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Objective: Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients. Design and Participants: Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire. Measurements: We analysed questionnaires that had complete demographic data. Results: Eighty‐seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members. Conclusions: Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common non-skin cancer in Australia, affecting 1 in 7 women by the age of 85 years. Current management of early breast cancer is becoming increasingly variable and complex. The typical range of treatments include some combination of surgery, chemotherapy and targeted therapy, immunotherapy, radiotherapy, and endocrine therapy. Neoadjuvant chemotherapy (NACT) in carefully selected patients can facilitate increased rates of breast conservation therapy, and when successful, offers improved cosmesis due to less extensive resection of tissue. A neoadjuvant approach also provides biological insight into a patient's tumour, prognostication based on a patient's response to therapy, as well as enabling their treating oncologist to personalise adjuvant strategies based on the presence or absence of residual cancer at surgery. Neoadjuvant chemotherapy has become an integral element in the provision of breast conserving surgery to selected early-stage breast cancer patients. Appreciating the indications and understanding the likely outcomes from NACT in select situations, can result in significant improvements in patient tailored care. • Neoadjuvant chemotherapy has significantly influenced surgical management. • There are multiple indications for NACT, however weaknesses do exist. • An understanding of NACT can provide best oncological and cosmetic outcomes for patients. [ABSTRACT FROM AUTHOR]

Legal institutions worldwide construct theories about gender's ontology—i.e., theories about what gender is—and use those constructions to govern. In this article, I analyse how the Family Court of Australia constructed ontologies of gender to govern young people's gender-affirming hormone use. By analysing the 'reasons for judgment' published about cases where minors applied for the Court's authorisation to use hormones, I show that the Court constructed two theories about the ontology of gender concurrently—one essentialist and the other performative—which it leveraged to arbitrate the legitimacy of hormone use. By critically examining the Court's ontological assertions, I argue that both theories advanced anti-queer directives that tethered the legitimacy of hormone use to its promise to produce normatively gendered subjects. This analysis highlights that legal regimes concerned with controlling gender-affirming practices have much more at stake than access to those practices alone. By governing mechanisms of gender's production, these regimes do not merely shape how gender can be expressed but also the possible forms of gender itself. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between exogenous hormone use and the risk of cataract surgery among working‐aged Australian women. Methods: A total of 91 760 female participants aged 45–65 years and without prior history of cataract surgery were prospectively enrolled between January 2006 and December 2009 in New South Wales (NSW), Australia. A baseline self‐reported questionnaire was used to collect information on participant demographic, socio‐economic, lifestyle characteristics, medical history as well as the use of hormonal contraception and hormone replacement therapy (HRT). Cataract surgery for these participants during 2006–2019 was determined according to the Medicare Benefits Schedule database. Cox regression was used to assess the association between exogenous hormone use and incident cataract surgery during the follow‐up. Results: During a mean follow‐up of 11.3 years, 10 444 participants underwent cataract surgery with a corresponding incidence of 11.4% (10 444/91 760). Compared with never users, ever and current users of HRT had a 22% and 14% increased risk of cataract surgery, respectively. A dose–response with longer HRT use resulting in a larger increase in cataract surgery risk was observed (p for trend <0.001). Among participants never used HRT, hormonal contraception had a protective effect against incident cataract surgery (hazards ratio: 0.87; 95% confidence interval: 0.80–0.94). Conclusions: Use of HRT significantly increased the risk of cataract surgery, and hormonal contraception use had a protective effect on cataract surgery among HRT non‐users. Further studies assessing the effect of different hormone types and doses are needed. [ABSTRACT FROM AUTHOR]

