Menopause -- natural change | |
A clinician's guide to menopause. Donna E Stewart, Gail Erlick Robinson (editors). Washington DC: Health Press 1997 (ix + 243 pp.). ISBN: 0 88048 764 2. |
Menopause, for many women a natural reproductive milestone like menarche, is viewed by many doctors as an endocrinopathy requiring medical intervention and management. It is easy for women, as well as their clinicians, to blame everything that happens around this time on hormones. As a postmenopausal woman doctor, I applaud the authors of A clinician's guide to menopause for their emphasis on the naturalness of the transition and their wide view of the events which shape this passage. At the same time they present a sound scientific basis for their observations. The editors are directors of departments which combine psychiatry with gynaecology. The contributors, predominantly women, are from Canada, the United States and Australia. The two Australians are from the prestigious Key Centre for Women's Health in Melbourne. Thus, a wide spectrum of experience and opinion has been culled, with a refreshing emphasis on quality of life, psychological and emotional well-being. Nowadays, the loss of reproductive capacity is not often a major cause of grief related to the perceived loss of the main feminine role. There are many other losses at midlife and this book explores these using some very interesting case histories. In every chapter the emphasis is on health promotion as well as disease treatment. As many women today seek ways to avoid medication, the topic of "natural" therapy is sensibly addressed. "Times have changed since leeches and rest were prescribed treatment for menopausal symptoms", states one of the authors. The chapter on hormone replacement therapy (HRT) gives a very well balanced view and addresses the fear that HRT increases breast cancer risk. With so many women and their doctors becoming disenchanted about HRT, it is good to see a broader approach which puts HRT simply and sensibly into the context of the overall and individual management of the woman at menopause. I urge general practitioners to buy this book. It offers a fresh approach to the topic, is very readable and, despite multiple authorship, is not repetitive. It will certainly enrich my own practice. Margaret Smith
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