Menopause, Part 1—Women shifting gears (Guest editorial)

Honored? You bet. Although I admit to having suffered considerable vasomotor instability when Dr Tim Rowe first invited me to be the guest editor for a BCMJ issue dedicated to the menopause. At the issue’s inception—or perhaps conception in view of the lengthy gestation—I had not thought it would be a twin issue. I was offered the opportunity to invite whomever I felt could best clarify some of the issues surrounding the topic of menopause. My colleagues’ lives are extremely busy, and I am most grateful to them for contributing such excellent articles. I think they cover many of the important aspects of caring for women in their perimenopausal and menopausal years.

At first I thought that by now most physicians would have had their fill of discussion about the menopause. And perhaps you have, but our patients have not. The women we see in our practices are more informed than ever, and as the research becomes more confusing, it behooves us to approach their questions scientifically. Often our patients, armed with extensive knowledge and access to information, know more than we do about studies such as PEPI, RUTH, WHI, FIT, MORE, and STAR. This alphabet-soup represents just some of the completed and ongoing research efforts we are expected to be aware of. The results are just coming in, and have been referred to in the articles you will read in these BCMJ pages. Though there is no clear distinction between the two parts of this theme issue, the first will deal with perimenopausal symptoms in the short and long term, and the second part will focus on hormone therapy.

One of the clinical problems we face involves the basic vocabulary used to define the menopause and that transition time. Terminology becomes important as our understanding of the symptomatology and pathophysiology grows. Women in their 50s, 60s, or even 70s ask, “Am I through it yet?” Women in their 30s ask, “Am I into it yet?” What is it? The World Health Organization and the International Menopause Society have provided a set of definitions, some of which follow. Natural (as opposed to induced) menopause has occurred after 12 consecutive months of amenorrhea for which there is no other obvious cause. This retrospective definition is not always useful to the patient or her physician. Perimenopause includes the time just before the menopause and the first year after (which is also known as the postmenopause). Perhaps the better term is climacteric, which refers to the transition phase between the reproductive and nonreproductive state. It becomes the climacteric syndrome if it is symptomatic. Any suggestions for better words?

Despite the difficulty with words, I hope you enjoy the following pages and find clarification and answers to your own questions.

—Vera Frinton, MD, FRCSC 
Clinical Professor, Faculty of Medicine, UBC

References

Utian WH. Menopause Management 2000;9(1).