Development and present state of hormone replacement therapy.

The first therapeutic trials to evaluate the treatment of climacteric symptoms by the administration of ovarian tissue were reported in 1896, i.e. before the endocrine function of the ovary was known or estrogens had been discovered. These were followed by investigations using various ovarian, placental and urine extracts, implantation of ovarian tissue and by oral treatment with dried ovarian tissue. However, reasonably acceptable hormonal drugs did not become available until the third decade of this century, while drugs meeting modern requirements, including that of oral activity, have been available only since the 1940s. It took at least 20 more years before publications for lay people and intensive endocrinological research convinced both the affected women and the medical profession of the value and even the necessity of hormonal treatment for ovarian-deficiency sequelae. Nowadays the treatment of climacteric and post-climacteric symptoms with estrogens and progestogens is a highly effective and indeed common practice. However, their use is of less value for the therapy of post-climacteric cardiovascular diseases and osteoporosis. As regards the latter, it may be said that androgenic-anabolic steroids and Org OD 14, a steroid related to norethynodrel, have usefully extended the available therapeutic armamentarium. Estrogens and progestogens are widely used for the prophylaxis of post-climacteric osteoporosis and cardiovascular diseases because their exceptional efficacy is well proven. Intensive research has resulted in the development of highly effective and virtually harmless hormonal drugs that are available in a great variety of formulations for all possible modes of administration.(ABSTRACT TRUNCATED AT 250 WORDS)

The history and rationale of hormone replacement therapy.

Robert Wilson rendered women aged over 45 a great service. He provoked a line of research which has in 25 years resulted in a sensible approach towards the use of medication in treating the climacteric and post-menopausal oestrogen deficiency. The history of hormone replacement therapy (HRT) is described, as is the current approach to rational HRT. Some ideas are outlined for future development.

Contraceptive choice in the completed family.

PIP: In Belgium, the contraceptive choices and views on completed family size were studied. The study involved a 2-page questionnaire; the 1st part was self-administered while the 2nd half of the questionnaire allowed for the physician to interview the respondents. The survey studied the demographic characteristics of the respondents and the relationship of these characteristics to contraceptive choice, family size and possible future choice in contraception. Demographic information assayed included age and occupation and religion of the respondent and the number of unplanned children. 235 of the 359 respondents (2/3) considered their family complete. 70% of those surveyed used some form of contraception with oral contraceptives and female sterilization being the most popular currently used methods and oral contraceptives and condoms being the most popular ever used method. Motivations for contraceptive choice were also evaluated (family health, age, socioeconomic conditions, etc). Although a large number of unplanned pregnancies were reported, they were not necessarily unwanted. The failure a contraceptive method may account for this. Over 80% of those surveyed had used oral contraceptives at some time. Although the couples agreed on family size, the reasoning behind their decision was obtuse and not well planned. Sterilization created mixed emotions among both partners. Its popularity stems from the standard recommendation of discontinued use of oral contraceptives after age 35. However, doctors need to be considerate of the ambivalent feelings of their patients and recommend choices that leave options open without presenting health risks.^ieng

Hysterectomy in six European countries.

Gynaecologists have been criticized in recent years because of their attitude towards hysterectomy; it is often stated that they are too ready to consider hysterectomy to be indicated and that hysterectomies are carried out too frequently. In order to obtain insight into the incidence of hysterectomy, 2066 women between 40 and 70 yr of age, composing a sample covering 6 European countries, were asked whether they had undergone this operation. Of the total sample, 11.4% had been hysterectomized, the highest percentage being found in Italy (15.5%) and the lowest in France (8.5%). The most important factor that influenced the relative frequency of hysterectomy was age: the percentage of women who had undergone hysterectomy increased with age up to 55-59 yr, but fell thereafter. Another significant factor was civil status; there were fewer divorcees or widows at the moment of operation than married or never-married women. The relationship between the incidence of hysterectomy and age is a parabolic one. To explain this curve the authors postulate that two trends must have played a rôle: firstly; a greater need for hysterectomy with increasing age and, secondly a decrease in the reluctance of the gynaecological profession to perform a hysterectomy and/or of women to undergo this operation. Statistical analysis confirms the existence of this second trend over the period 1960-1975. The chances of a young woman losing her uterus before her 70th year went up linearly to 19.8% in 1975. By extrapolation a figure of 21% is obtained for 1980. Satisfaction with the result of the operation was lowest in Italy and Germany; satisfaction was also lowest in rural areas.

Vaginal cytology in the postmenopause. A study into some correlates.

A considerable number of women continue to have proliferative vaginal smears indicating a certain level of endogenous estrogen production. Some correlates of this were studied. No significant correlation was found with age since menopause or with overweight. No correlation was found between the proliferation of the vaginal smear and climacteric complaints, circulatory or nervous. The implications of a proliferative smear for the postmenopausal woman and of the postmenopausal estrone production are briefly discussed. They appear at least to be ambiguous, because, although they protect against some facets of the estrogen deficiency syndrome, the factors which are correlated to a high level of endogenous estrone production are known as risk factors, predisposing for a higher incidence of uterine bleedings and perhaps malignant degeneration of some target cell tissues.

Ideal family size in 5 European countries.

PIP: In July, August, and September 1969, a survey concerning knowledge, attitudes, and practice with regard to sexuality and family planning was conducted among 1000 women in Belgium, France, Great Britain, Italy, and West Germany. A quota sample of women between the ages of 16-45 was selected in such a way that each 10-year age group in each country comprised 1/3 of the total sample for each country. Focus in this report is only on answers to questions regarding family size, ideals about family size, and whether or not their children were planned. It was learned that in all 5 countries the ideal family size is small. Both men and women agreed that small families are preferable, although women have a slightly larger ideal family size than men. In 4 of the 5 countries, actual family size and ideal family size are equivalent, or actual family size is smaller. The emphasis in all 5 countries was upon having either 2 or 3 children.^ieng

[Social psychological and sexological aspects of oral contraception (author's transl)]. / Aspectos sociales, psicológicos y sexológicos de la contracepción oral.

An inventory is made on the hindrances to the acceptance of contraception in general and oral contraception in particular. They are grouped as hindrances related to the social and psychological significance of "making children", hindrances related to the social and psychological significance of "having children" hindrances, related to the method of oral contraception itself, to be divided in social hindrances, psychological hindrances and medical hindrances and finally hindrances related to the provision of the pill to the individual user. Each of these is amply discussed, the author expresses the hope that by identification of these hindrances, lessons may be learned for the future, when other methods of contreception become available.

PIP: Various obstacles exist relating to the acceptance of contraception, especially oral contraception. The idea of "making children" during sexual relations is important in many cultures to the fulfillment of the act and therefore can affect attitudes to contraception. There are also several factors relating to "having children": economic necessities, family lineage, status, religion, and socially approved family size. A major hindrance is the fact that the pill is a daily medication which demands voluntary use by the patient. Traditionally in many cultures men were responsible for family planning. Use of the pill must be controlled by women and they must understand the method. Such use may also have psychological and physical side effects which may result in rejection.