Australian Family Physician November 2004 - Women in Midlife
Vol 33(11):865-960
Our November 2004 issue focuses on health issues for women
in their midlife. This includes articles on hormone replacement therapy,
and menopause including the psychosocial issues. Issue also includes
articles on dysfunctional uterine bleeding, guidelines for the
management of postmenopausal osteoporosis and benzodiazepine dependence.
Toward a doctor-patient partnership
Jenni Parsons
The change in thinking on the role of hormone therapy (HT) as a result of the Women's Health Initiative (WHI) raised a number of important issues about the way we practise medicine.
Current status of hormone therapy in general practice in Australia
AIHW General Practice Statistics and Classification Unit
The BEACH program is a continuous national study of general practice activity in Australia. The subject of this analysis was all problems for which a hormone therapy (HT) medication was prescribed or supplied at HT encounters with women aged 40 years and over between March 2002 and April 2004.
Hormone therapy - weighing up the evidence
Helena J Teede
Hormone therapy (HT) use is well established for menopausal symptom relief, but its use is not currently considered justified for the prevention of disease.
Assessment of women in midlife
Sue Reddish
Midlife is much more than menopause. At the time of their life when women may be experiencing symptoms relating to decreased ovarian function, they are also confronted with a range of physical and psychosocial issues that may affect their wellbeing.
Is this menopause? Women in midlife - psychosocial issues
Amanda A Deeks
Psychosocial influences have been found to impact on the symptoms a woman may experience as she moves through the menopause transition. Consequently any assessment of the menopausal woman should include an exploration and understanding of how the many psychosocial factors influence the experience of menopause and midlife.
If not hormones - then what?
Alice Murkies
The Women's Health Initiative study has made women reconsider their use of hormone therapy and made medical practitioners review the risks and benefits to each patient. The significance of lifestyle, nonprescription, and prescription therapies for menopause management are of increasing relevance.
Menopause - a treatment algorithm
Sue Reddish
The Jean Hailes Foundation has developed an algorith for assessment and treatment of menopausal women.
Menopause forum - a case discussion on midlife issues
Helena J Teede, Sue Reddish, Amanda A Deeks, Elizabeth Farrell, Alice Murkies
The authors of our theme articles this month discuss their approach to the assessment and management of a woman presenting with issues relating to menopause and midlife.
Dysfunctional uterine bleeding
Elizabeth Farrell
Dysfunctional uterine bleeding (DUB) is the major cause of heavy menstrual bleeding and impacts on women's health both medically and socially.
Guidelines for the management of postmenopausal osteoporosis for GPs
Sheila O'Neill, Alastair MacLennan, Shona Bass, Terry Diamond, Peter Ebeling, David Findlay, Leon Flicker, Alex Markwell, Caryl Nowson, Nick Pocock, Philip Sambrook, Maria Fiatarone Singh
Since the last series of guidelines on the management of osteoporosis from Osteoporosis Australia was published in Australian Family Physician (October 2002), there have been further advances in our understanding of the treatment involved in both the prevention of bone loss and the management of established
Benzodiazepine dependence
Eric Khong, Moira G Sim, Gary Hulse
Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of use can be even more difficult if there are other comorbidities such as oestrogen deficiency with vasomotor symptoms and anxiety disorders.
Writing a police statement
Helen Louise Parker
Requests for police statements regarding a patient's medical condition or injuries are common. A lack of training in their preparation, coupled with ignorance as to their fate, combine to make the task one which is generally viewed as a necessary paperwork evil.
Eye Series: Dry eyes, menopause and hormone therapy
Chris Hodge, David Ng
A woman, 49 years of age, returns for a regular check up to monitor menopausal changes and to decide whether medication for her menopause symptoms is necessary.
Clinical challenge
Jenni Parsons
Questions for this month's clinical challenge are based on theme articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam.
Brain teaser: Unexplained lactation
Jerzy K Pawlak
A 50 year old woman presents with galactorrhoea. Breast examination was otherwise normal.
Clinical guidelines: breast cancer
Sara Bird Failure to diagnose breast cancer is a relatively common cause of complaints and claims involving general practitioners. This article examines the use of evidence based clinical guidelines and outlines some risk management strategies for GPs to minimise the possibility of a complaint or claim arising from an allegation of failure to diagnose breast cancer.
Changing attitudes to 'the change'
Katrina Allen, Peter Mansfield
In order to practise efficiently, experienced doctors use heuristics (decision making shortcuts). In most cases decision making shortcuts improve the service we offer, allowing us to make appropriate decisions more quickly. However, occasionally shortcuts can mislead. It is important to reflect on the shortcuts we use so as to reduce the risk of mistakes.
Better outcomes - a case study
Julie McCormack, Julian Thomas
It is estimated that mental health problems will affect more than 20% of the Australian adult population in their lifetime. The 2001 Australian Commonwealth budget provided $120.4 million over 4 years to improve the quality of care provided through general practice to Australians with a mental health illness.
What's new in research that should change the way we detect and treat hypertension?
Mark R Nelson
The management of hypertension remains central to the preventive strategies employed in general practice. BEACH data confirms it is the commonest management problem in this environment.
Data monitoring (and safety) committees - what are they and why do we need them?
Marie Pirotta, Patty Chondros
Randomised controlled trials (RCTs) are considered the gold standard of evidence for clinical decisions and are the keystone of the Cochrane Collaboration. However, such trials are resource intensive in terms of time and money, difficult to conduct, and usually rely on the altruism of the population for their participants.
Sphygmomanometers - an audit in general practice
Nayankumar C Shah, David W Sibbritt, Susan Heaney, Jan Sharples
The accuracy of sphygmomanometers used in Australian general practice is unknown but potentially important.
The use of herbal medicines for the treatment of menopausal symptoms
Mulavana Parvathy, David W Sibbritt, Jon Adams
Hormone therapy (HT) is the most effective treatment for some symptoms (eg. hot flushes, dry vagina) associated with menopause. However, its popularity has recently been challenged following adverse publicity related to side effects.
GPs' views on active nutrition management for their patients
Lisa Nicholas, Dimity Pond, David CK Roberts
Patient nutrition management has the potential to reduce patient suffering and health care costs. At the forefront of providing nutrition management in Australia are general practitioners and dieticians. Consumers have stated that while they perceive dieticians to have the highest expertise in nutrition, they rank GPs second.
Doctor-patient treatment goals in the management of osteoarthritis in general practice
Suzanne McKenzie, Charles Bridges-Webb
Patients can be asked to record symptoms important to them. Doing this is especially appropriate for interventions to improve function or relieve symptoms, and when the choice of measures concentrates on what the patient wishes to change.