THE CONTROVERSIAL CLIMACTERIC THE CONTROVERSIAL CLIMACTERIC The workshop moderators' reports presented at the Third International Congress on the Menopause, held in Ostend, Belgium, in June 1981, under the auspices of the International Menopause Society. Edited by P. A. van Keep, W. H. Utian and A. Vermeulen The editors were assisted by Pamela Freebody MTaUMITED LANCASTER· BOSTON· THE HAGUE International Medical Publisher Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England British Library Cataloguing in Publication Data International Congress on the Menopause (3rd: 1981: Ostend) The controversial climacteric. 1. Climacteric - Congresses I. Title II. Keep, P.A. van III. Utian, W.H. IV. Vermeulen, A. V. International Menopause Society 612 '.665 RC884 ISBN-13: 978-94-011-7255-4 e-ISBN-13: 978-94-011-7253-0 DOl: 10.1007/978-94-011-7253-0 Published in the USA by MTP Press A division of Kluwer Boston Inc 190 Old Derby Street Hingham, MA 02043, USA Library of Congress Cataloging in Publication Data International Congress on the Menopause (3rd: 1981 : Ostend, Belgium) The controversial climacteric. Includes index. 1. Menopause-Congresses. I. Keep, Pieter A. van. II. Utian, Wulf H., 1939- III. Vermeulen, A. (Alex), 1927- IV. International Menopause Society. V. Title. [DNLM: 1. Climacteric-Congresses. W3 IN667 3rd 1981s/WP 580 161 1981c RG186.I57 1981 618.1'75 82-256 ISBN-13: 978-94-011-7255-4 AACR2 Copyright © 1982 MTP Press Limited Softcover reprint of the hardcover 1st edition 1982 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, witho.ut prior permission from the publishers. Typeset by Swiftpages Ltd., Liverpool iv Contents Principal contributors vii Preface xv 1 Gonadal function in the ageing male K. D. Voigt 1 2 The pre-menopause H. P. G. Schneider 9 3 Sociological aspects of mid-life M. Hepworth 19 4 Some biochemical consequences of post-menopausal hormone replacement treatment U. Larsson-Cohn 29 5 Psycho-sexual aspects of mid-life A. A. Haspe/s and H. Musaph 39 6 The breast J. McQueen 51 7 Neuroendocrine changes in the peri-menopause U. J. Gaspard and P. Franchimont 61 v THE CONTROVERSIAL CLIMACTERIC 8 Hysterectomy E. V. van Hall 73 9 Androgens in post-menopausal women A. Vermeulen 81 10 The peri-menopause at the cellular level J. H. H. Thijssen 87 11 Osteoporosis O. L. M. Bijvoet 95 12 Potency and hepato-cellular effects of oestrogens after oral, percutaneous, and subcutaneous adminis tration S. Campbell and M. I. Whitehead 103 13 Progestins in the peri-menopause M. Notelovitz 127 14 Epidemiologic aspects of the benefits and risks of oestrogen therapy D. Cramer 137 15 Menopause clinics: purpose, function, and inter national comparisons W. H. Utian 147 Other communications Free communications 163 Posters 172 Index 175 VI Principal contributors T. Abe O. l. M. Bijvoet Tohoku University School of Medicine, Academisch Ziekenhuis Leiden, Department of Obstetrics and Afdeling Klinische Endocrinologie, Gynaecology, Rijnsburgerweg 10, 1-1 Seiryo-machi, 2333 AA Leiden, The Netherlands Sendai 980, Japan J. Botella Llusia Universidad Complutense de Madrid, P. Aschheim Departamento de Obstetricia y INSERM, U. 118, Ginecologia, Unite de Recherches Gerontologiques, Planta 5° Norte, 29 rue Wilhem, Ciudad Universitaria, 75016 Paris, France Madrid 3, Spain F. Bottiglioni s. Universita di Bologna, Ballinger Istituto di Patologia Ostetrica e University of Sydney, Ginecologica, Department of Behavioural Sciences, Policlinico S. Orsola, Sydney, NSW 2006, Australia Via Massarenti 13, 40138 Bologna, Italy F. Bayard J. P. Bourguignon INSERM, U. 168, Universite de Liege, Laboratoire d'Endocrinologie Clinique Pediatrique, Experimentale, 66 boulevard de la Constitution, C.H.U. Rangueil, 4020 Liege, Belgium Chemin du Vallon, 31054 Toulouse Cedex, France P. F. Brenner University of Southern California School of Medicine, E. W. Bergink Department of Obstetrics and Organon International B. V., Gynecology, Scientific Development Group, Women's Hospital, P.O. Box 20, 1240 