Research on the Menopause in the 1990s (Report of a WHO Scientific Group)

WHO Technical Report Series, No 866, 1996; vii + 106 p (available in English; French and Spanish in preparation); ISBN 92 4 120866 X; $20 (CAN) / $18 (US) / 20 (Sw fr); Order no 1100866

This book provides an expert assessment of what is known about the menopause, its immediate and long-term effects on health, and the possibilities for their treatment and prevention. Noting the many methodological problems surrounding research on the menopause, the report makes a special effort to separate those areas where firm conclusions can be reached from those where questions remain and further research is needed. Particular attention is given to the risks and benefits of hormone therapy and to the question of whether research conducted in industrialized countries can be generalized to women living elsewhere. Some 500 references to recent studies are included.

In view of the growing number of postmenopausal women and the significant health problems they face, the report aims to reach conclusions that can help women, clinicians and policy makers make the best decisions concerning the management of both immediate symptoms and long-term effects on the cardiovascular and skeletal systems. Equally important is the report's identification of areas requiring further research. Conclusions and recommendations reflect the consensus reached by a group of 25 leading experts.

The report has twelve sections. Methodological problems are addressed in the first, which considers the strengths and weaknesses of various investigative approaches and explains why certain designs are more likely to yield reliable results. Against this background, the next sections review the demography of the menopause and female-to-male mortality ratios by age and geographic region, and summarize what is known about the endocrinology of the normal menopause, giving attention to the relationships between age, level of circulating hormones and menstrual status. A section on the symptoms of the menopause and their treatment underscores the importance of distinguishing between symptoms that result from loss of ovarian function and symptoms that arise from the aging process or from the socio-environmental stress of the mid-life years. Subsequent sections provide a brief discussion of the cultural context of the menopause and assess the risks and benefits, for women in the late premenopause, of different contraceptive options.

The most extensive sections attempt to resolve some of the controversy surrounding the use of hormone therapy to reduce the risks of osteoporotic fractures and cardiovascular diseases while also answering the question of whether hormone therapy increases the risk of breast cancer, endometrial cancer and other gynecological cancers. Information ranges from advice on calcium and vitamin D supplementation for the prevention of osteoporosis, through the reasons why postmenopausal women are at increased risk for cardiovascular disease, to estimates of the increase in relative risk of breast cancer among women using estrogens alone for different lengths of time.

The report concludes with a balanced discussion of strategies for managing the health consequences of the menopause, emphasizing the need for a clear distinction between short-term therapeutic and long-term preventive goals, since the risks and benefits of the two types of therapy are very different.

 

World Health Statistics Annual 1995

World Health Organization, 1996; xxv + 852 pp (available in English and French); ISBN 92 4 067950 2; $150 (CAN) / $135 (US) / 150 (Sw fr); Order no 0179500

This annual publication presents detailed country-specific statistical data on mortality rates, causes of death and other indicators of health trends at national and global levels. Health statistics, which are submitted to WHO by national health and statistical offices, are compiled each year in order to help policy makers interpret changes over time and compare key indicators of health status in different countries. Reflecting the introduction of a more rigorous procedure for data collection, the 1995 volume already contains official statistics from an expanded number of countries. The volume also continues a new format resulting in more concentrated coverage of mortality and causes of death.

Statistics are presented in two parts. Part A, which contains two tables, summarizes worldwide health and demographic data. The first table shows assessed 1995 population size and composition by major age group, and gives estimates of the population growth rate, crude birth rate and crude death rate in 1995 for all countries having a population of at least 150,000, according to United Nations' estimates. Country-specific data are followed by summary values for major geographical areas and WHO regions. The second table presents statistics on poverty, housing conditions, food availability and child mortality as health-related background information for the United Nations' 1996 themes: Year for the Eradication of Poverty, the World Food Summit and the Human Settlements Conference.

The second and most extensive part contains over 800 pages of vital statistics and life tables based on data submitted by more than 60 of the 190 member states of WHO, and validated by WHO. Country statistics are presented in three tables. The first gives the number of deaths by underlying cause, according to age and sex. The second table shows the number and age distribution of infant deaths and the infant mortality rate per 100,000 live births. The final table indicates life expectancy at birth and at selected ages for each country, together with the number of survivors out of a synthetic cohort of 100,000 persons for the latest available year. The probability of dying from selected causes, by age group, is also indicated.

New in this edition are recent historical series for all newly independent states of the former USSR, including a review of life expectancy and causes of death from 1981 through 1994, differences between the sexes and comparisons with other regions of the world. Countries represented for the first time include Azerbaijan, Georgia, the Republic of Moldova, South Africa, Turkmenistan and Zimbabwe.

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