John Studd

Whilst professional bodies such as the Royal College and the American College of Obstetricians and Gynecologists have well-established standards for audit of management for most gynaecology disorders, such standards for premenstrual disorders (PMDs) have yet to be developed. The International Society of Premenstrual Disorders (ISPMD) has already pu...

An email survey of patient attending a PMS and Menopause Centre produced 238 patients whose principal presenting symptom was depression. Seventy-seven percent claimed to have had severe or moderate depression, 17% had had at least one psychotic episode and 14% had attempted suicide. Fifty-eight percent had seen a psychiatrist. Seventy-one percent h...

Depression is more common in women, occurring at times of hormonal fluctuations as premenstrual depression, postnatal depression and perimenopausal depression. These are all related to changes in hormone levels and constitute the diagnosis of reproductive depression. There is a risk that severe premenstrual depression can be misdiagnosed as bipolar...

Many cases of depression in women are due to endocrine factors and treatment by antidepressants or mood stabilizing is inappropriate Reproductive Depression includes Premenstrual Depression (PMDD), Postnatal Depression and Climacteric Depression, which is more severe in the transitional phase 2 or 3 years before the periods cease rather than in the...

The purpose of this study was to classify the clinical subtypes of core premenstrual disorders during the International Society for Premenstrual Disorders' second consensus meeting. Multiple iterations were used to achieve consensus between a group of experts; these iterations included a two-generational Delphi technique that was preceded and follo...

The second consensus meeting of the International Society for Premenstrual Disorders (ISPMD) took place in London during March 2011. The primary goal was to evaluate the published evidence and consider the expert opinions of the ISPMD members to reach a consensus on advice for the management of premenstrual disorders. Gynaecologists, psychiatrists,...

The purpose of this study was to classify the clinical subtypes of core premenstrual disorders during the International Society for Premenstrual Disorders' second consensus meeting. Multiple iterations were used to achieve consensus between a group of experts; these iterations included a two-generational Delphi technique that was preceded and follo...

The understanding of the cause and treatment of premenstrual disorders is confused but it is essentially the result of cyclical ovarian activity, usually ovulation, and an effective treatment should be by suppressing ovulation. This can be done by an oral contraceptive but as these women are progestogen intolerant the symptoms may persist becoming...

Bipolar disorder and severe premenstrual syndrome (PMS) have many symptoms in common, but it is important to establish the correct diagnosis between a severe psychiatric disorder and an endocrine disorder appropriately treatable with hormones. The measurement of hormone levels is not helpful in making this distinction, as they are all premenopausal...

Reproductive depression is the depression in women that is related to the hormonal changes of the menstrual cycle, pregnancy and the menopause and is manifested clinically as premenstrual depression, postnatal depression and climacteric depression. These three components occur in the same vulnerable women in that a woman with depression in the meno...

Premenstrual depression, postnatal depression and climacteric depression are related to changes in ovarian hormone levels and can be effectively treated by hormones. It is unfortunate that psychiatrists have not accepted this form of treatment and this paper is an attempt to simplify this treatment, which should include transdermal estrogens, possi...

Premenstrual disorders (PMD) are characterised by a cluster of somatic and psychological symptoms of varying severity that occur during the luteal phase of the menstrual cycle and resolve during menses (Freeman and Sondheimer, Prim Care Companion J Clin Psychiatry 5:30–39, 2003; Halbreich, Gynecol Endocrinol 19:320–334, 2004). Although PMD have bee...

The recent report of a two-fold increase in esophageal cancer in women taking oral bisphosphonates is yet another reason to question current relegation of hormone replacement therapy (HRT) to a minor role in the correction of many problems occurring in the younger postmenopausal woman. Women under the age of 60 years with low bone density, flushes,...

In spite of the negative press reports following the 2002 Women's Health Initiative (WHI) publication, women can be reassured that in the correct circumstances, hormone replacement therapy (HRT) is beneficial and safe, particularly if treatment is started below the age of 60. Transdermal estradiol is probably safer than oral estrogens as coagulatio...

