WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

CHAPTER 10: GYNECOLOGIC AND URINARY ASPECTS
OF MENOPAUSE
Piergiorgio Crosignani, M.D.;* † Susan Hendrix, D.O.; ‡§ Vivian W. Pinn, M.D., Ph.D.**
KEY POINTS a
1. Changes in the menstrual cycle have been described in several clinical
studies during the menopausal transition [C].
2. It is important to know how to diagnose endometrial cancer because it
is a cause of abnormal uterine bleeding [C,D].
3. Management of uterine bleeding during HRT includes observation, surgery,
or specific modifications of the treatment regimen [C,D].
4. Vulvovaginal complaints in menopause are very common, and estrogen is
efficacious in their treatment [A,C,D].
5. (UI) is common with aging. The relationship between UI and menopause is not well understood [C,D].
6. Estrogen may benefit urge incontinence; however, it may exacerbate stress UI [A].
7. There are multiple new agents shown to be effective in the treatment of incontinence [A].
8. Some SERMs may increase risk for pelvic organ prolapse [B].
* From the First Department of Obstetrics and Gynecology, University of Milan, Milan, Italy.
† Paragraphs 1 to 4.
§ From the Division of Gynecology, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Hutzel Hospital, Detroit, MI,
U.S.A.
‡ Paragraphs 5 to 7.
** From the Office of Research on Women’s Health, NIH, Bethesda, MD, U.S.A.
Changes in the menstrual
cycle have been described
in several clinical studies
during the menopausal
transition.
a Evidence categories are given in square brackets. A = randomized controlled trials (rich body of data); B = randomized controlled trials (limited data);
C = nonrandomized trials and observational epidemiologic studies; D = panel expert judgement. (See also table 1–1.)
203