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Treatment of the Postmenopausal Woman: Basic and Clinical Aspects
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Rogerio A. Lobo; ed. 443 pages. New York: Raven Press; 1994. $138.00.
As the number of postmenopausal women in the United States increases, so does the number of popular-press books that address menopause. Under these circumstances, do physicians need another text on menopause?
As Rinzler has recently described, many women either do not accept the use of postmenopausal hormones or feel that their physicians have not given them sufficient information about the risks and benefits of such therapy or about alternatives to it. Treatment of the Postmenopausal Woman provides the information that physicians need to convey to their patients concerning the risks and benefits both of postmenopausal hormone therapy and alternative therapeutic approaches. Lobo has compiled authoritative reviews by an outstanding collection of authors on the many issues surrounding menopause, from physiologic changes to chronic disease risk and quality of life. Frequently using graphs and figures, this book summarizes the most recent findings from ongoing investigations, presenting various approaches to treatment clearly and in detail. In sum, this book is comprehensive, balanced, and accessible to the general internist.
The use of postmenopausal estrogens is intended to alleviate menopausal symptoms and to prevent heart disease and osteoporosis. Because postmenopausal estrogen therapy increases the risk for breast cancer among current users and because the addition of progestogens does not eliminate that risk, an adverse effect is beyond doubt. This adverse effect involves a disease (breast cancer) whose risk factors (unlike those for heart disease, for example) are not easily modified. Further, the purported benefit of estrogen therapy in reducing the risk for hip fracture (by preventing osteoporosis) relies on extended treatment. Half of all hip fractures occur in women older than 80 years, and recent evidence indicates that the protection against fractures dissipates within 4 to 7 years of the discontinuation of postmenopausal therapy.
The communication of risks and benefits to women must include these types of details. Breast cancer should not be the price we pay to reduce the risks for heart disease and fractures. For physicians to advise women to take postmenopausal hormones simply on the basis that the benefits outweigh the risks is inappropriate in this, the last decade of the century. As one of the book's authors notes: "All women should receive information about alternatives for risk prevention (exercise, diet, smoking cessation, calcium intake, etc)." Another states: "Whether a woman takes ERT (estrogen replacement therapy) or not should be her informed decision." Treatment of the Postmenopausal Woman will assist physicians as they help their patients make these informed decisions.
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