What women want from hormone replacement therapy: results of an international survey.

OBJECTIVES: To find out what women in France, Germany and the UK want from hormone replacement therapy (HRT). METHODS: A questionnaire sent to almost 2000 women in France, Germany and the UK followed up by more detailed interviews with 100 women from each country. RESULTS: From the questionnaire sent to 1871 women aged 48-55 years in France, Germany and the UK, it was found that 72% had not used HRT. The main reason for this seemed to be the prescribing physician who did not mention or recommend HRT. Some cultural differences were apparent. For example, in the UK 10% of the women did not use HRT because of perceived contraindications while the corresponding figures in France and Germany were 20% and 23%, respectively. Fear of side-effects was most common in Germany (20%), followed by the UK (14%) and much less in France (8%). In the detailed interviews with 100 women from each country, based on their menopausal status and the fact that they had received HRT, it was found that the main motivating factor was a desire to avoid the effects of ageing and prevent osteoporosis. In spite of their expectations being largely met, about one-third of the women sampled stopped taking HRT, mainly due to a dislike of breakthrough bleeding. CONCLUSIONS: The women who took HRT generally found it a positive experience and women who did use it derived considerable benefit. However, the main determinant whether HRT was used or not was the attitude of the patient's physician.

Quality of life after the menopause: influence of hormonal replacement therapy.

OBJECTIVE: Our purpose was to demonstrate the clinical efficacy and effect of hormone replacement therapy in menopause on quality of life. STUDY DESIGN: A randomized, open, 6-month comparison of hormone replacement therapy (estradiol transdermal system [Estraderm TTS] plus chlormadinone) and symptomatic treatment (verapipride) was performed. Analysis was by intention to treat. RESULTS: In 499 postmenopausal women with moderate and severe symptoms enrolled by 101 physicians, hormone replacement therapy was superior to symptomatic treatment on all assessments of quality of life and clinical efficacy. The effects were independent of the incidence of hot flushes. CONCLUSION: The effect of hormone replacement therapy on the quality of life of postmenopausal women was significantly superior to symptomatic treatment.

[Respective importance of the different risk factors for osteoporosis]. / Importance respective des différents facteurs de risque d'ostéoporose.

Among the factors which influence accumulation of bone mass, genetic factors related to race and family are preponderant: they account for approximately 80% of the variance observed in adulthood. At puberty, nutritional factors and physical activity modulate the accumulation of bone and determine whether or not optimal bone mass is achieved. In women, estrogen deprivation following menopause, and also more minor disorders of gonad function, are the main causes of decreased bone mass; their respective contributions are analyzed.

[Vaginal contraception in 1982. Realities and perspectives (author's transl)]. / La contraception vaginale en 1982. Realities et perspectives.

PIP: In recent years, there has been a definite renewal of interest in vaginal contraception. Locally applied suppositories and creams contain surfactants such as benzalkonium chloride or phenyl-mercury nitrate which are powerful spermicidal drugs capable of achieving spermatolysis of previously immobilized spermatozoa. They are highly efficient spermicides as indicated by a Pearl's index close to 1.5, provided they are employed exactly as prescribed. Sponge-soaked spermicides remain active for 2 or 3 days which is a good palliative to the short-lived efficacy of other galenical preparations. Locally applied spermicides have the added advantage of possessing bactericidal properties and preventing M.S.T. Vaginal rings inhibit ovulation through a continuous release of progestogen with a strong antigonadotropic action. A number of different rings have been tested with varying degrees of success. When anovulation is actually obtained, it is frequently accompanied by hyperestrogeny, spotting, and amenorrhea. Furthermore, metabolic and in particular lipid disorders induced by progestogens cannot be avoided. (author's modified)^ieng

[Changes in blood cell counts and coagulation factors during labor and after delivery (author's transl)]. / Etude de quelques paramètres hémocytométriques et de l'hémostase au cours du travail et après l'accouchement.

Hemostasis and blood cell counts were studied during pregnancy, during labor, and after delivery in 76 women. Results were compared with data from a control group of 24 women. Previously published data are reviewed and the variations of studied factors are discussed. No reliable biologic test is available at present for assessing the risk of puerperal thromboembolism.

[Oral contraceptives, risk factor of myocardial infarction related to blood lipids (author's transl)]. / Pilule-Lipides sanguins et risque coronarien.

PIP: Retrospective studies show that OC (oral contraception) increases female mortality due to cardiovascular deficiency. According to a 1977 study of the Royal College of General Practitioners, the mortality rate for pill users between 15-24 is 14.9/100,000, against 11.8/100,000 for nonusers, and 241.50/100,000 against 119.50/100,000 in the age group 45-49. While between 1950-60 the incidence of infarction diminished for women in all age groups, between 1960-70 mortality for infarction increased 50%, and strictly in those countries where the pill had a great diffusion. It is believed that about 40% of infarctions before 45 are among OC users. Cardiovascular risk is increased by perturbations of the lipid metabolic system, and the combined effects of estroprogestational agents on circulating cholesterol level differs according to the composition used. Ethinyl estradiol increases the level of circulating cholesterol, while derivates from norethindrone diminish it. It can be concluded that estroprogestational associations tend to increase the level of circulating triglycerides, except when this effect is moderated by the presence of Norgestrel. Any prescription for OC must be preceded by a severe lipid evaluation; for women over 40 the use of an IUD would be better indicated than OC.^ieng