[Is the clinical profile of women treated with tibolone similar to that of women receiving a classical estrogen-progestogen therapy? Data from a nationwide survey in France]. / Le profil clinique des femmes qui utilisent la tibolone est-il le même que celui des femmes utilisant un traitement hormonal classique ? Données d'une enquête nationale en France.

OBJECTIVES: To compare the pre-existing risk profiles for breast or endometrial cancer of menopaused women receiving tibolone or another hormone replacement therapy in France, with a view to examining the possibility of biases of selection of patients and of detection of these cancers in the Million Women Study. PATIENTS AND METHODS: Nationwide survey conducted in France among a representative sample of 153 gynaecologists. The particulars of the last two consulting menopaused women treated with tibolone (N = 306) and of the last two treated with a classical estrogen-progestogen therapy (N = 306) were collated then analysed. RESULTS: Compared to those treated with a classical estrogen-progestogen therapy, more women receiving tibolone were aged 60 years or over (40 vs 31%; P < 0.01). More of them had risk factors for breast cancer (history of mastodynia or mastopathy, elevated mammographic breast density) (6 vs 50%; P < 0.01). More of them had a history of uterine investigation or exploration or of irregular bleeding (61 vs 53% of women with a history of irregular bleeding; P < 0.05). Overall, 84% of women treated with tibolone had at least one risk factor for breast or endometrial cancer vs 75% of those receiving a classical estrogen-progestogen therapy (P < 0.01). DISCUSSION AND CONCLUSION: Owing to its specific properties, tibolone is generally prescribed to women with a higher risk profile for breast or endometrial cancer than those receiving a classical estrogen-progestogen therapy, which may entail patient selection and cancer detection biases in non-randomised, open-label, observational studies.

[Age fifty and menopause. Complaints expressed and unexpressed by women. Practitioners' perception and therapeutic impact]. / La cinquantaine et la ménopause. Plaintes exprimées et non exprimées par les patientes. Perception par les médecins et impact sur la prise en charge.

OBJECTIVE: Identification of symptoms appearing at the time of menopause, and evaluation of their spontaneous expression level, connection with menopause and therapeutic impact. POPULATION AND METHOD: Opinion survey carried out with 1229 French gynaecologists. RESULTS: The classical symptoms of menopause (hot flushes, night sweats, dry vagina) are spontaneously expressed by women. Atypical symptoms of menopause (sexual, relational and neuropsychological disorders) are less expressed. They are considered by practitioners as related to menopause, but less than classical symptoms. The ageing symptoms (muscle loss, joint pain, skin ageing, and disappearance of phantasms...) are scarcely expressed by women and connected with menopause by a minority of gynaecologists. The stronger the connection with menopause is, the more the symptom justifies a hormonal treatment of menopause. Thus, when classical symptoms are present, the hormonal treatment is almost always justified but it is less justified in case of atypical symptoms, and more disputable for the ageing symptoms. DISCUSSION AND CONCLUSION: Beyond the most evident signs of menopause, several other symptoms scarcely expressed by women can justify a hormonal treatment of menopause even when the connection with menopause is not demonstrated. Improvement of menopause treatment strategy requires taking into account all these symptoms, and a hormonal substitution that might be sometimes broader than the estrogenic therapy (androgenic, for example).