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A decade after the Women' s Health Initiative-the experts do agree

Endocrinology and Metabolism, University of California, San Diego.
Menopause (New York, N.Y.) (Impact Factor: 3.08). 07/2012; 19(8):846-7. DOI: 10.1097/gme.0b013e31826226f2
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    Menopause (New York, N.Y.) 02/2014; 21(3). DOI:10.1097/GME.0000000000000205 · 3.08 Impact Factor
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    ABSTRACT: Abstract Background: After publication of the Women's Health Initiative study in 2002, use of menopausal hormone therapy (HT) has declined by nearly 80% worldwide and internists now play only a limited role in menopause management. Over the past decade, new data have increased our knowledge of the multiple effects and mechanisms of HT. Methods: Existing literature was reviewed. Results: A consensus has emerged that the benefits of HT outweigh the risks for the relief of symptoms in women who have recently undergone menopause and are not at excess risk of breast cancer and cardiovascular disease. Non-hormonal agents, selective estrogen receptor modulators (SERMs), and tibolone are also useful in management. Factors entering into the decision-making process regarding menopause management are increasingly complex and involve consideration of effects on multiple systems and potential disease-related events. These considerations suggest that internists trained to evaluate and integrate factors influencing multiple organ systems should re-engage in menopause management. Most internists currently lack the core competencies and experience necessary to address menopausal issues and meet the needs of women who have completed their reproductive years. We believe that this situation is detrimental to women's health, leads to fragmented care, and should change. Conclusions: We propose that the multidimensional expertise that characterizes the internist may provide the most comprehensive approach to menopause management. For the internist to meet this need, a set of core competencies must be attained, which will require new didactic programs to be developed for medical students, residents and practicing physicians.
    Journal of Women's Health 03/2014; 23(4). DOI:10.1089/jwh.2014.4746 · 1.90 Impact Factor
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    ABSTRACT: Many aspects of women's reproductive life have fallen under the medical gaze and the end of women's fertility has been no exception. For several years hormone therapy (HT) was considered the best solution for menopause symptoms and in some countries more than 50% of eligible women were prescribed oestrogen. Clinicians were accused of 'medicalising the normal' by applying the biomedical model to a natural lifestage and thus defining menopause as an illness which deviates from biological normality. The purpose of this paper is to review what women and their clinicians 'know' about menopause, and what happens when these two different types of knowledge collide. In the last decade, menopause has been demedicalised, partly because of criticism from feminist researchers, partly due to the publication of major studies indicating elevated risk of breast and ovarian cancers and venous thromboembolisms and, partly because neither physicians nor women experiencing menopause know what constitutes normality. The combined result has been that many clinicians have been cautious about prescribing drugs to treat problematic symptoms. This raises the concern that demedicalisation of menopause may have gone too far, leaving the 20-30% of women who experience distressing symptoms without adequate help or relief.
    Human Fertility 07/2014; 17(3):1-5. DOI:10.3109/14647273.2014.929184 · 1.02 Impact Factor

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May 21, 2014