Climacteric Symptoms and Hormonal Treatment with special reference to Sequential Transdermal Therapy

Abstract: Changes during female menopause include increased prevalence of vasomotor symptoms, vaginal symptoms, changes in sexlife and metabolic changes with increased risk of osteoporosis and cardiovascular disease. These changes are to some extent counteracted by estrogen replacement therapy.The aim was to study the prevalence of vasomotor symptoms, sexlife and estrogen replacement therapy in a postmenopausal population. The aim was also to study the effects of a new sequential transdermal estrogen/gestagen therapy on endometrium, bleeding pattern, Quality of Life and on plasma lipids and lipoproteins.Two epidemiological studies with postal questionnaires were answered by 1469 and 1867 women, respectively. Their ages were between 55 and 65 years. The prevalence of postmenopausal vasomotor symptoms was high. Eighteen percent of the women still had moderate to severe vasomotor symptoms even 15 years after menopause. There was a great discrepancy between the prevalence of vasomotor symptoms and hormonal replecement use. Many women discontinued treatment within the first year of treatment. The most common reason for discontinuation was lack of symptoms when treatment was ceased (25% ), followed by "fear of side-effects of the treatment" in 20% of the women.Most women had a regular sexlife even 15 years after menopause and the most common reason for sexual inactivity was lack of partner.One hundred and ten women with climacteric symptoms received a new sequential transdermal estradiol/norethisterone acetate therapy in a multi-centre study for one year. The therapy resulted in secretory endometrium in most women (65%) and only one woman developed hyperplasia after one year. The bleeding pattern for 1195 cycles were studied and 89% of the cycles -were regular or amenorrboic. The treatment resulted in improvement of Quality of Life after 9 months of treatment among 84% of the 110 studied women. The women experienced less anxiety and depression and increased vitality and self-control according to the Psychological Well Being Index. They also experienced better sleep according to the Sleeping Scale. The women also indicated less vasomotor and somatic symptoms and less anxiety and depression according to The Women Health Questionnaire. This test also showed improvements in sex-life, emotions and cognitive symptoms among the women.Twenty-five women at one centre were also studied concerning the effect of the treatment on plasma lipids and lipoproteins. The total cholesterol and LDL-cholesterol was reduced after three years of treatment. The triglycerides and HDL cholesterol was not significantly changed after 3 years of treatment.

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