Female sexual dysfunction (FSD) is a multidimensional problem combining biological, psychological and interpersonal elements of multiple etiologies. Menopause-related sexual dysfunction may not be reversible without therapy. Hormonal deficiency does not usually decrease in severity over time. Many options are available for the successful treatment...

To establish whether treatment for three years with pro-juven progesterone cream affects progression of atherosclerotic plaques or bone density in postmenopausal women. Design Randomized double-blind placebo-controlled trial. Sample One hundred and thirty-one healthy postmenopausal women aged between 50 and 75 years with at least one asymptomatic a...

Despite the overwhelming evidence that hormone replacement therapy (HRT) is effective not only in alleviating the symptoms of the climacteric, but in preventing osteoporosis and reducing the cardiovascular and cerebrovascular consequences of estrogen deficiency, it has been estimated that fewer than 3% of women receive HRT for more than 3 years and...

Summary The late cervimetric progress of 913 consecutive spontaneous primigravid labours has been examined and related to their outcome. A prolonged deceleration phase was present in 44 patients (5 per cent). Of these, only 12 (27 per cent) had a normal vaginal delivery, 17 (39 per cent) had a forceps delivery, and 15 (34 per cent) were delivered b...

A case is made for estrogens to be the first-choice therapy for the prevention and treatment of osteoporosis in women below the age of 60 years. Estrogens produce a dose-related increase in bone density and also, by their effect on collagen, have a beneficial effect not only on the bone matrix but the intravertebral disc. Bisphosphonates do not hav...

The reluctance of physicians to use estrogens in women with hormone responsive disorders is a tragic result of the 2002 WHI study. Although their hostility to estrogen therapy antedated these studies, the flawed data is now used as justification for the denial of estrogens for treatment of low bone density and various types of hormone responsive de...

To evaluate the effect on climacteric symptoms and quality of life, and the safety of four doses of progestelle progesterone cream administered for 24 weeks to postmenopausal women complaining of moderate to severe menopausal symptoms. Design Single-centre, double-blind, randomized, placebo-controlled study. Population Two hundred and twenty-three...

In the past, medical attitudes to female sexuality were grotesque, reflecting the anxiety and hypocrisy of the times. In the medieval world, the population feared hunger, the devil, and women, being particularly outraged and threatened by normal female sexuality. The 19th century attitude was no better as academics confirmed the lower intellectual...

Hypoactive sexual desire disorder (HSDD) is a common clinical problem that may have a very negative impact on a woman's quality of life. Diagnosis and treatment is challenging, as one must keep in mind the complex web of factors influencing sexual functioning alone or in concert. Data suggest that androgens are significant independent factors affec...

Few meaningful data are available on the use of testosterone for treatment of postmenopausal women with hypoactive sexual desire disorder not receiving estrogen or estrogen plus progestin. This double-blind, randomized, placebo-controlled trial evaluated the efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire d...

The relationship between mood changes and the menstrual cycle has been recognized for many years. Initial treatments involved removal of the ovaries to prevent fluctuation of oestradiol, but this was also associated with the long-term effects of hypo-oestrogenism such as osteoporosis or heart disease. More recently, the use of high-dose oestrogen h...

The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy are unknown. We conducted a double-blind, placebo-controlled, 52-week trial in which 814 women with hypoactive sexual desire disorder were randomly assigned to receive a patch delivering 150 or 300 microg of...

A great change in the attitude of the medical profession and public towards the menopause has occurred in the past 5 years in the United Kingdom. The concept of normality of the menopause is being replaced by one of a chronic deficiency state lasting for up to 20 years. In some patients this may require therapy, and clinics have now been establishe...

A menopause clinic has been established as part of the National Health Service at the Birmingham and Midland Hospital for Women. An investigation was made into 112 women accepted for treatment during the first year. Treatment consisted of mestranol and norethisterone in a graded 28-day cycle. Treatment was maintained for 6 cycles. Patients were ass...

After the hypocrisy and tyranny directed at female sexuality in the 19th Century the change of attitude occurred slowly. Literature became more permissive with authors like D. H. Laurence, Henry Miller and Anais Nin being influential. Theatre and cinema remain conservative. In the real world Marie Stopes’Married Love was greatly influential, listed...