Study Question: What is the association between menopausal hormone therapy (MHT) and cause-specific mortality?Summary Answer: Self-reported MHT use following early natural menopause, surgical menopause or premenopausal hysterectomy is associated with a lower risk of breast cancer mortality and is not consistently associated with the risk of mortality from cardiovascular disease or other causes.What Is Known Already: Evidence from the Women's Health Initiative randomized controlled trials showed that the use of estrogen alone is not associated with the risk of cardiovascular mortality and is associated with a lower risk of breast cancer mortality, but evidence from the Million Women Study showed that use of estrogen alone is associated with a higher risk of breast cancer mortality.Study Design, Size, Duration: Cohort study (the UK Biobank), 178 379 women, recruited in 2006-2010.Participants/materials, Setting, Methods: Postmenopausal women who had reported age at menopause (natural or surgical) or hysterectomy, and information on MHT and cause-specific mortality. Age at natural menopause, age at surgical menopause, age at hysterectomy and MHT were exposures of interest. Natural menopause was defined as spontaneous cessation of menstruation for 12 months with no previous hysterectomy or oophorectomy. Surgical menopause was defined as the removal of both ovaries prior to natural menopause. Hysterectomy was defined as removal of the uterus before natural menopause without bilateral oophorectomy. The study outcome was cause-specific mortality.Main Results and the Role Of Chance: Among the 178 379 women included, 136 790 had natural menopause, 17 569 had surgical menopause and 24 020 had hysterectomy alone. Compared with women with natural menopause at the age of 50-52 years, women with natural menopause before 40 years (hazard ratio (HR): 2.38, 95% CI: 1.64, 3.45) or hysterectomy before 40 years (HR: 1.60, 95% CI: 1.23, 2.07) had a higher risk of cardiovascular mortality but not cancer mortality. MHT use was associated with a lower risk of breast cancer mortality following surgical menopause before 45 years (HR: 0.17, 95% CI: 0.08, 0.36), at 45-49 years (HR: 0.15, 95% CI: 0.07, 0.35) or at ≥50 years (HR: 0.28, 95% CI: 0.13, 0.63), and the association between MHT use and the risk of breast cancer mortality did not differ by MHT use duration (<6 or 6-20 years). MHT use was also associated with a lower risk of breast cancer mortality following natural menopause before 45 years (HR: 0.59, 95% CI: 0.36, 0.95) or hysterectomy before 45 years (HR: 0.49, 95% CI: 0.32, 0.74).Limitations, Reasons For Caution: Self-reported data on age at natural menopause, age at surgical menopause, age at hysterectomy and MHT.Wider Implications Of the Findings: The current international guidelines recommend women with early menopause to use MHT until the average age at menopause. Our findings support this recommendation.Study Funding/competing Interest(s): This project is funded by the Australian National Health and Medical Research Council (NHMRC) (grant numbers APP1027196 and APP1153420). G.D.M. is supported by NHMRC Principal Research Fellowship (APP1121844), and M.H. is supported by an NHMRC Investigator Grant (APP1193838). There are no competing interests.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background. Exocrine pancreatic insufficiency (EPI) is common in patients with type 2 diabetes. However, the prevalence of EPI varies significantly in different studies. Untreated EPI in these patients can adversely affect their nutrition and metabolism. The aim of this study is to estimate the pooled prevalence of EPI in patients with type 2 diabetes and to explore the potential risk factors. Methods. A systematic search was performed in PubMed, Web of Science, and Embase, which included studies meeting inclusion criteria from 1960 to 1 April 2021. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "Type 2 diabetes" and "pancreatic exocrine insufficiency." The Stata 16.0 software was used for data analyses. The random-effects model was used to estimate the pooled prevalence rates and 95% CI using "metaprop program." Results. The pooled prevalence of EPI was 22% (95% CI: 15%–31%) in patients with type 2 diabetes and 8% (95% CI: 4%–14%) of them developed severe pancreatic insufficiency. In the subgroup analyses, the prevalence of EPI in type 2 diabetes was correlated with geographic location. The prevalence in Asian countries (35%, 95% CI: 22%–49%) is higher than in Europe (18%, 95% CI: 10%–29%) and Australia (9%, 95% CI: 4%–16%). Furthermore, patients with higher insulin requirements, who are more likely to be insulin-deficient, have a higher prevalence of EPI. The pooled prevalence was 27% (95% CI: 17%–37%) in type 2 diabetes with higher insulin requirement (1 group) and 15% (95% CI: 1%–40%) in patients with lower insulin requirement (2 group). In addition, the morbidity of severe EPI in the higher insulin requirement group (12%, 95% CI: 7%–19%) was sextuple as much as the lower insulin requirement group (2%, 95% CI: 0%–13%). EPI was more common in subjects younger than 60 compared with elderlies (25% vs. 19%). Conclusion. The prevalence of EPI in type 2 diabetes may be overestimated. Furthermore, the higher prevalence may be closely related to β-cell function. Endocrine disease therapy would potentially represent a novel therapeutic approach for patients with type 2 diabetes and EPI. [ABSTRACT FROM AUTHOR]

