Estrogen therapy: from women's choice to women's preference.

The climacteric is not an illness, but the menopause is an event that troubles a woman's present life and puts her future life at risk. One would like to think that, for the woman of the new millennium, the menopause has simply become what it is: a feminine milestone that marks the transition and path to another period of life. She appears younger than her mother was at her age, she has given birth when she decided to, she has had the number of children she wanted, and her social and professional roles are well defined. Nevertheless, none of this makes much difference--the 'change of life' is still something difficult to live through, a bend to negotiate, each woman going at her own pace, using her own means, with the cards that life has already dealt her. Where do we gynecologists come in, what part have we to play in our patients' lives? Sometimes, we need to be less discreet and ask some of those questions women may have trouble voicing aloud. Let us try to help them to talk about their mood changes, the changes in their body, and their anxiety about osteoporosis and aging. Shame or fear of ridicule are still often among the ideas on the menopause and, by preventing honest answers from being given, often modify the scientific statistics on menopausal women--especially as women are often at a loss to know which of the different opinions to believe. The media air their news, the medical community offers its dissent, while friends recount frightening stories. Between the danger of offending Mother Nature and the risk of missing out on the progress of science, what is the right modus operandi that helps to add quality to the quantity of life still there to be enjoyed after the menopause? The doctor-patient relationship is of the utmost importance here, since an atmosphere of confidence and trust is the basis of mutual comprehension. By understanding the patient's needs, her desires, and her ways of coping with the situation, the physician will enable her to accept the proposed prescription. The mode of administration should be proposed and not imposed, offered first as one of many possibilities, and should take into account the lifestyle, the private and professional situation of the particular woman, and her habits and tastes, allowing her a true role in the decision-making process. Observance and compliance will therefore naturally follow, with a woman feeling she has been listened to and understood as a mature adult, and not as a stupid individual or a child. After all, there are not very many medical situations where both patients and physicians have such an array of products and routes of administration available to them. This was the way patients in the Aerodiol studies were considered, and it was also the way that they responded, after the initial surprise factor which opened the road to interesting exchanges. Local acceptability was graded as good to excellent by the spray users. While the Kupperman score was as significantly reduced in both the group that received the Aerodiol spray and the group treated via the transdermal route, mastalgia, one of those side-effects known to dramatically reduce the acceptability of a treatment, was significantly less frequent and user satisfaction was similarly greater at week 16 in the Aerodiol group. The approach, as well as the drug itself, seems to have been well appreciated, as a great number of patients (66% versus 34% for the transdermal route) wanted to continue the treatment after the end of the protocol. How else do our patients express their satisfaction if not by their compliance (which is, after all, our aim)? Compliance was not a problem with the pulsed estrogen therapy and nasal administration of it. The woman's preference could well be the doctor's choice, meaning true informed consent from both parties.