The management of persistent menopausal symptoms with oestradiol-testosterone implants: clinical, lipid and hormonal results.

Seventeen patients attending two menopause clinics were treated with combined subcutaneous implants of oestradiol (40 mg) and testosterone (100 mg), because oral oestrogens had not provided adequate symptomatic relief, particularly of decreased libido. There were significant improvements in libido, enjoyment of sex and tiredness (P less than 0.01), and in lack of concentration (P less than 0.05), but there was no significant change in flushes, sweats and depression. Based on an analogue scale, libido increased from a mean basal score of 13.5 to a maximum of 86.1 at 3 mth. Symptomatic improvement was maintained for 4-6 mth. There were no significant changes in total serum cholesterol and triglycerides nor in cholesterol subfractions. When expressed as a percentage of the preimplant values, maximal changes in hormonal parameters were observed at 1 mth. Thus, follicle stimulating hormone (FSH) was 53% of basal, luteinising hormone (LH) 54%, oestradiol 186%, total testosterone 291%, and free testosterone 342%. Only 1 patient complained of hirsutism and weight gain. We conclude that the hormonal implants provided substantial symptomatic relief, particularly of loss of libido, while causing rises to mid-follicular concentrations of oestradiol and maximal testosterone levels about three times normal, without significant effects on plasma lipids.

Support for breastfeeding in the first postpartum month: perceptions of breastfeeding women.

Support for breastfeeding, particularly in the early weeks, remains a challenge for health professionals. Focus group interviews with South Australian metropolitan mothers about their first month postpartum explored perceptions of available breastfeeding support. Women discussed breastfeeding support as related to place, people and timing. Findings of this retrospective qualitative study indicate that breastfeeding women perceived midwives as unable to provide the support and relationship they needed due to limitations of time and inconsistent rosters of staff. Additionally, confusion was reported to arise from conflicting advice given by midwives. The issues raised by participants provide an opportunity for midwives to consider reshaping their practices to meet the perceived needs of breastfeeding women in the early postpartum period.

Oestrogens and menopausal and postmenopausal women.

The majority of women experience a variety of symptoms at the time of the menopause, but these are frequently regarded as being unworthy of management by their doctors. Recent reports of a possible association between exogenous oestrogens and endometrial carcinoma have increased professional reluctance to prescribe oestrogens for menopausal symptoms. This report describes the initial 50 patients who have attended a special clinic established to manage symptomatic menopausal women; common complaints included hot flushes, lack of energy, altered temperament, dyspareunia and headache. Oestrogen therapy was effective in the alleviation of symptoms and the practical aspects of oestrogen use are discussed. It is recommended that with due recognition of its potential complications, oestrogen therapy should be made available to symptomatic menopausal women, and that it requires further study in regard to its place in the long-term prophylaxis of osteoporosis.

Low-dosage clonidine (Dixarit) in menopausal flushing.

Results of an open evaluation of the therapy with low-dosage clonidine (Dixarit) in a series of 20 patients with symptoms of menopausal flushing are presented. Twelve of the 17 patients who completed the 12-week trial noted an improvement in their condition: this improvement was marked in eight patients. The greatest improvement was noted in the perimenopausal group of women whose dosage requirement was 25 microgram three times a day. Postmenopausal women tended to be more refractory to the therapy and required larger dosages for the relief of symptoms.

A new method of endometrial cytological sampling--the Gynoscann: a comparison with Vabra curettage.

A new method of outpatient endometrial sampling--the Gynoscann--has been evaluated in a pilot study by comparing it with Vabra curettage. This method was well tolerated by patients, and produced samples that were similar to or better than those from Vabra curettage. We recommend that sampling by the Gynoscann be considered as the first investigation for abnormal uterine bleeding.

The effect of exogenous oestrogens on depression in menopausal women.

A study of the effects of conjugated oestrogens (Premarin) upon the depression scores of depressed and non-depressed menopausal women was carried out. Depression levels were obtained for both groups before and after four weeks of hormone replacement therapy. The Beck Depression Inventory (BDI) was used to assess depression levels, while a semistructured interview provided information related to the physiological, psychological and sociocultural stresses affecting individual women. Depression scores of the depressed group did not improve within the given treatment period, in contrast with improved scores for the non-depressed subjects who reported increased feelings of well-being following hormone replacement therapy.

Early evaluation of postmenopausal hormonal steroid therapy by scanning electron microscopy of the uterine epithelium.

Scanning electron microscopy has been used in a preliminary study to evaluate the value of steroid replacement therapies in restoring uterine epithelium in postmenopausal patients. All therapies resulted in increased epithelium over controls, but one regime was markedly better than others.

Oral discomfort at menopause.

The relationship between oral discomfort and menopause was assessed in 149 women who were divided into three groups determined by response to a questionnaire. The groups consisted of 50 premenopausal women (30 to 43 years old), 47 menopausal women not receiving medical treatment for symptoms of menopause (37 to 66 years old), and 52 menopausal women attending a menopause clinic before and during treatment for menopausal symptoms (30 to 63 years old). The last group had a general medical assessment, including psychological and oral examinations with oral smears and cultures, and the following blood tests: full blood examination, follicle-stimulating hormone, oestradiol, folate, vitamin B12, iron, and total iron binding capacity. Of this last group, 33% reported oral discomfort but had no obvious organic abnormalities that could account for this symptom. The prevalence of oral discomfort was found to be significantly higher in perimenopausal and postmenopausal women (43%) than in premenopausal women (6%). The results also showed an association between oral discomfort and psychological symptoms in menopausal women. Approximately two thirds of the menopausal women with oral discomfort, but without oral clinical signs, found that this symptom was relieved after hormone replacement therapy. The results indicated that oral discomfort is a common symptom of menopause, that it often occurs without overt clinical signs, and that it frequently resolves during appropriate hormone replacement therapy.

Conjugated equine oestrogen versus placebo in the management of menopausal symptoms.

One hundred women underwent a 10-week sequential double-blind/crossover to compare conjugated equine oestrogen (Premarin, 0.625 mg and 1.25 mg) with one and two placebo tablets in the management of menopausal symptoms. Sixty-one subjects completed each of in the four regimens. Thirty-one of these continued with their own choice of regimen for a further nine months. Premarin 1.25 mg proved to be significantly more effective (P less than 0.01) in ameliorating menopausal symptoms than Premarin 0.625 mg and both levels of placebo. Premarin 1.25 mg was also preferred as the treatment of choice by the 31 women (P less than 0.001).