D Ross

A randomised comparison of the effects of oral versus transdermal 17β‐oestradiol, each combined with sequential oral norethisterone acetate, on serum lipoprotein levels

Objective To investigate the effects of oral versus, transdermal 17β‐oestradiol, given in both cases with sequential addition of oral norethisterone acetate, on serum lipid and lipoprotein levels in postmenopausal women.

HORMONAL MANIPULATION AND GYNAECOLOGICAL CANCER : THE TAMOXIFEN DILEMMA

Tamoxifen has a well established place in the adjuvant therapy of primary carcinoma of the breast. Its effects on breast cancer cells are both anti-oestrogenic and non-oestrogen-receptor mediated. Tamoxifen has oestrogenic effects on non-breast tissues such as liver, bone, the cardiovascular system and the urogenital tract. The effect on the endometrium is to increase the incidence of polyps, hyperplasia and carcinoma. Again, non-oestrogen receptor-mediated actions may be involved. With more widespread use of tamoxifen now being advocated, for instance in the primary prevention of breast cancer, careful assessment of benefit and risk is required.

Development and validation of an objective method of determining skin erythema to transdermal oestradiol patches

One problem which has limited the acceptance of transdermal oestradiol patches is skin reaction at the site of patch application. The reported incidence ranges up to a maximum of approximately 40%14, with a smaller percentage of women discontinuing therapy. Skin reactions typically consist of erythema and oedema, with more severe reactions such as blistering occumng occasionally. The original patch (Estraderm TTS, Ciba-Geigy, Basel, Switzerland) consisted of a fluid filled reservoir containing oestradiol, covered by a semi-permeable inner membrane and kept in contact with the skin by a ring of adhesive. This was referred to as a ‘reservoir’ patch. Subsequently, the ‘matrix’ patch was developed. This looks quite different and contains oestradiol distributed in adhesive across the whole of the patch surface. Anecdotal and published reports”‘ suggest that the incidence of skin reactions differs between reservoir and matrix patch systems. Any study relying on subjective assessment of skin changes is potentially confounded by observer bias. This can never be excluded in a comparison of vkually dissimilar patches. Therefore we have developed an objective method of measuring patch site skin irritation using photographic digital image analysis.

Selection Bias in HRT Epidemiology

Natural progesterone Madam Your correspondent Dr Elizabeth Williams (Letters, February 1996) seems unaware that progesterone is present in men, women and children in the adrenals, where it is converted into oestrogens, testosteroncs and cortisones. I have been using progesterone for over 40 years. Progesterone promotes increased bone mineral density I, lowers blood pressure, and there is no evidence of cancer risk. Women anxious to avoid oestrogen, as well as those who respond badly to progestogens or dislike cyclical bleeding, may find progesterone a valuable alternative although medication cannot be oral, transdermal or by implant. Progesterone may be given per vagina and rectum, or by intramuscular injections. Treatment is continuous, as endometrial shedding is unnecessary. Dr Katharina Dalton 60 Wimpole Street London WIM 7DE Reference I. Prior rc. Endocr Rev 1990; II: 386-389

Randomised Cross-Over Comparison of Effects on Uterine Artery Pulsatility Index of Oral Norgestrel and Vaginal Progesterone in Postmenopausal Women Given Transdermal Oestradiol

Cultural and ethical dimensions The postmenopausal phase of a womans life may span 30 years or more. Fifty years ago postmenopausal women were considered asexual but studies from Kinsey onwards have put paid to this myth, so much so that women may need reassurance if they choose not to be sexually active! Western society defines female sexuality within the context of a penetration focused heterosexual relationship. With the rise of feminist thinking, this viewpoint has been challenged and the importance of non-genital sensuality has been recognised. Valuing a wider range of choice of expression of her sexuality is important for the postmenopausal woman for whom ageing, illness or surgery may limit her previous pattern of sexual expression. Non-penetrative options may also be important if her partner has erectile problems, or may be chosen by the woman following a change of partner as part of safer sex practice. Longitudinal studies have shown that sexual behaviour