Lynne T. Shuster, MD, Women’s Health Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Sharonne N. Hayes, MD, Women’s Heart Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Mary L. Marnach, MD, Women’s Heart Clinic, Department of Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Virginia M. Miller, PhD, Departments of Surgery and Physiology and Biomedical Enginering and Office of Women’s Health, Mayo Clinic College of Medicine, Rochester,MN,USA.

Women in the Western world may expect to spend a significant portion of their lives in postmenopause. After menopause, women are at increasing risk for several conditions associated with aging that may or may not be related to declining hormone levels. Caring for women seeking advice and treatment for menopausal concerns presents a golden opportunity to not only identify individuals at risk for early intervention but also to address prevention and screening strategies important to sustaining health.
Keywords: cancer, cardiovascular disease, menopause, osteoporosis, screening.

Geriatrics & Aging 2005;9,October 2005,51-54.

Dear Editor,

I very much enjoyed Dr. Jerrilynn Prior’s article entitled “Symptomatic Menopause--What Are the Safe and Effective Options?” in the October 2005 edition of your journal. I have three questions.

Question 1-Does Dr. Prior recommend the addition of a progestin for women with an intact uterus using vaginal estrogens for dryness/dysparunia?

Question 2-In figure 1, she suggests that women with disturbing hot flushes combined with osteoporosis take transdermal estradiol along with daily micronized progesterone at a dose of 300 mg. In the text of her article, she states that this dose of OMP is equivalent to 10 mg of MPA. This seems like a higher dose of MPA than most would use for daily dosing. Is this correct?

Question 3-Is there evidence to assure us that unopposed progestin therapy (as she suggests as treatment for severe vasomotor symptoms without osteoporosis) is safe?

Again, thanks very much for the informative article.

Sincerely,

A. Lewis
Family Medicine
Calgary, AB

Marla Shapiro, CCFP, MHSc, FRCPC, FCFP, Assistant Professor, University of Toronto, Department of Family Medicine; Medical Consultant, CTV, Toronto, ON.

Whether women are taking hormone replacement therapy for the prevention of heart disease, osteoporosis or the symptoms of menopause, results from the Women's Health Initiative (WHI) study have brought to the forefront many concerns. Results from this as well as the HOPE study are reviewed, followed by the ensuing responses and recommendations from medical societies. Assessing and tailoring hormone replacement therapy for every woman individually is what can be recommended clearly until further studies are published.
Key words: menopause, hormone replacement therapy, current controversies

With a life expectancy of 81.

Jerilynn C. Prior MD, FRCPC, Professor of Endocrinology/Metabolism, Department of Medicine, University of British Columbia and Vancouver Hospital, Vancouver,

Abstract
Estrogen and progesterone (so-called "hormone replacement") therapy was formerly considered essential for menopausal women. The purpose of this paper is to outline the shifts in concepts related to estrogen and progesterone therapy and to describe situations in which it remains a practical, effective therapy for older women.

Estrogen and progesterone are useful for women >65 years old who have osteoporosis diagnosed by bone mineral density or vasomotor symptoms (VMS) disturbing sleep, especially if either are combined with recurrent urinary tract infections or severe dysparunia. If a woman has had a fragility fracture (in a fall from a standing height or less), hormone therapy should be combined with a bisphosphonate such as etidronate for optimal fracture prevention.

Optimal hormone therapy for older women, ideally, is transdermal (patch or gel), rather than oral, to decrease thromboembolic risks. Several lines of evidence suggest that low estrogen doses (such as 25 µg Estraderm®‚ patch, one pump Estragel®) are adequate. Oral micronized progesterone (Prometrium®), given daily, avoids flow, is effective for VMS and increases bone formation. Optimal therapy is daily full or moderate dose progesterone (200 to 300 mg or 5-10 mg medroxyprogesterone).

Jocalyn P Clark, MSc

The National Council on the Aging in Washington, D.C. recently released the findings of its landmark study entitled Healthy Sexuality and Vital Aging.¹ This unprecedented look at older people's sexuality will surely debunk many long-held views about the sexual lives of elderly North Americans. For one, older people appear to be both having sex and enjoying it. Over half of the older people in this study were found to have engaged in sexual activity within the last month, and 40% reported wanting sex more frequently. Only 4% wanted sex less often. Among those who were sexually active, over three-quarters said that maintaining an active sex life is an important aspect of their relationship with their partners. In addition, more than 70% said they were as satisfied or more sexually satisfied than they were in their 40s.