Nathan G Kase1. 1. Department of Obstetrics, Gynecology and Reproductive Science, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10026-6574, USA. nathan.kase@mssm.edu
Abstract
BACKGROUND: Midlife women (aged 35-65 years) present a complex combination of clinical challenges and health care opportunities. To meet these issues effectively, recognition of the various phases of the entire menopausal transition is necessary, because each possesses unique biological properties underlying phase-specific clinical presentations. OBJECTIVE: The aim of this article is to inform health care decisions by defining the endocrine, metabolic, and clinical consequences of therapeutic inaction or intervention at each stage of the midlife experience. METHODS: Using PubMed, MEDLINE was searched for age- and phase-specific publications about ovarian function and corresponding clinical manifestations in women aged 35 to 65 years. Large, long-term longitudinal prospective, case-control, and observational studies were selected for inclusion. Results of the Framingham Heart Study, Study of Women's Health Across the Nation, Nurses' Health Study (NHS), and Women's Health Initiative (WHI), as well as materials from the World Health Organization and American College of Obstetricians and Gynecologists, were obtained from the relevant groups' Web sites in 2008. RESULTS: Synthesis of the data acquired, particularly the confirmatory and contrasting elements displayed in the WHI and NHS publications, leads to a set of guiding principles whereby individualized phase-specific management strategies may be safely employed. These include the value of weight control and exercise; use of specific nonhormonal therapies for defined indications; definition of strict inclusion/exclusion criteria; and individualization of timing, regimen, dosage, and portal of entry for possible hormone therapy. CONCLUSION: An evidence-based, restrictive inclusion/exclusion strategy can be used to maximize benefits and minimize risks for this large, growing, and health-conscious but increasingly vulnerable population.
BACKGROUND: Midlife women (aged 35-65 years) present a complex combination of clinical challenges and health care opportunities. To meet these issues effectively, recognition of the various phases of the entire menopausal transition is necessary, because each possesses unique biological properties underlying phase-specific clinical presentations. OBJECTIVE: The aim of this article is to inform health care decisions by defining the endocrine, metabolic, and clinical consequences of therapeutic inaction or intervention at each stage of the midlife experience. METHODS: Using PubMed, MEDLINE was searched for age- and phase-specific publications about ovarian function and corresponding clinical manifestations in women aged 35 to 65 years. Large, long-term longitudinal prospective, case-control, and observational studies were selected for inclusion. Results of the Framingham Heart Study, Study of Women's Health Across the Nation, Nurses' Health Study (NHS), and Women's Health Initiative (WHI), as well as materials from the World Health Organization and American College of Obstetricians and Gynecologists, were obtained from the relevant groups' Web sites in 2008. RESULTS: Synthesis of the data acquired, particularly the confirmatory and contrasting elements displayed in the WHI and NHS publications, leads to a set of guiding principles whereby individualized phase-specific management strategies may be safely employed. These include the value of weight control and exercise; use of specific nonhormonal therapies for defined indications; definition of strict inclusion/exclusion criteria; and individualization of timing, regimen, dosage, and portal of entry for possible hormone therapy. CONCLUSION: An evidence-based, restrictive inclusion/exclusion strategy can be used to maximize benefits and minimize risks for this large, growing, and health-conscious but increasingly vulnerable population.
Authors: Harvey S Levin; Nancy R Temkin; Jason Barber; Lindsay D Nelson; Claudia Robertson; Jeffrey Brennan; Murray B Stein; John K Yue; Joseph T Giacino; Michael A McCrea; Ramon Diaz-Arrastia; Pratik Mukherjee; David O Okonkwo; Kim Boase; Amy J Markowitz; Yelena Bodien; Sabrina Taylor; Mary J Vassar; Geoffrey T Manley; Opeolu Adeoye; Neeraj Badjatia; M Ross Bullock; Randall Chesnut; John D Corrigan; Karen Crawford; Sureyya Dikmen; Ann-Christine Duhaime; Richard Ellenbogen; V Ramana Feeser; Adam R Ferguson; Brandon Foreman; Raquel Gardner; Etienne Gaudette; Luis Gonzalez; Shankar Gopinath; Rao Gullapalli; J Claude Hemphill; Gillian Hotz; Sonia Jain; C Dirk Keene; Frederick K Korley; Joel Kramer; Natalie Kreitzer; Chris Lindsell; Joan Machamer; Christopher Madden; Alastair Martin; Thomas McAllister; Randall Merchant; Amber Nolan; Laura B Ngwenya; Florence Noel; Eva Palacios; Ava Puccio; Miri Rabinowitz; Jonathan Rosand; Angelle Sander; Gabriella Satris; David Schnyer; Seth Seabury; Xiaoying Sun; Arthur Toga; Alex Valadka; Kevin Wang; Esther Yuh; Ross Zafonte Journal: JAMA Netw Open Date: 2021-04-01