 Pages·1997·878.42 MB·\508

by  B.G. Wren (Editor)

Progress

in the
Management

o/the
Menopause

Progress

in the

Management

ofthe

Menopause

Edited by
Barry G. Wren
MD, BS, MHPEd, FRACOG, FRCOG
Dirutor; Sydney Mmopaus~ Cmtr~
Chairman, Scimtific Committu of

th~ 8th Int~rnational Mmopaus~ Soci~ty Congr~ss

The Proceedings of the 8th International Congress on the Menopause,
Sydney, Australia, November 1996
0
CRC Press
c~
Taylor & Francis Group
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Copyright © 1997 Taylor & Francis
library of Congress Cataloging-in-Publication Data
International Congress on the Menopause (8th: 1996 : Sydney, N.S.W.)
Progress in the management of the menopause : proceedings of the
8th International Congress on the Menopause, Sydney, Australia, 3-7
November 1996/ edited by Barry Wren.
p. cm.
Includes bibliographical references and index.
ISBN 1-85070-799-5 (hardcover)
1. Menopause-Congresses. I. Wren, Barry G. II. Title.

[DNLM: 1. Menopause--congresses. 2. Estrogen Replacement Therapy­

-congresses. 3. Estrogens--therapeutic use--congresses. WP 580
I61p 1997]
RG186.I57 1996
618.1'75-dc21
DNLM/DLC
for Ubrary of Congress 97-34442
CIP
British Library Cataloguing in Publication Data
Progress in the management of the menopause
1. Menopause 2. Menopause - Hormone therapy
I. Wren, Barry G.
618.1'75
ISBN 1-85070-799-5
The photograph used for the cover design, of an osteoporotic vertebral body,

