CME : Your SA Journal of CPD - Volume 23, Issue 4, 2005
Volume 23, Issue 4, 2005
Author Dennis A. DaveySource: CME : Your SA Journal of CPD 23, pp 168 –172 (2005)More Less
The menopause is an ideal time to make a comprehensive health review. <br>Decisions about HRT rest with each woman after consultation with her doctor. <br>Decision-making requires an individual 'medical judgement'. <br>The absolute and attributable risks and benefits of HRT as well as the relative risks must be considered. <br>Statistical significance does not always imply clinical significance. <br>Conclusions from relatively older groups of women in WHI trials do not necessarily apply to younger postmenopausal women. <br>Younger postmenopausal women have more distressing menopausal symptoms and much lower absolute risks. <br>For many women the immediate need for relief of menopausal symptoms outweighs consideration of both long-term risks and benefits. <br>Age, severity of symptoms, medical status and history are key factors in decision-making. <br>HRT is the most effective treatment for vasomotor symptoms and enables many women to live full and active lives without embarrassment or distress.
Author Mike DaveySource: CME : Your SA Journal of CPD 23, pp 174 –178 (2005)More Less
Recent publications of prospective randomised controlled trials have called into question the role of progestogen use in menopausal women. <br>Progestogens are necessary to protect the endometrium from the hyperplastic effect of oestrogen. <br>Progestogens differ markedly in their effects on different organ systems. <br>In the cardiovascular system, the less androgenic progestogens have potential advantages as regards their effect on lipid profile, direct vascular effect, insulin resistance and haemostasis. <br>By virtue of their effect on breast tissue enzymes, progestogens may increase the concentration of oestradiol in breast tissue. Progestins differ in this effect. <br>Less androgenic progestogens have a favourable effect on the apoptosis proliferation ratio in breast tissue. Individualisation of menopausal hormone therapy is important, especially in the high-risk patient.
Author M-T. Van der MerweSource: CME : Your SA Journal of CPD 23, pp 180 –185 (2005)More Less
There is an age-related increase in obesity between the ages of 45 and 65 years. <br>The metabolic syndrome is a multifaceted clinical disorder that is closely linked to obesity and its diagnositic criteria are constantly being reassessed. <br>Hormonal changes and changes in body composition are of specific relevance to the menopause. <br>The main decrease in energy expenditure in a patient aged 70 years compared with a person aged 25 years would be in the capacity for intense exercise, occupational energy expenditure, dietary-induced thermogenesis and a drop in basal metabolic rate. <br>Postmenopausal BMI will be strongly related to: <ul> <li>pre-menopausal BMI (a positive correlation) </li> <li>pre-menopausal level of physical activity (a negative correlation) </li> <li>ethnicity (Afro-American, Caucasian and Hispanic women appear more susceptible to postmenopausal weight gain, while Chinese and Japanese women appear relatively protected) </li> <li>surgical induction of menopause. (positive correlation) </li> <li>hormonal use (affords a relative protection with a 1 - 1.5 index less rise in BMI). </li> </ul> With age, and in the absence of GH and HRT, muscle protein will be replaced by adipose tissue leading to reduced physical ability and obesity, notably in the subcutaneous, abdominal and visceral areas. <br>In addition to having a favourable effect on lean body mass and bone mineral density, HRT with oestradiol with or without progesterone or norethisterone will also decrease percentage body fat with a favourable increase in the ratio of subcutaneous to visceral fat ratio in the abdominal ratio. <br>Weight gain is not inevitable in the menopause.
Author Ernst W.W. SonnendeckerSource: CME : Your SA Journal of CPD 23, pp 188 –195 (2005)More Less
Many users of complementary and alternative medicine (CAM) also use conventional medicine. <br>Botanical therapies, which are mostly herbs, are used to treat menopausal conditions. <br>The most studied of the botanicals for menopause related conditions are phyto-oestrogens. <br>Phyto-oestrogens are non-steroidal diphenolic plant compounds that have oestrogen-like biological activity or are metabolised into compounds with oestrogenic activity. <br>Phyto-oestrogens have a high affinity to bind with the beta-oestrogen receptor but a low affinity for the alpha receptor. <br>They can act like a selective oestrogen receptor modulator (SERM). <br>Isoflavones, found especially in soy beans and red clover, are the main class of phyto-oestrogens used to treat menopausal conditions. <br>Randomised controlled trials considered in this article show that generally results are mixed. <br>The mode of action of preparations made from black cohosh appears to be dopaminergic rather than oestrogenic. <br>Wild yam creams, marketed as progesterone precursors or balancing formulas, only have progestogenic effects if their diosgenin has been hemisynthetically converted to progesterone or the latter has been added. Although they are absorbed, these creams do not provide endometrial protection. <br>Medical practitioners need to be knowledgeable about CAM and must question their patients about the use of herbal preparations because of possible interactions and side-effects outlined in this article.
Author Peter De JongSource: CME : Your SA Journal of CPD 23, pp 204 –205 (2005)More Less