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The Menopause in Practice.
  1. M Wahab
  1. Consultant in Obstetrics and Gynaecology, George Eliot Hospital, Nuneaton, Warwickshire, UK

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    Catrina Bain, Mary Ann Lumsden, Naveed Sattar, and Ian A Greer. (Pp 71; £14.95.) Royal Society of Medicine Press, 2002. ISBN 1-85315-516-0.

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    The field of the management of the menopause is expanding. There is a plethora of data from randomised and observational studies that confirm the effectiveness of HRT in the treatment of menopausal symptoms and for the prevention of postmenopausal bone loss and osteoporotic fractures in addition to a reduction in colon cancer. In the light of the recently published large randomised studies (HERS and WHI), this book will be a useful evidence based guide to general practitioners, postgraduate medical students, and general gynaecologists.

    In a modern, well written, easy to comprehend nine chapters, this book tries to give recommendations for the use of HRT. It addresses the definition of the menopause and its symptoms in three chapters as an introduction to the management and use of HRT. There is a general review of the different preparations and route of administration in chapter 4. The risks of osteoporosis, cardiovascular disease, and thromboembolism are addressed in three elegantly written chapters.

    Compliance with HRT remains low and abnormal bleeding pattern in addition to fear of cancer, especially breast cancer, has been the main causes of non-compliance. These issues are addressed in chapters 4 and 9. Two four lines summery in a box for a quick and easy take-home message follow each paragraph. The further reading list at the end of each chapter is up to date and provide an excellent opportunity to expend upon the topics covered.

    It is arguable whether continuous combined HRT (ccHRT) represent the favourable long term HRT and whether women who are happy on the cyclical sequential HRT should be transferred to ccHRT. Continuous combined HRT is associated with more incidents of unscheduled bleeding in addition to the antagonistic effect of the progestogen on the lipoprotein profile. More detail, however, is not possible given the size of the book and its design as a brief guide.

    Table 5.1 listed the absolute contraindications, but in later chapters, the authors’ view was that HRT use in these women is appropriate with an individualised approach preferably in a specialist clinic. In my copy table 9.1 is missing, although mentioned in the text.

    Overall I recommend this book as an up to date quick reference addressing the issues of the menopause.

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    Footnotes

    • The reviewers have been asked to rate these books in terms of four items: readability, how up to date they are, accuracy and reliability, and value for money, using simple four point scales. From their opinions we have derived an overall “star” rating: * = poor, ** = reasonable, *** = good, **** = excellent.

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