[The Dutch College of General Practitioners practice guideline 'The menopause'; reaction of the field of obstetrics and gynaecology].
In the Dutch College of General Practitioners' (NHG) practice guideline on the menopause (which also covers hormone therapy), menopausal transition is considered as a physiological life process with inconveniences which can generally be settled by providing information, while leaving hormonal treatment for women who experience serious restrictions in their daily life as a consequence of vasomotor flushes or urogenital atrophy. In those cases, the guideline says, hormonal treatment should not be given for longer than three to six months, after which it should be stopped until a relapse arises. However, it usually takes at least six months of oestrogen replacement therapy to restore urogenital atrophy as well as for the woman to recover from its discomforts such as dyspareunia. Dosages of oestrogens in different hormonal therapies should be 50% or 25% of those advocated in the guideline, as the lowest effective dosage of oestrogen is sufficient. More generally, a woman affected by menopausal inconveniences is not a patient. She deserves to decide for herself whether or not she is willing to use hormone replacement therapy, and if so, she should be allowed to decide on the duration of hormone treatment. The physician should provide adequate information and benevolent supervision.
Hamerlynck
J V Th H
JV
Academisch Medisch Centrum, afd. Verloskunde en Gynaecologie, Meibergdreef 9, 1105 AZ Amsterdam.
Knuist
M
M
D004305:Dose-Response Relationship, Drug; D015914:Estrogen Replacement Therapy / Q000523:psychology / Q000592:standards*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006176:Gynecology / Q000592:standards*; D006801:Humans; D008593:Menopause / Q000502:physiology*; D009426:Netherlands; D009774:Obstetrics / Q000592:standards*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic
D004967:Estrogens