Post Reproductive Health

In Europe ovarian cancer represents the third most common cancer of the female genital tract, with 30,000 newly diagnosed patients per year. Family history is the most significant risk factor. Lifetime risk for ovarian cancer increases from 1.4% for women with a negative family history to 14.6-32.2% in women from affected families. About 5-10% of ovarian cancers are hereditary and supposed to occur in three different forms: hereditary breast and ovarian cancer syndrome (HBOC), site-specific hereditary ovarian cancer (HOC) and hereditary nonpolyposis colorectal cancer syndrome (HNPCC). HBOC and HOC account for 80-90% of the cases and are associated with inactivating germline mutations of the BRCA1 and BRCA2 genes. For BRCA1 and BRCA2 mutation carriers the cumulative risk by age 70 of developing ovarian cancer is 45-60% and 25-30%, respectively. Approximately 10-15% of familial ovarian cancers are related to the HNPCC syndrome with a cumulative ovarian cancer risk of 9% by age 70. Germline polymorphisms may further modify ovarian cancer risk. Bilateral prophylactic oophorectomy reduces the risk of developing ovarian cancer in HBOC and HOC families by 50%. Tubal ligation also significantly reduces the risk in BRCA1 mutation carriers (odds ratio 0.39). Knowledge of the genetic background provides an objective basis for individual risk assessment and prevention.

The antioxidants glutathione, selenium and vitamins C and E meet the criteria for nutraceuticals and their in vivo concentrations can undoubtedly influence and improve many disease processes. In an attempt to quantify and correlate their individual roles as nutritional supplements with their therapeutic potential to improve symptoms and lifestyle during the menopause, we conducted a literature search covering the 15 years up to 2001. Few publications were found dealing specifically with menopausal women. Approximately 90% reported research with vitamins and/or selenium and only one paper investigated a possible correlation between glutathione and breast cancer. This relatively low level of research interest in nutritional or antioxidant aspects of the menopause may just reflect a preoccupation with the more general chronic diseases of an ageing population, without necessarily acknowledging the important physiological changes that occur in women. The little encouraging data in the literature should stimulate more research into the prognostic value, mechanisms and efficacy of nutraceutical supplementation that specifically relate to menopausal women.

Coronary artery disease is the greatest cause of death and disability in women. Women often have atypical chest pain which should be thoroughly evaluated. Women benefit as much as men from coronary care, thrombolysis, coronary artery bypass grafts and coronary angioplasty but are more likely to have advanced disease, and be hypertensive, diabetic and older at presentation- and thereby have increased complications and mortality. All clinical trial data published so far does not identify HRT therapy as a means of preventing or treating CAD. Since women are older at presentation they are vulnerable to age bias, which may therefore appear to be gender bias.

The premenopausal period is a time when the risk of coronary events for women is low. It is, however, a key period during which the atherosclerotic process, the leading cause of death in women, becomes established. The role of female sex hormones in protecting premenopausal women from overt atherosclerosis is widely accepted. Proof of a direct oestrogen, atheroprotective effect, however, continues to prove elusive. The specific risk factors are diabetes, hypertension, lipid abnormalities, smoking, body habitus, inflammatory disease and prothrombotic tendencies. Reproductive factors do not appear to play a major role in defining cardiac risk and the absolute risk posed by the oral contraceptive is low; concerns about cardiac risk should not be exaggerated.

Ageing need not herald the end of a satisfying sex life. Research shows that men and women over the age of 60 can enjoy sexual activity, and it appears to be factors arising from the male that, most frequently, influence whether or not sexual activity will continue. With improved treatments now available to treat male sexual dysfunction and an ongoing search for greater understanding of the aetiology and management of female sexual dysfunction, in addition to improved general health, it is anticipated that the proportion of sexually active older people will increase. It is the responsibility of healthcare professionals to ensure that elderly people feel comfortable seeking help for sexual difficulties and that help is made available to all, irrespective of age and sex.