Aim: In children with Prader‐Willi syndrome (PWS), growth hormone (GH) improves height and body composition; however, may be associated with worsening sleep‐disordered breathing (SDB). Some studies have reported less SDB after GH initiation, but follow‐up with polysomnography is still advised in most clinical guidelines. Methods: This retrospective, multicentre study, included children with PWS treated with GH at seven PWS treatment centres in Australia over the last 18 years. A paired analysis comparing polysomnographic measures of central and obstructive SDB in the same child, before and after GH initiation was performed with Wilcoxon signed‐rank test. The proportion of children who developed moderate/severe obstructive sleep apnoea (OSA) was calculated with their binomial confidence intervals. Results: We included 112 patients with available paired data. The median age at start of GH was 1.9 years (range 0.1–13.5 years). Median obstructive apnoea hypopnoea index (AHI) at baseline was 0.43/h (range 0–32.9); 35% had an obstructive AHI above 1.0/h. Follow‐up polysomnography within 2 years after the start of GH was available in 94 children who did not receive OSA treatment. After GH initiation, there was no change in central AHI. The median obstructive AHI did not increase significantly (P = 0.13), but 12 children (13%, CI95% 7–21%) developed moderate/severe OSA, with clinical management implications. Conclusions: Our findings of a worsening of OSA severity in 13% of children with PWS support current advice to perform polysomnography after GH initiation. Early identification of worsening OSA may prevent severe sequelae in a subgroup of children. [ABSTRACT FROM AUTHOR]

Background: We aimed to identify compliance with systemic treatment recommendations in early breast cancer (EBC) patients managed by Australian BreastSurgANZ members. Methods: A retrospective analysis of patients diagnosed with EBC included in BreastSurgANZ prospective database from January 2002 to December 2016 was conducted. Data was available on patients with BC treated by over 350 surgeons across the six states and two territories of Australia. Results: Over the 15 year period, 102 660 EBC episodes were recorded in 99 800 patients. As a group, the five key performance indicators (KPIs) set by the BreastSurgANZ relating to systemic treatment were achieved. Overall, patients were compliant with systemic treatment recommendations with 89.1% of patients receiving treatment in accordance with recommendations from their treating surgeon. The highest rate of non-compliance with systemic treatment was for endocrine therapy (11.9%). Of the 2368 patients who did not proceed with the recommended endocrine treatment, 1284 (54%) patients did so because of patient refusal. Failure to receive chemotherapy was associated with older age (aOR 1.02; p < 0.001), patients living in regional areas (aOR 1.23; p = 0.001) and those with node negative disease (aOR 0.97; p = 0.003). Conclusions: The majority of Australian patients with EBC are being recommended for adjuvant systemic therapy in accordance with BreastSurgANZ KPI’s. Treatment compliance was very high. This finding emphasises the importance of prospective data collection and auditing of established KPIs by surgeons, in areas other than direct surgical outcomes. Further research into the reasons why patients refuse treatment is needed. [ABSTRACT FROM AUTHOR]