has been reproduced by kind permission of

Professor Lis Mosekilde, University ofAarhus, Denmark

No part ofthis publication may be reproduad, in any form, without permission from the
publishers except for the quotation ofbmfpassages for the purpose ofreview.
Typeset by H&H Graphics, Blackburn, Lancs.
Contents
List of principal contributors xi
Foreword xvii
1 Pieter van Keep Memorial Lecture 1
Menopause: a modern perspective from a controversial history
W H. Utian
Section 1 Plenary papers
2 Politics of the menopause: my body, my life, my choice 12
N.Alhery
3 Selective estrogen receptor modulators as a new postmenopausal
prevention-maintenance therapy 18
V. C. Jordan,] 1. MacGregor and D. A. Tonetti
4 Media and menopause 26
W McCarthy
5 Dietary soy phytoestrogens and the health of menopausal women: overview and
evidence of cardioprotection from studies in non-human primates 30
C. L. Hughes,] M Cline,] K Williams, M. S. Anthony,] D. Wagner and T. B. Clarkson
6 Estrogens and dementia: a clinical and epidemiological update 40
V. W Henderson
7 Menopause transition 50
C. A. Morse
8 New delivery systems for hormone replacement therapy 58
1. S. Fraser and Y. Wang
9 The consequences oflongevity 68
M. Lachowsky
10 Alternative to hormone replacement therapy for menopausal management
possible role ofKampo medicine 71
T. Aso, T. Kuyama, H. Kaneko and M. Seki
Section 2 Reports of epidemiological trials
11 A European trial on secondary prevention of cardiovascular disease 80
K Schrnck-Gustafsson
12 The Women's Health Initiative 83
S. R. Johnson
v
PROGRESS IN THE MANAGEMENT OF THE MENOPAUSE
Section 3 Management of the weU menopausal woman
13 Management of a well menopausal woman: the role ofmenopause clinics 90
M. Smith
14 A psychological approach to the management of menopause 94
A. Collins
15 Lifestyle approach to management of the menopause 99
] R Guthrie, L Dennerstein, P. R Ebeling,] D. Wa'*. E. C. Dudley,] L. Hopper,
A. Green and H. C. Bu~
16 An Asian perspective of the menopause 108
S. Punyahotra and K Limpaphayom
17 Dealing with the complications of HRT management 114
M. DOren
Section 4 Hormone replacement therapy and osteoporosis
18 Estrogens and bone cells 120
P. H. Stern, C. Tarjan and] L. Sanders
19 Bone structure and function in relation to aging and the menopause 126
Li. Mosekilde and] S. Thomsen
20 Clinical aspects of estrogens and osteoporosis 137
E. F. Eriksen
21 Prevention ofosteoporosis with estrogen and its analogs: what is new? 143
D. W. Purdie
22 Osteoporosis: treatment options 148
E.Seeman
23 Alternatives to hormone replacement therapy: what is the role ofcalcium and
vitamin D? 160
] D.R inge
24 A new estrogen gel: clinical benefits 166
A. Viitanm
25 The health economics of osteoporosis and estrogen replacement therapy 170
R L. Prince
26 A screening model for osteoporosis using dermal skin thickness and bone
densitometry 175
M. P. Brincat, R Galea and Y. Muscat Baron
27 Bone density and skin thickness changes in postmenopausal women on long-tenn 179
corticosteroid therapy
Y. Muscat Baron, M. Brincat and R Gaka
Section 5 Hormones and breast cancer
28 Role of hormones in human breast development: the menopausal breast 184
] Russo and I. H. Russo
vi
CONTENTS
29 Steroidal control of cell proliferation in the breast and breast cancer 194
E. A. Musgrove and R L. Sutherland
30 Progestogen use and breast cancer 203
R Sitruk-Ware and G. Plu-Bureau
Section 6 Hormone activity in the endometrium
31 Hormonal activity in the endometrium: tissue remodeling and uterine bleeding 212
L. A. Salamonsen
32 Biology of the endometrium 217
E.-M. Rutanen
33 Ultrasound and the endometrium in postmenopausal women 226
J C. Grimwade, E. A. Farrell and A. L. Murkies
34 Clinical implications for the endometrium of hormone replacement therapy 231
J H. Pickar
35 Unresolved issues in endometrial cancer and postmenopausal hormone therapy 236
N. S. Weiss, S. A. A. BeresJurd, L. F. Voigt, P. K Green andJ A. Shapiro
36 Bleeding from an atrophic endometrium 241
S. K Smith
Section 7 Androgens and the menopause
37 Androgen production over the female life span 248
H. M. Buckler and W. R Robertson
38 Androgens and bone function 256
S. R Davis
39 The use of androgens in the postmenopause: evidence from clinical studies 262
B. B. Sherwin
Section 8 Phytoestrogens and their influence on menopause
40 The effect of soy on menopausal symptoms 268
G. Wilcox
Section 9 Hormones and brain function
41 Effects ofsex steroids on brain cells 278
L. M. Garcia-Segura, M. C. Fernander.-Galaz, J A. Chowen and F. Naftolin
42 Neurosteroids: metabolism and activities 286
E. E. Baulieu
43 Estrogen treatment for senile dementia-Alzheimer's type 302
H. Honjo, M. Vrabe, K Ilvasa, T. Okubo, H. Tsuchiya, N. Kikuchi, T. Yamamoto,
S. Fushiki, T. Mizuno, K Nakajima, M. Hayashi and K Hayashi
vii
PROGRESS IN THE MANAGEMENT OF THE MENOPAUSE
Section 10 Management of women with chronic medical diseases
44 Epilepsy and sex hormones 310
E. R Somerville
45 Hormone replacement therapy in diabetes 315
J c. Stevenson and I. F. Godsland
46 Arthritis, menopause and estrogens 323
G. H .M . ~and T. D. spector
47 Hormone replacement therapy following myocardial infarction, stroke and
venous thromboembolism 328
A. Pines
Section II The aging male
48 Factors determining androgen levels in aging males 334
A. Vermeulen
49 The benefits and risks ofandrogen therapy in the aging male: prostate disease,
lipids and vascular factors 340
L.J G. Gourm
50 Adrenal androgens in the adult male 352
K CarlstrOm
Section 12 Menopausal medicine under difficult conditions
51 Menopausal medicine under difficult conditions: Pakistan 362
S. Wasli
52 Menopausal medicine under difficult conditions: the Philippines 367
J RJalbuma
53 Menopausal medicine under difficult conditions: \Ugoslavia 375
T. Moskovic
Section 13 Hormones and mood change
54 Neuroendocrinology of the climacteric period and hormonal replacement therapy 380
A. R Genaz.z.ani, M. Stomati, A. Spinetli, M. M. Greco, A. D. Genazzani and F. Petraglia
55 Estrogens in the treatment of climacteric depression, premenstrual depression,
postnatal depression and chronic fatigue syndrome 385
J J W. Studd and N. Panay
56 Hormones and libido 393
A. Graziollin
Section 14 Hormones and the cardiovascular system
57 Mechanisms ofaction for estrogen in cardioprotection 402
G. l Gorodeski
58 Progestogens do not attenuate cardiovascular benefits by estrogens 419
G. Samsioe
viii
CONTENTS
59 In vitro and in vivo effects ofestrogens on prostacyclin and thromboxane and on 427
other vasoactive compounds
A. O. Mueck, H. Seeger and T. H. Lippert
60 Long-term effects of cyclic combined conjugated estrogens and dydrogesterone 432
in postmenopausal women
M. Gambacciani, M. Ciapon~ B. Cappagli, L. Piaggesi, C. Benussi, S. Picchetti and
A. R. Genauani
Section 15 Compliance with hormonal therapy
61 How can compliance be improved in a general practice setting? 440
P.-J. Roberts
62 What measures should we adopt to improve hormone replacement therapy 446
compliance during the next decade?
A. H. MacLennan
63 A general practitioner's outlook on long-term hormone replacement therapy and 452
the general practitioner/specialist relationship
S. V. Drew
Section 16 Hormone replacement therapy in women over 60
64 Hormone replacement therapy in women over 60: management ofosteoporosis 458
prevention
S. Palacios
65 Hormone replacement therapy in women over 60: management of cancer risks 463
J J
M. Foidart, Desreux, A. &liard, A. C. Delvigru, X. Denoo, C. Colin, S. Fournin" and
B. de Lignims
66 Hormone replacement therapy in women over 60: management ofcompliance 469
B. de Lignims
Section 17 Towards better recognition of urogenital aging
67 The female perspective: women's attitudes towards urogenital aging 476
H.J Wright
Index 481
ix