North Mission Road, 534{) BH Oss, The Netherlands Los Angeles, CA 90033, USA VB THE CONTROVERSIAL CLIMACTERIC R. D. Bulbrook A. Demoulin Imperial Cancer Research Fund Universite de Liege, Laboratories, Clinique Gynecologique et Obstetricale, Department of Clinical Endocrinology, 81 boulevard de la Constitution, P.O. Box 123, 4020 Liege, Belgium Lincoln's Inn Fields, London WC2A 3PX, UK L. Dennerstein University of Melbourne, P. M. H. G. Buytaert Department of Psychiatry, Universitaire Instelling Antwerpen, Clinical Sciences Building, Afdeling Obstetrie en Gynaecologie, c/o P.O. Royal Melbourne Hospitals, 2000 Antwerpen, Belgium Melbourne, Victoria 3050, Australia S. Campbell King's College Hospital Medical School, J. G. van Dijk Department of Obstetrics and Academisch Ziekenhuis Leiden, Gynaecology, Vrouwenkliniek, Denmark Hill, Gebouw35 A, London SE5 8RX, UK Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands E. Cohen Hasharon Hospital, 7 Keren-Kayamet-Le-Israel Street, C. D. van der Does Petah-Tiqva, Israel Diaconessenhuis, Afdeling Gynaecologie, A.Collin Houtlaan 55, Leicester Polytechnic, 2334 CK Leiden, The Netherlands P.O. Box 143, Leicester LEl 9BH, UK N. Dombrowicz D. Cramer Pepermanstraat 9, Boston Hospital for Women, 4100 Seraing, Belgium Division of the Brigham and Women's Hospital and Harvard Medical School, J. Donnez 75 Francis Street, Universite Catholique de Louvain, Boston, MA 02115, USA Cliniques Universitaires Saint-Luc, M. G. Crane Departement de Gynecologie- Obstetrique, Loma Linda University, 10 avenue Hippocrate, Loma Linda, CA 92350, USA 1200 Bruxelles, Belgium N. Crona University of Goteborg, B. Ehret Department of Obstetrics and Kliniken am Burggraben, Gynecology, Abteilung Gynakologie, Sahlgrenska Sjukhuset, Alte Vlothoerstrasse 65, 41345 Goteborg, Sweden 4902 Bad Salzuflen, West Germany D. A. Davey University of Cape Town Medical School, F. ~Ikik Department of Obstetrics and rlopital Broussais, Gynaecology, Clinique Medicale Propedeutique, Observatory, 96 rue Didot, 7925 Cape, South Africa 75674 Paris Cedex 14, France Vlll PRINCIPAL CONTRIBUTORS L. FAhraeus A. R. Genazzani University Hospital, Universita degli Studi di Siena, Department of Obstetrics and Cattedra di Patologia Ostetrica e Gynaecology, Ginecologica, 581 85 Linkoping, Sweden Via Pietro Mascagni 4, 53100 Siena, Italy E. Fairhurst University of Manchester, C. Gold Department of Geriatric Medicine, University of Toronto, University Hospital of South Manchester, Toronto General Hospital, Nell lane, 1849 Yonge Street, Suite 307, Manchester M20 8lR, UK Toronto, Canada M4S 1Y2 M. Featherstone l. Goldie Teesside Polytechnic, The Royal Marsden Hospital (london Department of Social Studies, and Surrey), Middlesbrough, Cleveland Bl 3BA, UK Fulham Road, london SW3 6JJ, UK M. Flint R. B. Greenblatt Montclair State College, Medical College of Georgia Department of Anthropology, School of Medicine, Upper Montclair, NJ 07043, USA Department of Endocrinology, Augusta, GA 30901, USA G. Forti Universita di Firenze, M. van Haaften Scoula di Specializzazione in Academisch Ziekenhuis Utrecht, Endocrinologia, Afdeling Endocrinologie, Via Morgagni 85, Catharijnesingel 101, 50134 Firenze, Italy 3500 CG Utrecht, The Netherlands J. Hailes P. Franchimont Royal Women's Hospital, Universite de Liege, Menopause Clinic, Institut de Medecine, Melbourne, Victoria, Australia laboratoire de Radioimmunologie, Tour de Pathologie, E. V. van Hall C.H.U. - BiUiment B23, Academisch Ziekenhuis leiden, Sart Tilman par Liege 1, Belgium Rijnsburgerweg 10, 2333 AA leiden, The Netherlands R. D. Gambrell A. A. Haspels Medical College of Georgia, Academisch Ziekenhuis Utrecht, Department of Obstetrics and Universiteitskliniek voor Obstetrie en Gynecology, Gynaecologie, Augusta, GA 30912, USA Catharijnesingel 101, 3500 CG Utrecht, The Netherlands U. J. Gaspard Universite de Liege, R. P. Heaney Faculte de Medecine, Creighton University, Clinique Gynecologique et Obstetricale, Department of Medicine, 81 boulevard