The Management of the Menopause & Post-Menopausal Years: The Proceedings of the International Symposium held in London 24–26 November 1975 Arranged by the Institute of Obstetrics and Gynaecology, The University of London

415 Pages·1976·9.39 MB·English

by  Wendy Cooper (auth.)

The Management of the Menopause
& Post-Menopausal Years
AYERST LABORATORIES
is pleased to be involved with the Institute of Obstetrics and
Gynaecology in the publication of this book-the proceedings of
the Symposium on the Menopause and Post-Menopause.
With speakers from all over Britain as well as from six other
countries, the Symposium was truly international, ~nd the high
attendance at this London meeting demonstrated the interest in
this area of medicine.
Ayerst's involvement in hormone research spans 30 years and
includes not only the development of natural conjugated estrogens
for replacement therapy but also the dissemination of scientific and
clinical information on the use of hormones in menopausal women.
The publication of this book symbolizes Ayerst's continuous
enthusiasm for co-operation between the medical profession and
the pharmaceutical industry in the interest of increasing medical
knowledge.
A YERST LABORATORIES,
FARNBOROUGH,
ENGLAND.
Edited by Stuart Campbell
The Managetnent of
the Menopause &
Post-Menopausal Years
The Proceedillgs of the Illtematiollal S ylllposilllll
held ill LOlldoll 24-26 Novelllber 1975
Arrallged by the Illstitllte oj Obstetrics and G)'na('(olo<~y,
The Univcysity oj London
MTP
Published in the UK by
MTP Press Limited
St Leonard's House,
Lancaster,
England
Copyright © 1976 MTP Press Limited
Softcover reprint of the hardcover 1s t edition 1976
First published 1976
No part ofthis book may be reproduced
in any form without permission from the
publishers except for the quotation of
brief passages for the purposes of review.
ISBN 978-94-011-6167-1 ISBN 978-94-011-6165-7 (eBook)
DOI 10.1007/978-94-011-6165-7
Contents
Page
LIST OF CONTRIBUTORS
IX
FOREWORD
Xlll
SECTION A
EPIDEMIOLOGY Chairmall: N. F. Morris
I A woman's view of the menopause 3
Wendy Cooper
2 Epidemiology of the climacteric syndrome I I
L. J. Benedek]a SZlllatl/l
3 Frequency and severity of menopausal symptoms 25
C. J. Dewhllrst
4 Physical changes associated with the post-menopausal years 29
E. Cope
Discussion 43
SECTION B
ENDOCRINOLOGY (Part I)
Chairmall: R. W. Beard
5 Endocrine changes associated with the menopause and 49
post-menopausal years
I. D. Cooke
6 Intensive steroid and protein hormone profiles on 63
post-menopausal women experiencing hot flushes, and a group
of controls
s. Call1pbell
Discllssion 79
ENDOCRINOLOGY (Part 2)
Chairlllatl: R. W. Beard
7 Pharmacology of natural and synthetic estrogem
K. Fotherby
8 Estrogen target organs and receptor 97
R. W. Taylor
Discussion 103
v
SECTION C
PSYCHOLOGICAL ASPECTS
Chairman: C. H. Naylor
9 Emotional response to the menopause 109
Margaret Christie Brown
10 Psychiatric aspects of the menopause II7
C. Barbara Ballinger
TI Psychological changes following hormonal therapy 127
M. Dorothea Kerr
12 Estrogens, plasma tryptophan levels in peri menopausal 135
patients
M. Aylward
13 Double blind psychometric studies on the effects of natural 149
estrogens on post-menopausal women
s. Campbell
14 Double blind cross-over study of estrogen replacement 159
therapy
Jean Coope
Discussion 169
SECTION D
LIPID METABOLISM Chairman: T. M. Coltart
15 The menopause and coronary heart disease 175
M. F. Oliper
16 The effects of ethinyl estradiol and conjugated equine 185
estrogens on plasma'lipids in oophorectomized women
C. H. Bolton
17 The effect of synthetic and natural estrogens on glucose 195
tolerance, plasma insulin and lipid metabolism in
post-menopausal women
T. Pyorala
Discussion 211
SECTION E
CALCIUM METABOLISM