Osteoporosis affects one in three women. There has been some confusion among women and health professionals about the management of osteoporosis since the publication of the Women's Health Initiative and Million Women studies. This guidance regarding estrogen-based and non-estrogen-based treatments for osteoporosis responds to the controversies abo...

The 19th century medical attitude to normal female sexuality was cruel, with gynecologists and psychiatrists leading the way in designing operations for the cure of the serious contemporary disorders of masturbation and nymphomania. The gynecologist Isaac Baker Brown (1811-1873) and the distinguished endocrinologist Charles Brown-Séquard (1817-1894...

The Women's Health Initiative study worked on the assumption that one dose would fit all asymptomatic postmenopausal women. The investigators therefore often used the wrong dose, of the wrong hormones, on the wrong patients and therefore came to many wrong conclusions. Different combinations of different hormones are necessary for different symptom...

We have seen in previous chapters that the underlying cause of premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD) remains unknown, although cyclical ovarian activity appears to be a key factor.1 A logical treatment, therefore, is to suppress ovulation and thus prevent the neuroendocrine changes that cause the distressing symptoms. The...

The study was undertaken to determine the effect of advice to discontinue hormone replacement therapy (HRT) on 100 women who were well established on treatment without side-effects. The study was retrospective from November 2003 to April 2004, in a single gynecological practice in London, UK. One hundred consecutive long-term estrogen and testoster...

Ovariotomy--the removal of normal ovaries, known as Battey's Operation--began in 1872 and became the fashionable treatment of menstrual madness, neurasthenia, nymphomania, masturbation and "all cases of insanity". This practice was supported by distinguished gynecologists and psychiatrists, becoming one of the great medical scandals of the 19th cen...

The controversy surrounding prophylactic oophorectomy is discussed. The importance of adequate hormone replacement with estradiol and particularly testosterone is discussed as is the severe limitation of considering publications which describe the unacceptable practice of hysterectomy and bilateral salpingo-oophorectomy without hormone replacement...

Many women are seeking alternatives to conventional forms of hormone replacement. This study evaluates the endometrial effects of natural progesterone cream used in conjunction with transdermal oestradiol. Open plan study conducted over 48 weeks. Tertiary referral London teaching hospital. Women at least two years postmenopausal. Women were recruit...

Natural progesterone creams are gaining popularity as a possible treatment for menopausal symptoms, and many women may be using them with estrogen. We planned to evaluate, using an open plan study, the systemic absorption of a combination of transdermal estrogen and progesterone. Women applied transdermal progesterone 40 mg and transdermal estrogen...

A prospective controlled study of 2000 patients to determine the incidence of postmaturity and the effect of a policy of non-induction of labour in prolonged pregnancy is reported.‘Certain postmaturity’ was identified in 4% of the patients and was associated with an increased incidence of babies with Apgar scores of <5 at 1 min; induction of labour...

The aim of this study was to determine whether the changes in bone metabolism, which we have demonstrated previously with antenatal dexamethasone therapy, are associated with a lower bone mineral density. We assessed bone mineral density in the proximal femur and lumbar spine using dual photon X-ray absorptiometry after delivery in 15 women who rec...

Objective To assess the risk of maternal osteoporosis associated with antenatal corticosterioid administration for neonatal respiratory distress syndrome prophylaxis. Design Prospective longitudinal study. Setting Maternity unit of Chelsea and Westminster Hospital, London. Population Fourteen pregnant women who received dexamethasone therapy for fe...

Connective tissue collagen is thought to contribute to the generation of urethral pressure. It has been previously shown that skin collagen and urethral pressure are oestrogen dependent. This study demonstrates a correlation between urethral pressure measurements and skin collagen content. It is suggested that the beneficial effect of oestrogens on...

Uterine artery embolisation is a new minimally invasive technique used for the treatment of fibroids. Twenty-one women underwent bilateral uterine artery embolisation at our unit, and we assessed the efficacy, morbidity and patient satisfaction with the procedure. Mixed outcomes were found. Reduction in fibroid volume measured by magnetic resonance...

