Change of life | |
Menopause. David H Barlow, Barry G Wren. Oxford: Health Press 2000 (70 pp.). ISBN 1 899541 08 X. |
The stated aim
of this book is "to increase understanding of the physiological and psychological effects of menopause and ultimately contribute to effective symptom management". The authors are gynaecologists with acknowledged expertise in all aspects of menopause including research and education. Barry Wren was a prime mover in the formation of the Australian (now Australasian) Menopause Society and its first president. Their book is a model of clarity and comprehension. In a mere 71 pages they have covered a huge field in simple words with clear, striking figures and tables. In this era of information overload it is refreshing to have so much information compressed into such a concentrated, pocket-sized format. I have read it cover to cover and recommend it unreservedly to all clinicians who practise menopause medicine. It is also of particular value to general practitioners who may feel overwhelmed by larger textbooks and the plethora of media articles, the latter concentrating mainly on the possible negative aspects of hormone replacement therapy (HRT), particularly breast cancer. This book also offers good information for lay people, as it is scientific but simple. There are a few minor omissions. I appreciate that such a small book has had to be selective, but I would like to have read a bit more about oestrogens and brain function. The chapter on sexuality mentions "partners" but does not give much guide to relationship issues, such as where, how, or why to seek help. There are also a few minor points with which I take issue. The authors state that "the majority of postmenopausal women taking HRT still use sequential preparations". This may be so in the US and the UK, but in Australia more women nowadays prefer continuous combined therapy. Elsewhere they state "the aim of HRT is to restore oestrogen in responsive tissue to its premenopausal levels". Only with oestradiol implants, I believe, is this likely. For many women even moderate doses of oestrogen produce significant side effects, notably mastalgia. Lower doses are usually sufficient to relieve symptoms and avoid side effects. Exercise is mentioned only as an alternative treatment for osteoporosis. Many large trials have shown it to be effective as adjunctive not just alternative therapy. I challenge the statement (on page 44), which states "Following menopause ovarian production of testosterone ceases and the only testosterone available to women is the result of conversion of adrenal androstenedione to testosterone". This only occurs if the ovaries are removed, otherwise ovarian testosterone is still produced, from the stroma, and accounts for more than 50% of the circulating testosterone.1 But these are minor grouches. The recommended price, is a little quirky and presumably due to fluctuating exchange rates, but it certainly represents value for money. Overall, this small book is an object lesson in the art of succinctness. It is a superb, practical mine of information. Pure gold! Margaret Smith
|