Climacteric : the journal of the International Menopause Society
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Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis and management of cardiovascular risk. Key risk factors that need to be controlled in the perimenopausal woman are hypertension, dyslipidemia, obesity and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. ⋯ Whether the findings of WHI in older postmenopausal women can be applied to younger perimenopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older postmenopausal women no longer displaying menopausal symptoms. Both gynecologists and cardiovascular physicians have an important role to play in identifying perimenopausal women at risk of cardiovascular morbidity and mortality, and should work as a team to identify and manage risk factors, such as hypertension.
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In a follow-up study of 948,576 women, based on respective relative risk (RR) estimates of 1.23 and 1.20 for incident and fatal ovarian cancer among current users of postmenopausal hormone therapy (HT), the Million Women Study investigators have estimated that, since 1991, HT has resulted in 1300 additional cases and 1000 deaths. ⋯ Only the findings among non-hysterectomized women were to some limited extent interpretable and, among them, there was virtually no evidence to suggest that current HT use increases the risk of ovarian cancer. It follows that the estimated numbers of additional cases of incident and fatal ovarian cancer that were attributed to HT use were spurious, and arbitrary extrapolation back to 1991, which was many years before the Million Women Study, had no scientific rationale.
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There is an increased interest amongst women in seeking alternatives for hormone replacement therapy because of their fear of side-effects. It is claimed that acupuncture is effective for curing menopausal symptoms, and to be a safe treatment in the hands of well-trained and qualified practitioners. ⋯ However, because its mechanism of action is not fully understood in physiological terms, acupuncture is considered by many clinicians to be of no value. This article reviews the currently available evidence as regards the effectiveness and safety of acupuncture in treating menopausal symptoms.
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To determine, first, the prevalence and severity of various symptoms related to estrogen deficiency in women within a few years of receiving treatment for breast cancer, second, how women perceive the effects of these symptoms on their quality of life and, third, what measures have been taken to relieve vasomotor symptoms. ⋯ The majority of women receiving treatment for breast cancer report menopausal symptoms, which negatively correlate, not only with their own, but also with their partner's quality of life. Most women experiencing hot flushes are not receiving treatment due to lack of both awareness and confidence in the existing treatment options.