[The Dutch College of General Practitioners practice guideline 'The menopause'; reaction of the field of general practice].
The Dutch College of General Practitioners' practice guideline on the menopause will not be any major cause for discussion. The hot issue of giving oestrogens to peri- and postmenopausal women to prevent osteoporosis or cardiovascular disease was already covered in the practice guideline on osteoporosis. This guideline on the menopause shows that there is no consensus on when it is safe to stop contraception. The advice to use supplementary contraception, such as condoms, until 1 year after the last menstruation will not be met with a high rate of compliance. If oestrogen therapy is necessary in women with serious vasomotor symptoms who still have their uterus, calendar packets containing 14-16 oestrogen-only pills and 12-14 oestrogen/progesterone combination pills can be used. Administration of transdermal oestrogens has no added value and is more expensive. Tibolone is even more expensive and has more side effects. Clonidine is less effective but can be an alternative for women who choose not to take hormones or in whom oestrogens are contraindicated.
van den Bosch
W J H M
WJ
Universitair Medisch Centrum St Radboud, afd. Huisartsgeneeskunde, Postbus 9101, 6500 HB Nijmegen. w.vandenbosch@hsv.kun.nl
D002318:Cardiovascular Diseases / Q000517:prevention & control; D003267:Contraception; D004967:Estrogens / Q000008:administration & dosage*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008593:Menopause / Q000502:physiology*; D009426:Netherlands; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012955:Societies, Medical; D013997:Time Factors
D004967:Estrogens