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Recent Developments in Hormone Replacement Therapy (HRT)
C.E. Kearney (Research Fellow)
D.W. Purdie (Professor)
Centre for Metabolic Bone Disease, Hull Royal Infirmary, Hull, United Kingdom
Summary
- Oestrogen therapy is the modality of choice for preventing and managing postmenopausal osteoporosis.
- Available data does not support widespread, non-discriminatory prescription of HRT for cardiovascular benefit.
- HRT is associated with a small increase in the risk of localised breast cancer; it is best avoided in patients with thrombophilia and those predisposed to venous thromboembolism (VTE).
- Selective oestrogen receptor modulators (SERMs) such as raloxifene provide an alternative to HRT in the older woman at risk of osteoporosis and may yet provide an alternative to oestrogen in other situations.
- Tibolone may be used for the treatment of osteoporosis and menopausal symptoms (where it is as effective as continuous combined oestrogen therapy, but with less likelihood of bleeding).
Editor's Comment
HRT, though initially developed to treat menopausal symptoms, is now an established intervention in the prevention and treatment of osteoporosis. Determining further potential clinical benefits and risks associated with the use of HRT is a field of intense current enquiry. Recent developments include the emergence of SERMs and the re-emergence of the gonadomimetic tibolone.
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Appropriate Use of Mammography
Manu M. Shroff (Head)
Archana Verma (Clinical Assistant)
Department of Imaging, Hinduja Hospital, Mumbai, India
Summary
- Women have a baseline risk of developing breast cancer of approximately 4-6% over the course of their lifetime.
- A significant reduction in breast cancer deaths can be achieved by screening.
- One of the most critical aspects of breast cancer detection is correct positioning of the patient and proper exposure of the mammogram in order to obtain quality images.
- If the results of mammography are unclear, ultrasound is the next step in imaging evaluation.
- Slow or no apparent growth should not deter recommendation for biopsy in cases of highly suspicious mammographic findings.
- Use of a second mammogram reader can allow detection of an additional 5-15% of cancers.
Editor's Comment
Selecting appropriate women for breast cancer screening and completing appropriate mammographic assessment are central to the successful early detection of breast cancer. The scope of this paper encompasses both of these requirements and highlights the importance of regular review of existing practice.
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Clomiphene Challenge Test (CCT) and Prediction of Reproductive Potential
Siya S. Sharma (Assistant Professor)
Pratap Kumar (Professor; Head)
Department of Obstetrics & Gynaecology, Kasturba Medical College, Manipal, India
Summary
- The clomiphene challenge test (CCT) assesses the reserve of the gonadal-hypothalamic axis as an indicator of female fecundity.
- The CCT gains prospective information on ovarian responsiveness, by provocative testing to stimulate follicle-stimulating hormone (FSH) release.
- FSH response to the CCT reflects ovarian follicular inhibin capability and can detect abnormalities not apparent from basal (day 23) FSH levels.
- The CCT provides a reliable method of predicting ovarian response to ovarian induction treatment.
Editor's Comment
The CCT appears to be a simple, economical and practical means of evaluating the patient's ovarian reserve before pursuing in vitro fertilisation (IVF) attempts.
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