de la Constitution, 2500 California Street, 4020 Liege, Belgium Omaha, NE 68178, USA IX THE CONTROVERSIAL CLIMACTERIC J. H. C. L. Hendriks P. A. van Keep Katholieke Universiteit, International Health Foundation, Sint Radboudziekenhuis, 8 avenue Don Bosco, Instituut voor Rontgendiagnostiek, 1150 Bruxelles, Belgium Geert Groteplein Zuid 18, 6500 HB Nijmegen, The Netherlands R. J. B. King Imperial Cancer Research Fund M. Hepworth Laboratories, University of Aberdeen, Department of Hormone Biochemistry, Department of Sociology, P.O. Box 123, Edward Wright Building, Lincoln's Inn Fields, Dunbar Street, London WC2A 3PX, UK Old Aberdeen AB9 2TY, UK G. Langer E. Hirvonen Psychiatrische Universitatsklinik, University Central Hospital, 14 Lazarettgasse, Department of Obstetrics and 1097 Wien, Austria Gynaecology, 00290 Helsinki 29, Finland U. Larsson-Cohn University Hospital, F. A. Holstein Department of Obstetrics and Universitat Hamburg, Gynaecology, Universitats-Krankenhaus Eppendorf, 581 85 Linkoping, Sweden Abteilung Mikroskopische Anatomie, C. Lauritzen Martinistrasse 52, Universitat Ulm, 2000 Hamburg 20, West Germany Frauenklinik, Prittwitzstrasse 43, A. Holte 7900 Ulml Donau, West Germany University of Oslo, Institute of Psychology, R. F. Lax P.B. 1094, Blindern, 1185 Park Avenue, Oslo 3, Norway New York, NY 10028, USA H. S. Jacobs C. Lecart St. Mary's Hospital Medical School, Universite Catholique de Louvain, Paddington, Cliniques Universitaires Saint-Luc, London W2 1P G, UK Departement de Gynecologie- Obstetrique, v. H. T. James 10 avenue Hippocrate, 1200 Bruxelles, Belgium St. Mary's Hospital Medical School, Department of Chemical Pathology, B. de Lignieres Paddington, Hopital Necker, London W2 1P G, UK Service d'Endocrinologie et de Gynecologie Medicale, H. L. Judd 149 rue de Sevres, University of California, 75730 Paris Cedex 15, France Los Angeles School of Medicine, Department of Obstetrics and M. A. Limouzin-Lamothe Gynecology, Hopital Bichat, Center for the Health Sciences, 34 avenue Hoche, Los Angeles, CA 90024, USA 75008 Paris, France x PRINCIPAL CONTRIBUTORS R. Lindsay B. Moore Helen Hayes Hospital, Dudley Road Hospital, Regional Bone Center, Department of Obstetrics and Route9W, Gynaecology, West Haverstraw, NY 10993, USA Dudley Road, Birmingham B18 7QH, UK P. Linkowski Universite de Bruxelles, H. Musaph Departement de Psychiatrie, Academisch Ziekenhuis Utrecht, Hopital Erasme, Universiteitskliniek voor Obstetrie en 808 route de Lennik, Gynaecologie, 1070 Bruxelles, Belgium Catharijnesingel101, 3500 CG Utrecht, The Netherlands J. McQueen Beckenham Hospital, J. Need 379 Croydon Road, Flinders Medical Centre, Beckenham, Kent BR3 3QL, UK Department of Obstetrics and Gynaecology, B. Maoz Bedford Park, South Australia 5042, Ben-Gurion University of the Negev, Australia Soroka Medical Center, P.O. Box 151, M. Neves-e-Castro Beer Sheva 84120, Israel Organon International B.V., Scientific Development Group, F. Michiels P.O. Box 20, Parklaan 55, 5340 BH Oss, The Netherlands 2700 Sint Niklaas, Belgium B. E. C. Nordin A. Mikkelsen MRC Mineral Metabolism Unit, University of Oslo, The General Infirmary, Institute of Behavioural Sciences in Great George Street, Medicine, Leeds LS1 3EX, UK P.O. Box 1111, Blindern, Oslo 3, Norway M. Notelovitz The Center for Climacteric Studies, G. Milhaud University of Florida, Hopital Saint Antoine, The Professional Center, Service de Medecine Nucleaire, 901 NW 8th Avenue, Suite B-1, 184 rue du Faubourg Saint Antoine, Gainesville, FL 32601, USA 75571 Paris Cedex 12, France H. van der Molen J.Ovadia Erasmus Universiteit, The Beilinson Medical Center, Afdeling Chemische Endocrinologie, Beilinson Hospital, P.O. Box 1738, Petah-Tiqva, Israel 3000 DR Rotterdam, The Netherlands J. R. Pasqualini H. Molinski C.N.R.S. Steroid Hormone Research Universitats-Frauenklinik Dusseldorf, Unit, Psychosomatische Abteilung, Foundation for Hormone Research, Moorenstrasse 5, 26 boulevard Brune, 4000 Dusseldorf, West Germany 75014 Paris, France Xl