Menorrhagia is not only heavy periods but usually also consists of pain, bouts of depression and menstrual headaches, as well as the exhaustion and loss of libido that come with the combination of these symptoms. If medical therapy fails, the options are use of a Mirena coil or various types of endometrial ablation. A hysterectomy with or without b...

The biological plausibility for the effect of sex hormones on the central nervous system is now supported by a considerable amount of clinical data. This critical review guides the reader through the plethora of data, from the earliest reports of menstrual madness in the nineteenth century to neurobiological work in the new millennium. It illustrat...

Over the years, clinical medicine has a record of fashionable treatments supported by the experts, the unscrupulous or the eccentric that are subsequently discredited to become an odd footnote of medical history. The many biochemical placental functional tests and ventrosuspension for all causes of infertility are examples in our specialty. Bleedin...

Premenstrual syndrome (PMS) is a chronic, poorly understood psycho-endocrine disorder severely affecting 5%; of women. Hormonal therapy which suppresses ovulation is the mainstay of medical treatment, but these interventions are rarely permanent. We evaluated the effectiveness and patient satisfaction with total abdominal hysterectomy/bilateral sal...

The aim of this study was to observe whether bone mineral density (BMD) improves over 5 years in older women using estradiol implants. A total of 18 women were selected who had commenced hormone replacement therapy (HRT) around the age of 60 years. The median age was 60.9 years (range 59.7-63.2 years). Each woman had a pretreatment bone scan and th...

Premenstrual syndrome is a collection of symptoms that may be encountered by up to 95% of the population, although it is estimated to affect 5% of women severely. The use of complementary and alternative therapies is high among this group, but does not seem to compromise conventional treatment. It has been established that complementary therapies a...

It is desirable that young women with primary ovarian failure achieve normal peak bone mass to reduce the subsequent risk of osteoporosis, and that there are management strategies to replace bone that is already lost. While estrogen (E2) is generally considered to prevent bone loss by suppressing bone resorption, it is now recognized that estrogen...

To assess long-term hormone replacement therapy (HRT) usage in women after hysterectomy and to assess the relationship between age and long-term use of HRT in these women. Problems and comments of those women responding to a questionnaire were evaluated. A postal semistructured questionnaire survey was performed in a single gynecological practice....

In this study, we investigate the use of complementary therapies by women attending a specialist premenstrual syndrome (PMS) clinic in the UK. Data was collected via an anonymous questionnaire survey of 100 women attending the clinic. Results showed 91% of women had used at least one form of complementary therapy for the management of their premens...

The anxiety regarding no-bleed regimens is that breakthrough bleeding and endometrial hyperplasia may occur. We aimed to demonstrate that 25 mg oestradiol implants can be adequately opposed by a low dose of progestogen protecting against osteoporosis. Twenty-two patients were recruited to the study. The mean age was 62 years and body mass index of...

The mean age of presentation of malignant melanoma in women is the early fifties, a time that may be concomitant with the onset of the menopause. As the lesion can often be successfully surgically excised, many women will enter the menopause disease-free but in need of treatment for their menopausal symptoms. Melanoma has traditionally been conside...

Premenstrual dysphoric disorder was discussed by a panel of European researchers. The criteria for diagnosis of the condition, its categorisation as a mental disorder, and its differentiation from depression and premenstrual syndrome are all considered. Data on the treatment of premenstrual dysphoric disorder, using serotonin reuptake inhibitors an...

It is almost impossible to cover all the options available for the treatment of premenstrual syndrome and premenstrual dysphoric disorder, as one reviewer suggested as many as 327 different treatment options. The authors have discussed the most common and relevant options. With severe PMS it is likely that only hormonal treatment and SSRI's will be...

To assess the usage of both conventional and complementary therapies by peri- and postmenopausal women for the treatment of menopausal symptoms. A prospective questionnaire was completed by 200 consecutive patients attending a tertiary referral London-based specialist menopause clinic between September and December 1999. The median age of responder...

A total of 105 HIV-positive patients underwent dual-energy X-ray absorbtiometry (DEXA) scan to assess bone mineral density (BMD). The prevalence of reduced BMD was found to be 71% and was higher in patients who had ever been treated with protease inhibitors (PI). Our results suggest a possible association between PI and reduced BMD, and further com...

