Positive approach to women in mid-life

WITH FEW EXCEPTIONS, our youth-obsessed culture either ignores middle-aged women or indulges in stereotypes. So I was pleased to learn that, at a recent conference, the US Census Bureau had extended my youth by redefining middle age as commencing at age 50. Despite this, here is a new textbook which focuses on women aged 40 to 65 and has a positive outlook. It encourages consideration of the variety of social and health circumstances that these women may enjoy, from single and childfree to a grandmother raising her grandchildren, from the peak of her career to pensioner. The messages are that “midlife is far more than hormones”; that it is an opportunity for women to take stock and explore health promotion opportunities; and that the doctor’s role is to facilitate this process.

The book is divided into four parts: Health promotion, Hormonal changes, Disease prevention and Cancer prevention. Each chapter is evidence-based and well referenced, and includes many US institutional websites for up-to-date information. Realistic case vignettes and algorithms could be helpful for general practitioners.

As an example of the useful content, the chapter discussing physical activity and exercise takes us through the considerable evidence base for resistance training, endurance training, yoga and t’ai chi, including the underlying physiological changes; provides 16 examples of what constitutes moderate exercise; and finally, summarises practical advice for prescribing exercise for both healthy women and those with various medical conditions, such as arthritis, osteoporosis or diabetes.

The chapter on hormone therapy explores in detail the ramifications of the recent large hormone replacement therapy (HRT) trials. Many alternatives to HRT are offered, including a detailed section on complementary therapies, and the author cites many ongoing studies.

The only small negative about this text is that it uses almost exclusively US data, references, acronyms and drug trade names. This means that chapters such as those on Pap testing have recommendations and pathology categories that differ from those used in Australia.

These are minor issues, however, and overall this is an excellent textbook.

Marie V PirottaDepartment of General Practice University of Melbourne, VIC