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From The CriticsReviewer: Tessa E Madden, MD, MPH (Washington University School of Medicine)
Description: This is an extensive review of both the basic science of the menopause, and the provision of clinical care to menopausal or perimenopausal women. Thorough discussions cover the physiologic effects of the menopause and appropriate, evidence-based management. This update of the 1999 edition is appropriate as the results of the Women's Health Initiative (WHI) have greatly impacted hormonal therapy and expanded our knowledge of physiologic changes associated with menopause.
Purpose: The purpose is to provide the scientific basis and rationale for management of menopausal women and the associated symptoms. This is a substantial and growing population in the United States. This edition incorporates the new clinical information from the WHI and it is valuable to have a single book that can serve as a reference for a wide range of topics, from understanding the molecular pharmacology of estrogen and progesterone receptors to alternative medical therapies for menopausal symptoms. In covering a diverse array of topics, the book succeeds in its mission.
Audience: According to the editor, the book is appropriate reading for all providers of women's healthcare and medical professionals in training. I would argue that the intended audience varies from chapter to chapter. Some of the basic science chapters are very dense and may not be appropriate for someone without a strong scientific background, but the chapters with clinical relevance are much more accessible. Dr. Lobo is a well known and respected expert in the field of reproductive endocrinology with over 300 publications.
Features: Chapters covering basic science and research aspects of the menopause transition, including estrogen and progesterone receptors, genetic programming and ovarian physiology begin the book. A thorough and up-to-date chapter details the epidemiology of menopause. Sections cover the varying effects of the menopause on physiologic systems, including cardiovascular, bone, and brain. A further section provides a comprehensive review of observational studies and clinical trials conducted on the effects of hormone therapy. The preface to each section by the editor greatly facilitates understanding of the key points contained in each chapter. A strength of the book is the inclusion of sections on traditional hormone therapy, other medical therapies, and complementary and alternative medicines. It's important for clinicians to be aware of these therapies, since greater numbers of women are choosing to avoid hormone therapy. Unfortunately, there is no discussion of the use of SSRIs for the treatment of menopausal symptoms. The chapter on contraception in older women is important as women over 40 have the second highest rate of unintended pregnancy in the U.S., but it contains outdated information about intrauterine devices (IUD). In addition, a discussion about use of the levonorgestrel IUD to protect the endometrium in women taking hormone therapy is lacking, particularly as the evidence suggests the addition of oral progesterones is problematic.
Assessment: Overall, this is an extremely useful and pertinent reference for any clinician providing care to peri- and postmenopausal women and competes as one of the most comprehensive and current menopause books available. The new edition is timely as we incorporate the WHI results and the lessons learned about hormonal therapy into our practices and our management of women in the menopause.