Book Review

Clinical Disorders of the Endometrium and Menstrual Cycle

N Engl J Med 1998; 339:1251-1252October 22, 1998

Article

Clinical Disorders of the Endometrium and Menstrual Cycle
Edited by Iain T. Cameron, Ian S. Fraser, and Stephen K. Smith. 449 pp., illustrated. New York, Oxford University Press, 1998. $149.50. ISBN: 0-19-262724-4

With the widespread use of effective contraception, monthly menses became common in women during their reproductive years. Previously, pregnancy and lactational amenorrhea had been more frequent, with only occasional ovulatory menses. As a result of this dramatic change, disorders associated with menstruation have become among the most common disorders that primary care physicians and gynecologists treat in young women. Moreover, the use of exogenous estrogens and progestins for contraception, control of the menstrual cycle, and hormone-replacement therapy has resulted in the need to diagnose and treat irregular bleeding from the endometrium among users.

This book attempts to provide an overview of clinical disorders of menstruation and the menstrual cycle. The contributors are recognized authorities from Europe, Australia, and North America.

The book has six sections. The first provides the cultural and historical background and discusses menstruation as a normal event from the woman's perspective. Also covered are the physiology of the endometrial vascular bed and guidelines for the practical assessment of endometrial morphology and function. The first three chapters, which discuss menstruation from a cultural and historical perspective, the mammalian origins of the menstrual cycle, and the endometrial vascular bed, are among the most interesting in the book, no doubt because such fascinating information is rarely contained in textbooks.

The second section is devoted to menorrhagia. Individual chapters discuss the definition and epidemiology of menorrhagia, its pathophysiology, the approach to diagnosis, and the medical and surgical therapies available for the various causes of the disorder. This section contains no information that is not available elsewhere, but the material is presented in a detailed and systematic fashion.

The third section covers amenorrhea, oligomenorrhea, and irregular bleeding during both the reproductive and the postmenopausal years. This is a weak section, with the individual discussions lacking the depth found in the first two sections of the book. The discussion of the polycystic ovary syndrome is particularly biased, presenting only the one view that the ultrasonographic appearance of the ovaries is important in making the diagnosis.

The fourth and fifth sections of the book discuss dysmenorrhea and the premenstrual syndrome. Adenomyosis, endometriosis, and the link between psychiatric illnesses and the menstrual cycle are also considered. The chapters detailing the effects of psychosocial factors on menstrual bleeding and pain and the effects of the menstrual cycle on psychiatric disorders are succinct but extremely informative and useful.

The last section discusses the pathophysiology and management of abnormal bleeding resulting from the use of intrauterine devices, contraceptive steroids, and hormone-replacement therapy. The chapters provide brief but complete overviews of these problems.

As the editors themselves acknowledge, there is considerable overlap among several of the chapters. Moreover, there is not always agreement on the best approach to a given problem. The various approaches serve to emphasize the need for further investigation into the abnormalities associated with menstruation. The real strength of this book, however, rests in the references provided. For serious readers, this book is a valuable resource in beginning to gain an understanding of what is known about the problems discussed. The unique organization of the book serves an important purpose in reminding readers about the diverse abnormalities associated with menstruation. Regulation of the menstrual cycle and of reproduction itself has brought with it a new set of medical problems that are disturbing to patients and physicians alike. Although most of these disorders are not life-threatening, they interfere with the quality of life and warrant appropriate intervention.

Robert W. Rebar, M.D.
University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526