Post Reproductive Health

The small amounts of oestrogen present in the ovary and initial inability to assay oestrogenic activity were major impediments to the isolation of these hormones. The development of a simple assay and the discovery of high levels of the hormones in urine during pregnancy led to both their isolation and commercial extraction. A variety of synthetic compounds were also found to exhibit oestrogenic activity. This review examines the discovery of both the natural and synthetic oestrogens.

Since ancient times the menstrual cycle has been thought to influence the occurrence and frequency of seizures. The phenomenon of catamenial epilepsy seizures, which either occur at or around the time of menstruation, or become more frequent at this time, has been the subject of much research, although the literature is beset by methodological problems. In contrast, epilepsy at the menopause has not attracted the same attention and in the last 15 years only three studies have been published. None of them has produced conclusive results on the effect of the menopause on the course of epilepsy or the effects, if any, of hormone replacement therapy on seizure control.

Cardiovascular disease (CVD) in the UK is an important public health problem and a significant burden to the National Health Service and Social Services. In 1998 ischaemic heart disease and cerebrovascular disease were the underlying causes of 32.4% of all deaths among women aged 50 years and over in England and Wales (personal communication from the Office for National Statistics). This review discusses the economics of interventions in the management of CVD in postmenopausal women. The evidence of net health effects of hormone replacement therapy (HRT) indicates that, at least in the case of primary interventions, healthcare professionals should consider alternatives to prescribing HRT to healthy postmenopausal women. A targeted programme of multiple interventions covering drug treatment for reducing blood pressure and lowering cholesterol in the high-risk groups combined with health education should play an important role in the prevention of CVD in this population. Given the multi-factorial aspects of the use of HRT, the effectiveness of alternative preventive treatments for other conditions, apart from CVD, such as osteoporosis and climacteric symptoms, should be investigated, preferably in randomised control trials.

This review begins by outlining some of the history behind the World Medical Association's Declaration of Helsinki. The Helsinki distinction between therapeutic and non-therapeutic research will be described and how this relates to a hypothetical HRT trial is considered. Then the ethical significance of research when it is combined with professional care is discussed.

The concept of clinical equipoise is one relevant to menopause research when it involves randomising treatments to participants. Other important considerations mentioned include minimal risk and scientific merit. The final section of the review suggests that the distinction between clinical audit and research is one likely to become increasingly important and that many of the more significant issues associated with audit will relate to confidentiality.

Dementia is a common disorder which may be due to a number of different conditions including Alzheimer's disease, vascular dementia, dementia with Lewy bodies and frontal lobe dementias. Neuropsychological assessment has an important role to play in establishing differential diagnosis and in terms of informing management and monitoring response to recently introduced antidementia drugs. This review briefly summarises the key clinical and neuropsychological features of the different dementias and then discusses both clinically useful screening tests and more detailed cognitive assessment batteries that are frequently used in dementia, as well as the purpose and content of clinical neuropsychological testing.

Objective. To investigate the views of women, general practitioners and practice nurses about current and future menopausal health care, including both health service provision and education.

Study design. Questionnaires were sent to a random sample of 1,000 women aged 40-65 and all general practitioners and practice nurses in the Wigan and Bolton area.

Main outcome measures. Responses to questions about knowledge and views about the menopause, hormone replacement therapy and health care.

Results. Completed questionnaires were returned from 59% (587/998) of women, 64% (181/281) of general practitioners and 82% (147/180) of practice nurses. Only 39% (219/555) of women, 63% (113/179) of general practitioners and 27% (39/144) of practice nurses were satisfied with their knowledge about the menopause/HRT. Ninety-four per cent (170/181) of general practitioners and 100% (143/143) of practice nurses felt the role of the practice nurse in menopause care could be developed in the future. Only 48% (66/139) of general practitioners wanted a practice based menopause/HRT clinic as opposed to 83% (109/131) of practice nurses and 82% (404/496) of women. Twenty-six per cent (41/161) of general practitioners wanted a community menopause clinic in the area as opposed to 73% (99/136) of practice nurses and 75% (351/467) of women.

Conclusions. Women, general practitioners and practice nurses want better menopause care provision. There is a need for further education of both women and health professionals and a great deal of support for extending the role of the practice nurse. General practitioners' views on clinic based care are discussed.