Chairman: C. V. P. Chamberlain
18 Post-menopausal changes in calcium and phosphorus 221
metabolism
C. E. Dent
vi
19 Osteoporosis and its relation to estrogen deficiency 225
J. M. Aitken
Discussion 237
SECTION F
SKIN Chairman: 1. L. Craft
20 The effect of estrogens on the skin 243
P. Shahrad and R. Marks
21 Effect of castration and peroral estradiol valerate and estriol 253
succinate therapy on the epidermis
L. Rauramo
22 The correlation of menopausal symptoms with cytohormonal 263
status
H. Gordon
23 Cervical colposcopic changes associated with the menopause 271
A. E. Cromptoll
Discussion 279
SECTION G
URINARY TRACT Chairman: J. Malvem
24 Post-menopausal changes in micturition habits and in urine 285
flow and urethral pressure studies
J. L. Osborne
25 The effect of estrogens on bladder function in the female 291
P. J. B. Smith
26 Urethral profile studies on menopausal women and the 299
effects of estrogen treatment
R. F. Ha"ison
Discussion 307
SECTION H
RISKS OF ESTROGEN THERAPY
Part I: Thromboembolism Chairman: S. Campbell
27 A double blind cross-over study with conjugated equine 313
estrogens on blood clotting
L. Poller
28 Effects of synthetic and natural estrogens on the coagulation ]21
system in post-menopausal women
J. Bonnar
Discussion 331
vii
Part 2: Cancer Chairman: R. B. K. Rickford
29 The effects of estrogen replacement therapy on the risk of 339
cancer during the post-menopausal years
C. J. Dewhurst
30 Estrogens and breast cancer 345
R. A. Sellwood
Discussion 351
SECTION I
THERAPEUTIC PROBLEMS
J.
Chairman: C. McClure Browne
3I The premature menopause 359
H. S. Jacobs and M. A. F. Murray
32 The rationale of operative removal of the ovaries at 369
hysterectomy
T. L. T. Lewis
33 Contra-indications to estrogen therapy and management of the 377
menopausal syndrome in these cases
Audrey Midwinter
34 Hormone implants in the climacteric syndrome 383
J. w.
W. Studd
Discussion 387
SECTION J
MANAGEMENT OF THE MENOPAUSE
J.
Chairman: W. W. Studd
35 A European viewpoint 391
Ch. Lauritzen
36 An English viewpoint 399
R.J.
Beard
37 Menopause-an American view 405
C. B. Hammond
38 A dissident viewpoint 423
L. Goldman
39 Financial implications of hormone replacement therapy 429
C. J. Dewhurst
Discussion 431
INDEX 437
viii
List of Contributors
Dr J. M. Aitken, Professor J. Bonnar,
Consultant Physician, Department of Obstetrics and
Essex County Hospital, Gynaecology,
Lexden Road, Trinity College Medical School,
Colchester, University of Dublill,
Essex, C033NB Rotunda Hospital,
Dr M. Aylward, Dublin, 1
Clinical Research Consultant,
Professor J. C. M. Browne,
Cefn Cottage,
Institute of Obstetrics and
Cefn Coed,
Gynaecology,
Merthyr Tydfil
Hammersmith Hospital,
Glam., CF48 2PH
Du Cane Road,
Dr C. Barbara Ballinger, London, W 12 oHS
Lecturer in Psychiatry,
Ninewells Hospital and
Mr S. Campbell,
Medical School,
Senior Lecturer,
Dundee, DD2 1 UB Institute of Obstetrics and
Mr R. J. Beard, Gynaecology,
Consultant Obstetrician and Queen Charlotte's Hospital for
Gynaecologist, Women,
Royal Sussex County Hospital, Goldhawk Road,
Eastern Road, London, W6 oXG
Brighton,
Sussex, BN2 5BE Mr G. V. P. Chamberlain,
Consultant Obstetrician and
Professor R. W. Beard,
Gynaecologist,
Department oj Obstetrics and
Queen Charlotte's Hospitalfor
Gynaecology,
Women,
St Mary's Hospital,
Goldhawk Road,
Paddington,
London, W60XG
London, W 2 1 PG
Dr C. H. Bolton, Dr Margaret E. Christie Brown,
Lecturer in Biochemistry, Consultant Psychotherapist,
Department of Medicine, Chelsea Hospital for Women,
Bristol Royal Infirmary, Dovehouse Street,
Bristol, BS2 8EW London, S. W.3
ix
Mr T. M. Coltart, Professor C. E. Dent,
Senior Lecturer, Department of Human Metabolislll,
Guy's Hospital Medical School, University College Hospital
London, SEI 9R T Medical School, .
