Book Review

The Menopause: Endocrinologic Basis and Management Options

N Engl J Med 2007; 356:2009-2010May 10, 2007

Article

The Menopause: Endocrinologic Basis and Management Options
Fifth edition. Edited by Bernard A. Eskin. 353 pp., illustrated. Abingdon, England, Informa Healthcare, 2007. $229.95. ISBN: 978-1-84214-327-8

For all of us who care for female patients 45 years of age or older, the interwoven issues of reproductive aging and other somatic aging make it difficult to identify the source of patients' concerns. Even the term “menopause” refers to an event — the last spontaneous menses — leaving us unsure about what term to use for the rest of the time in a woman's life.

This fifth edition of The Menopause brings together distinguished experts to improve our understanding of how changes in reproductive hormones affect women during and after menopause. An effort is made to separate the early effects of these changes from the effects characteristic of later years. The word “menopause” is used to describe the hormonal transition from the last menstrual period to about 65 years of age, and the term “geripause” is often used to describe the period of a woman's life after that. In an effort to be inclusive of issues that affect older women, the editor has included chapters on aging that cannot be clearly linked with estrogen deficiency (e.g., chapter 26, “Hearing Impairment in the Menopause and Beyond”) but that are still very useful for the clinician who is caring for these patients.

The strengths of the book lie in the excellent chapters on the endocrinology of the menopausal transition and in a very good review, written by the book's editor, of the debates on how and whether cellular senescence is linked with reproductive senescence (chapter 1, “The Menopause and Aging”). For clinicians treating patients who are caught up in the “bioidentical hormone” controversy, chapter 20, “Pharmacology of Hormonal Therapeutic Agents,” is very helpful, if perhaps beyond those readers with just a passing interest in steroid biochemistry. This chapter and chapter 10, “Sex Steroid Hormone Metabolism in the Climacteric Woman,” together make for an excellent review of our knowledge on the subject to date.

The chapters on sexuality during and after menopause and quality-of-life assessment during menopause provide the primary care physician with clinical tools that can be used to determine which among a patient's concerns can be attributed to changes in ovarian function and which may be related to other issues. The Menopause Rating Scale, a quick, well-validated office questionnaire, is also included in the book and discussed as a quality-of-life measurement tool. It can be used to help balance the risks and benefits of hormone-replacement therapy by assessing the quality of life before and after estrogen replacement. (Appendix 7.2 of the questionnaire has an obvious error that the publisher will correct for the next printing of the book.)

Another strength of this book is its thorough discussion of many problems faced by older women, including osteoporosis, cardiovascular disease, cognitive decline, urogenital issues, and breast cancer. The reader should be aware, however, that whereas some of this information is very clearly evidence-based, some is based more on practice and opinion. It is important to evaluate each of the recommendations based on the evidence.

The final section of the book focuses on treatment and wellness, including hormone-replacement options, complementary and alternative medicine, nutrition, and exercise. We are reminded in the foreword, written by Leon Speroff, that the menopausal transition provides an opportunity for both clinicians and their patients to seek a vital and healthy second half of life.

Kirtly Parker Jones, M.D.
University of Utah, Salt Lake City, UT 84132
kirtly.jones@hsc.utah.edu