Medlemsblad 4 2005 - SFOG

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Intressegrupper inom <strong>SFOG</strong> Privatgynekologerna Ordförande Dr Gunnar Möllerström Oxbackskliniken Lagmansv 14 152 40 SÖDERTÄLJE Tfn: 08-5509 9100 Fax: 08-5544 3120 E-post: gunnar.mollerstrom@tyfon.com Dr Håkan Forsgren Lovisa Läkarmottagning Saltängsgatan 15 602 22 Norrköping Tel: 011 - 16 44 00 E-post: hakan.forsgren@telia.com Dr Olof E. Löfgren Gynhälsan i Trelleborg Gamla Torget 3 A 231 63 TRELLEBORG Tfn: 0410 - 407 60 Fax: 0410 - 407 60 E-post: tremottab@swipnet.se Mödrahälsovårdsöverläkargruppen Ordförande Dr Pia Collberg Centrala Mödra-barnhälsovården Östersunds sjukhus 831 83 Östersund Tfn: 063-15 37 35 Fax: 063-15 45 29 E-post: pia.collberg@jll.se Sekreterare Dr Margareta Goop MHV-enheten, plan 4, VC Gripen Box 547 651 12 Karlstad Tfn: 054-67 67 07 Fax: 054-61 66 91 E-post: margareta.goop@liv.se Obstetriker och gynekologer under utbildning (OGU) Ordförande Dr Sara Törnblom KK Karolinska Universitetssjukhuset Solna 171 76 Stockholm Tfn: 08 - 663 63 90 Fax: 08 - 31 81 14 E-post: sara.tornblom@karolinska.se Sekreterare Dr Åsa Rosén KK Sahlgrenska Universitetssjukhuset/Östra 416 85 Göteborg Tel: 031 - 343 40 00 Fax: 031 - 25 43 87 E-post: asa.rosen@vgregion.se Gruppen för öppenvårdsgynekologi Ordförande Dr Cilla Salamon Ultragyn Odengatan 69 113 22 Stockholm Tfn: 08-587 101 99 Fax: 08-587 101 90 E-post: cilla.salamon@odenplan.ptj.se Sekreterare Dr Peter Krug Gyn. mott., Sjukhuset Box 113 311 22 Falkenberg Tfn: 0346 - 560 44 Fax: 0346 - 581 83 E-post: peter.krug@lthalland.se 52 MEDLEMSBLADET 4/ 05
Ny avhandling The Climacteric Management and Attitudes among Women and Physicians Aims: Paper I: To longitudinally assess the prevalence of climacteric symptoms, the use of hormone replacement therapy (HRT) and life-style factors in the same women in 1992 (aged 46-62 years) and in 1998 (aged 52-68 years). Paper II: To study changes in (i) the prevalence of HRT use and (ii) attitudes and knowledge about the climacteric among 46-62 years old women resident in Göteborg 1992 and 1998. Paper III: To study changes in management strategies concerning HRT among gynecologists in Sweden and to assess possible use of HRT among gynecologists. Paper IV: To investigate the effect on glucose homeostasis and plasma lipids of treatment with estradiol and norethisterone acetate (NETA) in postmenopausal women with type 2 diabetes. Patients and methods: Papers I & II: Population-based studies initiated in 1992 in 46-62 years old women, (5 birth cohorts) randomly obtained from the population register. The women received a postal questionnaire regarding life-style, the climacteric and its treatment. Paper I: In a prospective, longitudinal cohort study the same women (n = 3816) were assessed again in 1998 with a similar questionnaire. Paper II: In a new cross-sectional study 1998, with identical design as the study from 1992, a random sample of 5411 women of the same ages as in the study from 1992 was contacted. Paper III: In 1996, gynecologists in Sweden (n = 1323) were invited to return a postal questionnaire about (i) their attitudes, knowledge and management strategies concerning HRT and (ii) their own or their partners possible use of HRT. In 2003, the same technique was used and a similar questionnaire was sent to practicing gynecologists in Sweden (n = 1320). Paper IV: Thirty-one postmenopausal women with type 2 diabetes were included in a randomised, double-blind, placebo-controlled Louise Thunell, MD, Department of Obstetrics and Gynecology Sahlgrenska Academy at Göteborg University, Göteborg, Sweden study with cross-over design. Each treatment period was 6 months. All metabolic and anthropometric examinations were performed at baseline and after each treatment period. Results: Paper I: The prevalence of climacteric symptoms increased in the same women between 1992 and 1998: vasomotor symptoms 52%/62%, sleep disturbances 51%/69%, loss of libido 38%/57%, depression/irritability 57%/ 65%. Current use of HRT increased from 14% in 1992 to 34% in 1998. The number of smokers decreased (32% to 26%) and BMI and exercise increased. Paper II: HRT use increased between 1992 (13%) and 1998 (31%) in the cross-sectional comparison. The highest prevalence was reported in women 54 years of age (46%). Forty-four percent of the women were prepared to consider life-long HRT if the treatment was free from withdrawal bleedings (35%, 1992). Eighty percent believed that the risk of osteoporosis decreased during HRT use (61%, 1992) and 68% thought that the risk of breast cancer increased (58%, 1992). Paper III: In 2003, 11% of the gynecologists thought that all women without contraindications should be offered HRT compared to 44% in 1996. Twenty-five percent in 2003 stated that risk factors for osteoporosis were absolute indications for HRT compared to 60% in 1996. Current ischaemic heart disease was considered to be an indication for HRT by 7% in 2003 (60% in 1996). Seventyone per cent of female gynecologists and 68% of the male gynecologists´ partners used HRT in 2003 (88 och 86% in 1996). Paper IV: Estradiol/NETA therapy decreased hyperandrogenicity i.e. sex hormone binding globulin (SHBG) increased and free testosterone decreased. Lipoprotein (a) and plasminogen activator inhibitor- 1 (PAI-1) decreased. No changes in glucose homeostasis were found. Conclusions: Symptoms associated with the climacteric period increased in the same birth cohorts of women from 46-62 to 52-68 years of age. Use of HRT increased markedly between 1992 and 1998 in women in Göteborg, Sweden. Gynecologists in Sweden were more cautious in their management strategies concerning HRT in 2003 compared to 1996 and their personal use of HRT had also decreased. The impact on cardiovascular risk factors and glucose homeostasis of 2 mg estradiol/1 mg NETA in postmenopausal women with type 2 diabetes is probably neutral. Keywords: climacteric, epidemiology, longitudinal, climacteric symptoms, hormone replacement therapy, attitudes, knowledge, gynecologists, postmenopausal, type 2 diabetes, hyperandrogenicity, glucose homeostasis, lipids, PAI-1 MEDLEMSBLADET 4/ 05 53
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