[The Menopause Rating Scale (MRS II): methodological standardization in the German population]. / Menopause-Rating-Skala (MRS II): Methodische Standardisierung in der deutschen Bevölkerung.

The Menopause-Rating-Scale (MRS I) was used in clinical practice since 1992. The physician had to document the severity of 10 important estrogen-related climacteric symptoms. Practical experience and a critical methodological evaluation justified a revision: The MRS I should be converted into a self-administrative rating scale, the wording somewhat optimized, the layout adjusted and one item added. The standardization of the new scale (MRS II) was performed in a representative sample of the German population aged 45-60 years. Three dimensions were extracted from the menopausal symptoms using multivariate statistical techniques: somato-vegetative, psychological, and urogenital complexes of symptoms. A simple evaluation scheme was developed for the MRS II by summing up scoring points. Reference values for the frequency of 4 levels of intensity of complaints in the population were defined and provided for purposes of comparison. The MRS II meets a high methodological standard as an instrument standardized in the population. Moreover, it is convenient to apply this instrument in daily practice in order to quantitate variation of menopausal complaints.

[A new rating scale for the climacteric syndrome (Menopause Rating Scale (MRS)]. / Neue Bewertungsskala für das klimakterische Syndrom (Menopause Rating Scale [MRS]).

Since 1952 the Kupperman index has served as an indicator for climacteric symptoms. This index, original at that time, has been widely criticized in recent years. After worldwide criticism it was finally reduced to two true symptoms, namely hot flushes and genital atrophy. The so-called psychosomatic symptoms which are essential for the quality of life, insomnia, nervousness and depression, were largely disregarded. In 1994, an expert group of German, Austrian and Swiss members published a new score (Menopause Rating Scale [MRS]) selectively adopting most of the symptoms of the Kupperman index and adding the missing symptoms such as alteration of libido, urological complaints and vaginal dryness. In contrast to the Kupperman index, the Menopause Rating Scale (MRS) presented here registers every single symptom individually in a numerical and graphic way without any multiplication factor. Thus, an individual profile of each patient can be established. This new score may be completed by the physician or by the patient. An improvement in therapy can be rapidly recognized by means of the score as well as by the graphic presentation.

[Diagnosis and evaluation of climacteric symptoms. The "Menopause Rating Scale" MRS helps in diagnosis and evaluation of therapeutic effectiveness]. / Diagnostik und Evaluation klimakterischer Beschwerden. Die "Menopause-Bewertungsskala" MRS hilft bei der Diagnose und Beobachtung von Therapieeffekten.

For the evaluation of climacteric symptoms, Kupperman and his collaborators worked out guidelines as long ago as 1953. As time passed, however, their validity was increasingly called into question. In the nineteen-seventies, on the basis of large epidemiological studies, the conclusion was drawn that merely the symptoms hot flushes and vaginal atrophy were specific to the menopause, while other, largely psychological, complaints represented a "domino effect", so to speak. In contrast to this, the scale (Menopause Rating Scale [MRS]) presented here also permits the identification of emotional complaints. In addition, urinary tract problems, joint and muscle pain, and sexual disorders are also rated. For each of the ten symptom groups, a graphical rating scale ranging from 0.0 (no symptoms) to 1.0 (severe symptoms) is available that permits a synoptic individual complaints profile of the patient to be established.

[Evaluation of climacteric symptoms (Menopause Rating Scale)]. / Evaluation der klimakterischen Beschwerden (Menopause Rating Scale [MRS]).

Quantification and qualification of climacteric symptoms had been described by Kupperman et al in 1953. New findings and ideas in the following forty years needed a correction of Kupperman index. Two important groups reduced the essential symptoms only on two ones, vasomotoric hot flushes and genital atrophy. On the contrary, Menopause Rating Scale (MRS) presented here enables registration of so called psychic symptoms, too, essential for quality of life. Complaint from bladder and urethra, hints and muscles and sexual disorders are also registered. For each of the ten symptom groups there is a rating scale from 0.0 (no symptoms) to 1.0 (very strong symptoms), in a graphic, too. In this way an individual profile will be visible. Using MRC it is possible, to quantify a better or worst status during and after treatment and to depict it.

[Hormone substitution in the female climacteric--goals, means, effects]. / Hormonsubstitution im Klimakterium der Frau--Ziele, Wege, Wirkungen.

Traditional beliefs about climacteric symptoms and widespread imaginations about unwanted effects of estrogens in the pill have long been interfering with the recommendation of an early onset of effective replacement therapy. The somatic symptoms of rush or genital atrophia have later on been classified as hard evidence to justify a therapy, much more than the predominant psychic signs occurring in the postmenopausal years as mental depressions, decrease or lacking of libido, nervousness, insomnia. Those signs were neglected as weaker indications responding even to a placebo treatment. The present knowledge understands somatic and psychosomatic signs as an entiety, both being accessible to hormonal replacement therapy. 85% of the postmenopausal signs can effectively be treated with hormones. What is now known about atherosclerosis, lipid metabolism and osteoporosis in ageing woman adds further justification to even the prophylactic use of estrogens. Natural estrogens administered orally, transdermally or parenterally are the means of choice. The dosage might be tailored on the relief of symptoms (and afterwards reduced to a mere maintaining dosage), or given in a fixed cyclic regimen. The treatment cycle will be three or four weeks, a progestogen should be added for the last 12-14 days. Only one estrogen-androgen combination has survived (Gynodian). The transdermal application (in three different concentrations) with administration twice a week is in progress. Indications and contraindications for transdermal estrogens are similar to estrogens administered orally.

[Side effects of hormonal contraception. Experiences with 1,702 patients and 17,228 cycles]. / Nebenerscheinungen hormoneller Kontrazeption Erfahrungen bei 1702 Patientinnen und 17,228 Zyklen.

During 25 years 1,702 women with 17,228 cycles under oral contraceptive were observed. This report covers 1,021 women with 11,648 cycles and the frequency of side-effects. The acceptability of OC's is more and more dominated by the side-effects. All subjective symptoms were asked for and not--as usually done--just noted when the woman complained spontaneously. For objective results the bleeding calendar was controlled for amenorrhea, spottings and break-through bleedings. Lowering the ethinylestradiol dose below 50 micrograms (with monophasic OCs, micropills) resulted in a worse cycle control as far as bleeding and silent menstruation were concerned. The genuine normophasic method showed generally a far better cycle control. Combining this method with a new gestagen (Desogestrel) resulted a still better cycle control, especially with amenorrhea. The events of nervosity, gastrointestinal disturbances, changes of libido and fatigue were also less frequent with this OC (Ovidol-Oviol).

[Low-carat gold intrauterine device for contraception 44 years in the uterus]. / Niedrigkarätiges Goldintrauterinpessar zur Antikonzeption 44 Jahre im Uterus.

We report on a patient who retained a low-carat gold IUD in her uterus for 44 years. The IUD, which may have been hand-made, has one long and one short arm. The long arm lays within the uterine cavity and the short arm protruded from the cervical canal. The intrauterine device was inserted prior to the second World War. Since she tolerated it well, the patient did not seek regular medical check-ups. At 80 years of age, she complained of lower abdominal pain and the IUD was removed. The patient is suspected to have an ovarian tumor.

[A simple water bag system for mammosonography]. / Einfaches System mit Wasservorlauf "water bag" für die Mammasonographie.

A simple system for ultrasonic mammasonography in the suspended position is reported. The breast is immersed in a polyethylene bag filled with water at 38 degrees C. The scan is made using a hand-guided real-time probe. The quality of the image is equal to that obtained using more expensive systems.