University Street,
Professor I. D. Cooke, London, WCIE 6JJ
Department of Obstetrics and
Gynaecology, Professor C. J. Dewhurst,
Jessop Hospital for Women, Institute of' Obstetrics and
Sheffield, S3 7RE Gynaecology,
Queen Charlotte's Hospital for
Dr Jean K. M. Coope, Women,
General Practitioner, Goldhawk Road,
Group Practice Centre, Lorldon, W6 oXG
BoUington,
Nr Macclesfield,
Dr K. Fotherby,
Cheshire
Reader in Biochemistry,
Royal Postgraduate Medical.School,
Mrs Wendy Cooper,
Hllmmersmith Hospital,
Author and Journalist,
Du Cane Road,
32 Vesey Road,
London, W12 oHS
Sutton Coldfield,
Warwickshire
Dr L. Goldman,
Mr E. Cope, Medical Correspondent,
Consultant Obstetrician and Mill Green,
Gynaecologist, 29 Dartnell Park Road,
85 Banbury Road, West Br.lleet,
Oxford, OX2 6LG Surrey
Mr I. L. Craft,
Mr H. Gordon,
Senior Lecturer,
Senior Lecturer,
Institute of Obstetrics and
Institute of Obstetrics and
Gynaeco logy,
Gynaecology,
Queen Charlotte's Hospital for
Hammersmith Hospital,
Women,
Du Cane Road,
Goldhawk Road,
London, W12 oHS
London, W6 oXG
Mr A. E. Crompton, Dr C. B. Hammond,
Consultant Obstetrician and Associate Professor,
Gynaecologist, Duke University Centre,
St James's Hospital, North Carolina,
Leeds, LS9 7TF U.S.A.
x
Mr R. F. Harrison, Mr J. Malvern,
Lecturer, Consultant Obstetrician and
Institute of Obstetrics alld Gynaecologist,
Gynaecology, Queen Charlotte's HospitalJ1r
Queen Charlotte's Hospital.f<Jt Women,
Women, Goldhatvk Road,
Goldhawk Road, LOlldoll, W6 aXG
Londoll, W6 oXG
Dr R. Marks,
Dr H. S. Jacobs,
Senior Lecttlrer,
Senior Lecturer in GY'laecoloff,ical
Departlllent of lvledicillc,
Endocrinology,
The Welsh NatiOlwl School
St Mary's Hospital A1.edical School,
0( Medicine,
Paddington,
Heath Park,
London, W 2 1 PG Cardiff, CF4 4XN
J.
Dr L. B. Jaszmann,
Head, Departmellt ~f Obstetrics alld Dr Audrey Midwinter,
Gynaecology, Senior Lecttlrer,
of
Regional Protestallt Hospital, Department Obstetrics and
Bennekolll, Gynaecology,
Netherlands Bristol Royal Infirlllary,
Bristol, BS2 8HW
Dr M. Dorothea Kerr,
Clinical Assistant Professor o( Professor N. F. Morris,
Psychiatry, -, 4
Department Obstetrics alld
Cornell Unil'ersity Medical ColleJ?e, Gynaecology,
New York, 1\', Y. 10021, New Charillo Cross Hospital.
U.S.A. Fulham Pal;~e Road,
London, W.6
Professor C. Lauritzen,
Frauenklinik,
Dr M. A. F. Murray,
Universitat Ulm,
Research Biochelllist,
79 UlmjDonatl,
St Mary's Hospital Medical School,
Prittwitzstr. 43,
Paddillgtoll,
Germany
London, W 2 1 PG
Mr T. L. T. Lewis,
Consultant Obstetrician and Mr C. H. Naylor,
Gynaecologist, Consultant Obstetrician alld
Queen Charlotte's HospitalJlT Gynaecologist,
Women, Central Middlesex Hospital,
Goldhawk Road, Park Royal,
London, W6 aXG London, N. W. 1 a
Xl