To study the efficacy and tolerability of Aerodiol, a novel intranasal estradiol spray, and to determine an appropriate dose range. An exploratory, parallel-group, dose-finding study was followed by a large-scale, double-blind, placebo-controlled study. In the exploratory study, 134 postmenopausal women were allocated to receive a daily dose of 100...

For 285 subjects referred to a menopause clinic data were prospectively collected on the time elapsed since the onset of menopause (menopausal age), sexual activity, dyspareunia, smoking, chronic cough and constipation. Prolapse and atrophy were sought on examination. FSH assay confirmed menopausal status. We found an anterior wall prolapse in 51%...

Estrogen has been shown to stimulate osteoblasts in cell culture and increase bone formation in animal models. Such an anabolic effect of estrogen replacement therapy (ERT) would be beneficial to postmenopausal women with osteoporosis. Hence, we assessed the total collagen content and collagen crosslink maturity in iliac crest bone biopsy from 18 s...

It is well recognized that estrogen (E(2)) prevents postmenopausal bone loss by suppressing bone resorption. Despite evidence that E(2) may also stimulate bone formation in animals, an anabolic effect in humans is still controversial. To investigate this, we studied 22 older postmenopausal females, with a mean age of 65.4 yr and mean interval of 16...

Our purposes were to investigate patients' opinions of hysterectomy, bilateral oophorectomy, and hormone replacement therapy and to evaluate whether their outlook and experience influenced the overall satisfaction and continuation of hormone replacement therapy. Study Design: We conducted a questionnaire survey of 200 patients before and 2 years af...

It is well recognized that estrogen (E2) prevents postmenopausal bone loss by suppressing bone resorption. Despite evidence that E2 may also stimulate bone formation in animals, an anabolic effect in humans is still controversial. To investigate this, we studied 22 older postmenopausal females, with a mean age of 65.4 yr and mean interval of 16.9 y...

Leptin is a metabolic regulator of the hypothalamic- pituitary-gonadal axis, and plays an important role in human reproduction. Its neuro-endocrine effects are mediated by interactions with receptors in the hypothalamus, where emotional drive is also controlled. We postulated that circulating leptin concentrations are increased in premenstrual synd...

Twenty-five women with a previous total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH BSO) were given estradiol 50 mg implants at baseline, followed at 16 weeks with the combination of estradiol 50 mg and testosterone 100 mg. Blood samples were taken at 8-weekly intervals over 32 weeks. Serum levels of estradiol, testosterone, se...

The aim of the study was to investigate role of the feto-placental unit in the pregnancy-induced increase in maternal bone metabolism. To achieve this, circulating concentrations of carboxy terminal pro-peptide of type I pro-collagen (PICP, a marker of bone formation) and cross-linked carboxy terminal telopeptide of type I collagen (ICTP, a marker...

Objective To determine the pharmacokinetics of a progesterone cream following short and long term dermal administration. Design Single-centre, randomised, multiple-dose, open-label study. Setting Reproductive Medicine Trust, London. Population Twenty-four healthy postmenopausal women aged between 40 and 65 years were recruited through an advertisem...

The objective of this study is to review the published literature on psychological outcome of hysterectomy and oophorectomy for non-malignant indications. The relevant publications over the past 30 years until the end of 1997 were identified by a MEDLINE computer search. This was followed by hand searches of the relevant references in the literatur...

Current evidence suggests that information and treatment offered to women post-hysterectomy to prevent osteoporosis are poor. To pilot a general practice audit protocol, to assess its ability to identify hysterectomized women and to offer appropriate information on fracture prevention. A pilot audit study was designed to assess advice offered to hy...

There is evidence that infants of insulin-dependent diabetics have increased intrauterine bone resorption and reduced bone mineral content at birth. The aim of this study was to determine if type I diabetes is associated with abnormal maternal bone metabolism. We measured the circulating levels of carboxyterminal propeptide of type I procollagen (P...

Uterine artery embolisation is a new technique for the treatment of uterine fibroids. We report a death after this procedure.