Posted by SalArmy4me on May 18, 2001, at 0:42:52
In reply to HRT for insomnia post breast cancer, posted by suzie2u on May 17, 2001, at 21:43:36
You gotta read this...sorry its so long, but its good and I don't have the link for it:
Barlow, David H. Managing the menopause: from pumpkins to HRT. Lancet. 342(8863):66-67, July 10, 1993:
The consequences of the menopause have now exploded into an important public health issue. Today there can be few medical abbreviations better known to the lay public than HRT (hormone replacement therapy). Previously, the problems of the menopause were not thought to be very serious in terms of mortality or major morbidity statistics, and few women who were distressed by their symptoms were prepared to seek help.The effects of oestrogen withdrawal on the female skeletal and cardiovascular systems are reasonably well established. Similarly, the effects of oestrogen replacement in reducing fracture and cardiovascular disease risk are in little doubt today, although unresolved issues include how we should best balance benefit against risk and side-effects for the individual. Nevertheless, our insight into the more immediate aspect of the menopause-the menopausal syndrome-is still incomplete and this condition is not necessarily regarded as very important if studies of the care given to the women most at risk are representative [1,2]. .
Two papers from Leiden now highlight some of these issues [3,4]. Nearly 1000 hysterectomised and about 5500 non-hysterectomised women aged between 39 and 60 years in Ede, Netherlands, completed a detailed symptom questionnaire. The investigation examined not only undisputed menopausal symptoms, referred to as "typical" (hot flushes and sweats or vaginal dryness) and which affected most of those in the menopausal transition, but also twenty-one "atypical" symptoms which are either thought to be unrelated to the menopause or are disputed. Many women reported that atypical symptoms were troublesome and contributed to reduced well-being. Commonly these complaints responded to HRT, particularly tiredness and tenseness, but since the improvement correlated with the improvement in the typical symptoms the researchers concluded that any benefit of HRT was likely to be via the improvement in typical symptoms with the "atypical" improvement as a secondary effect. In addition, the hysterectomised women reported significantly more typical and atypical symptoms, especially in the youngest age groups studied (39-41 years), whether or not the ovaries had been retained.
Useful information on the prevalence of atypical symptoms was provided some years ago by Vessey's group in Oxford who showed evidence for an increase in psychological symptoms at the menopausal years-an association which could be primary or secondary to other effects, such as night sweats causing insomnia [5]. I would dispute the suggestion by the Leiden group that a correlation of some atypical symptoms with the severity of typical symptoms "proves" that the former are necessarily secondary effects. The researchers could be observing two parallel primary responses to oestrogen deficiency. In my view the nature of the psychological morbidity at the menopause remains controversial in terms of its origin but there is evidence from controlled studies that, for some women, HRT substantially improves the psychological symptoms [6,7]. I agree with the Dutch workers that the response to distressing psychological symptoms at the menopause should not be, at an early stage, an offer of tranquillisers or antidepressants when explanation, reassurance, and an offer of HRT may be more directly relevant.
The other important issue is the plight of hysterectomised women, with or without retained ovaries, who have been shown repeatedly to be more likely to experience menopausal symptoms than other women of the same age [8,9] and yet who still have a low level of HRT use [1].
poster:SalArmy4me
thread:63421
URL: http://www.dr-bob.org/babble/20010515/msgs/63437.html