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Menopause: Endocrinology and Management
edited by David B. Seifer, MD, and Elizabeth A. Kennard, MD, 270 pp, $99.50, ISBN 0-896-03677-4, Tottowa, NJ, Humana Press, 1999.
Arch Fam Med. 2000;9:391.
Menopause: Endocrinology and Management is a concise reference book aimed at physicians who care for menopausal and postmenopausal women. Its aims are to illuminate the current understanding of the endocrinology of menopause and to provide a sound basis for its successful treatment. Overall, it is informative, well written, and provides good summaries of the topics most pertinent to women undergoing menopause.
There are 16 chapters that include the expected topics, such as cardiovascular disease, osteoporosis and bone loss, depression, memory change, and genitourinary problems encountered during and after menopause. One chapter details the risks, benefits, and alternatives to conventional hormone replacement therapy (HRT). Other chapters review more recent developments, such as the use of androgens, selective estrogen reuptake modulators, and phytoestrogens.
The chapters are laid out well and are easy to read, with a list of contents at the beginning of each. However, many of the chapters lack tables, diagrams, and charts, which makes it difficult to find the exact information you require without reading through paragraphs of text.
The text begins with a concise, well-written overview of how to predict the onset of menopause and includes a thorough review of the epidemiologic, endocrinologic, and anatomic parameters to be considered. The information is up-to-date and well-referenced.
The chapter on osteoporosis prevention and treatment provides an evidence-based approach and comprehensive recommendations. However, the section on biochemical assessment was somewhat vague and, although the metabolic tests that can be performed are mentioned, there is little discussion of the potential usefulness of these tests as monitoring tools.
The chapter on HRT provides an excellent, clearly written, well-referenced overview of the benefits and risks of HRT. It also includes comprehensive tables on the formulations of HRT currently available, although more information on the rationale behind the selection of the various regimens could have been provided.
An important chapter, particularly for physicians who discuss risks and benefits of HRT with patients, is the one that details evidence on the cancer risk associated with HRT. Fear of cancer, particularly breast cancer, is probably the greatest barrier to patients starting an HRT regimen. The evidence concerning breast, endometrial, and ovarian cancer risk is concisely presented and discussed. The evidence on breast cancer is very neatly divided into case-control, cohort, and meta-analytic studies, and the confidence intervals around the relative risks are emphasized. This chapter provides an excellent approach to what can be a very confusing and controversial subject.
It is timely to include a chapter on phytoestrogens (plant estrogens), as they have made huge gains in popularity among the lay public during the past 5 years. The information in this chapter is up-to-date, fairly comprehensive, and well-referenced. However, the bulk of the evidence presented is from in vitro studies of phytoestrogen benefits, and the fact that there is far less evidence of the benefit to human subjects is not emphasized enough. Hence, the evidence presented is somewhat biased toward the value of phytoestrogens. In addition, there is little or no discussion of the potential negative impact of phytoestrogen use and, although it is stated that vasomotor symptoms are helped by phytoestrogens, the experimental evidence for this in the literature is weak.
The final chapter covers general care for the postmenopausal woman and discusses the recommended screening tests to be done at regular intervals. Although it provides a good overview of care, a recommendation of a 1-hour visit per patient is somewhat idyllic in today's managed care environment. The evidence-based approach is lacking in some parts of this chapter. A significant amount of space is dedicated to discussing the pros and cons of potential screening tests that have not been proven effective, such as chest x-rays for lung cancer, instead of discussing the approach to smoking cessation. More emphasis should have been placed on interventions that have been proven to be beneficial (such as patient behavioral change), rather than explaining why screening tests for ovarian and uterine cancer are not useful.
Because of the nature of the text, there is some overlap of the information presented. In the section on alternatives to HRT, details regarding the treatment of osteoporosis are superfluous, as it is discussed elsewhere and in greater detail. Also, in the discussion of HRT alternatives, some recommendations are made that are not supported by evidence and are somewhat controversial, including the use of bellargal for hot flashes.
This text provides an excellent overview of menopause and covers most of the pertinent topics. It is suitable as a reference text for any physician involved in caring for menopausal women.
M. Gina Glazier, MB, BCh
Philadelphia, Pa
(e-mail: glazier{at}mail.med.upenn.edu)
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