Menopause international最新文献

Premature ovarian insufficiency (POI) can have significant health implications for the affected patient population, but remains a largely under researched area. There is lack of evidence from randomised controlled trials to guide clinical practice, regarding the optimal hormone replacement therapy regimens, dose and route of administration. Furthermore, little research has addressed the effect of the various progestogens used on health parameters in women with POI. Here we describe an ongoing randomised clinical trial looking at the effects of micronized progesterone and medroxyprogesterone acetate, both used in combination with transdermal oestradiol on the cardiovascular system, lipid profile and coagulation cascade in women with POI as a step towards better understanding of the implications of hormone treatment in this cohort of women.

The case report discusses a very serious interaction between red clover and methotrexate not previously documented. It highlights the potential pitfalls of concomitant use of herbal remedies and conventionally prescribed drugs and the importance of advising our patients about OTC drugs. A 52-year-old woman attended her general practitioner for advice on menopausal flushing. She was on methotrexate weekly injections for severe psoriasis and was not keen to consider anything that would possibly affect her skin. Alternative therapies were discussed and red clover was suggested. This was bought OTC. After the third day of taking red clover capsules (430 mg), the patient developed severe vomiting and epigastric pain. She contacted the dermatology clinic that administers the methotrexate injection and was thought to have symptoms suggestive of methotrexate toxicity even though her liver function tests remained within normal levels. She had been receiving methotrexate injections for nearly two years with no adverse effects. The only new drug that had been started was red clover and this was thought to be the probable cause of the toxicity. It was withdrawn. The patient made a full recovery and received her next injection of methotrexate with no adverse effects. The interaction was reported to the MHRA with a yellow card.

Objective: To understand the physical and emotional impact of postmenopausal vaginal discomfort on relationships between women and their male partners.

Study design: In a quantitative, Internet-based survey, 8200 individuals from the UK, Denmark, Sweden, Norway, Finland, France, Italy, US and Canada (postmenopausal, married/cohabiting women, aged 55-65 years, who had experienced vaginal discomfort, and male partners of such women) completed a structured questionnaire.

Main outcome measures: Results for respondents from the UK (500 men, 500 women), expressed as percentages of women/men describing particular answers, are reported.

Results: Avoiding physical intimacy because of vaginal discomfort was reported by 69% of women and 76% of male partners, mainly due to concern about sex being painful (women 63%; men 61%); 18% of women considered vaginal discomfort had created emotional distance between them and their partners. Local estrogen treatment was used by 21% of women, among whom 58% subsequently reported less painful sex. Following such treatment, 33% of women and 30% of male partners reported an improved sex life, while 33% of women and 34% of male partners described becoming emotionally closer. Although 73% of women did not consider enough information about vaginal discomfort to be available, 60% would consult a physician to obtain this.

Conclusions: Although vaginal discomfort has a substantial impact on postmenopausal women and their partners, improvements in sexual and emotional relationships can follow use of local estrogen therapy. Not all women may be aware of therapeutic options; healthcare providers can improve outcomes by more openly communicating and initiating discussion with patients.