Post Reproductive Health

Bleeding problems are common in perimenopausal women. They affect quality of life. Traditionally, hysterectomy was the definitive 'cure'; however, the past two decades have seen the emergence of less invasive and safer alternatives, in the form of endometrial ablation. Like hysterectomy, these treatments have a high satisfaction rate. Endometrial ablation employing resection techniques may be the procedure of choice in perimenopausal women because the majority of the endometrial cavity is sampled, which may reduce the risk of undetected endometrial cancer. Since no operation is without risk, women should be appropriately selected and counselled.

This review presents key advances in the management of cervical cancer. Traditionally, cervical cancer is staged clinically and has been treated either by radical hysterectomy or by radiotherapy. Improvements in imaging have led to more accurate therapeutic decision making and treatment planning. The evidence on fertility-preserving surgery for cervical cancer and chemoradiotherapy for locally advanced cancer is summarized here. An improved understanding of the viral aetiology of cervical cancer has led to the development of therapeutic vaccination, with limited success. There is increasing recognition of the psychosexual needs of women who have survived cervical cancer.

The aromatase enzyme catalyses the last step in estrogen biosynthesis. There are two classes of third-generation aromatase inhibitors: irreversible steroidal inhibitors (e.g. exemestane) and reversible non-steroidal inhibitors (e.g. anastrozole, letrozole). All three agents have been found to be equivalent or superior to megestrol acetate as second-line therapy for metastatic breast cancer. In the first-line setting, large phase III trials have shown that all three are equivalent or superior to tamoxifen in women with metastatic disease. Several large trials with varying study designs have been launched to analyse their role in the adjuvant setting. The four that have reported found longer average disease-free survival for women who received an aromatase inhibitor than for those who did not. In addition, one trial, MA.17, has shown a survival advantage associated with the use of an aromatase inhibitor in node-positive patients. Guidelines produced by the American Society of Clinical Oncology suggest that adjuvant therapy for postmenopausal women with hormone-receptor-positive breast cancer should include an aromatase inhibitor. However, the long-term consequences of estrogen deprivation in postmenopausal women remain uncertain, particularly with regard to bone and cardiovascular health. The advantages and disadvantages of different hormonal strategies should therefore be carefully considered in each individual case.

The Internet was born in 1969; it was originally developed so that computers could share information on research and development in the scientific and military fields. The original Internet consisted of four university computers networked in the United States. Email became available two years later. The infant Internet initially required complex computing knowledge to be used. However, this was all to change with the development of the World Wide Web in the early 1990s, which made the Internet much more widely accessible. The Internet has since grown at a phenomenal rate and has evolved into a global communications tool. It is by nature anarchic, in that it is an unrestricted broadcast medium. Although this lack of censorship is a strength, it is also a weakness. The quality of information available on the Web is variable and discernment is required. With the growth of e-health, medicine and its allied specialties are faced with the challenges of providing their services in a novel way while maintaining the first principle of medicine, primum non nocere (first, do no harm). This provision of e-health care is in its infancy and this review explores issues arising from the use of the Internet as a medium for organizing menopausal health care in the third millennium.

Publication is an important stage in the research process, yet until recently few guidelines existed about how trials should be published. This article reviews recent developments such as Good Publication Practice for pharmaceutical companies and recommendations from medical editors, medical writers and the pharmaceutical industry which encourage responsible practices and greater transparency.