Menopausal hormone therapy (MHT) is effective for menopausal symptoms, however, its use is also associated with risks of serious health conditions including breast, ovarian and endometrial cancer, stroke and venous thromboembolism. MHT-related health risks increase with longer durations of use. In Australia, while overall MHT use fell when risk-related findings were published in 2002, a significant number of women continue using MHT long-term. We aimed to examine socio-demographic, health-related and lifestyle characteristics in relation to post-2002 MHT use, and to compare use for <5 and ≥5 years. Data from 1,561 participants from an Australian, national, cross-sectional survey of women aged 50–69 in 2013 were analysed. Odds ratios (ORs) were calculated using logistic regression for characteristics related to overall MHT use post-2002 and multinomial logistic regression for associations between MHT duration of use [never/<5 years/≥5 years] and personal characteristics, adjusting for sociodemographic, reproductive, health and lifestyle factors. Post-2002 MHT use was associated with increasing age (p-trend<0.001), hysterectomy versus no hysterectomy (OR:2.55, 95%CI = 1.85–3.51), bilateral oophorectomy vs no oophorectomy (OR:1.66, 95%CI = 1.09–2.53), and ever- versus never-use of therapies other than MHT for menopausal symptoms (OR:1.93, 95%CI = 1.48–2.57). Women with prior breast cancer (OR:0.35, 95%CI = 0.17–0.74) and with more children (p-trend = 0.034) were less likely than other women to use MHT. Prior hysterectomy was more strongly associated with MHT use for ≥5 years than for <5 years (p = 0.004). Ever-use of non-MHT menopausal therapies was associated with MHT use for <5 years but not with longer-term use (p = 0.004). This study reinforces the need for MHT users and their clinicians to re-evaluate continued MHT use on an ongoing basis. [ABSTRACT FROM AUTHOR]

Children with low‐grade gliomas have excellent long‐term survival outcomes. The development of therapies targeted to the driver mutations along the Mitogen Activated Protein (MAP) kinase signalling pathway are providing long‐term stability for many patients with these tumours. Given the frequency of these tumours residing within or near the suprasellar region, our patients commonly suffer from hormone deficiencies. In Australia, the Pharmaceutical Benefits Scheme currently restricts growth hormone therapy to patients who are not being actively treated for cancer, including those receiving targeted therapies. This viewpoint hopes to facilitate an important discussion amongst our colleagues as to whether this should be changed to allow growth hormone to become available to children on chronic tumour suppressive therapy. [ABSTRACT FROM AUTHOR]

Objective: An increasing number of trans and gender diverse (TGD) individuals are seeking gender‐affirming hormone therapy for gender transition. Little is known about the levels of training, experience and confidence of endocrinologists in providing care and lack of training and experience is a potential barrier to individuals seeking appropriate and timely health care. We aimed to assess the level of training and confidence of Australian endocrinologists and trainees in the endocrine management of trans and gender diverse individuals in a representative sample. Design: Endocrinologist and trainee members of the Endocrine Society of Australia were invited to participate in an anonymous 14‐item survey. Of the 545 members, 147 clinicians (95 adult endocrinologists, 2 paediatric endocrinologists and 50 endocrinology trainees) responded. Results: When presented with a scenario regarding commencement of gender‐affirming hormone therapy, only 19% felt confident providing clinical care to TGD individuals. Compared to other areas of endocrinology, 75% felt less or not at all confident in commencing hormone therapy in a TGD patient. No training in transgender medicine during medical school or during their endocrinology training was reported by 96% and 60%, respectively. There were significantly higher levels of confidence in all aspects including performing a consultation in those who had previously seen a TGD patient. The desire for more training was high (91%). Conclusions: These results highlight the shortfall in training in TGD health care amongst endocrinologists and show that prior clinical experience is associated with higher levels of confidence. Medical schools and endocrinology fellowship training programmes will need to adapt to meet the increasing demand for quality TGD health services. [ABSTRACT FROM AUTHOR]

Background: Recommendations for using menopausal hormone therapy (MHT) and bisphosphonates for postmenopausal osteoporosis management have changed over time. After the release of the Women's Health Initiative (WHI) trial results in 2002, new evidence on risks and benefits of MHT became available, and newer guidelines generally specify that MHT should not be prescribed for prevention of chronic disease, including osteoporosis. This raises the question of whether bisphosphonate prescribing changed over time to compensate for the decrease in MHT use. Materials and Methods: We examined trends in dispensed prescriptions in Australia (national) and Canada (province of Manitoba) in relation to prescribing recommendations. Administrative data were used to describe dispensing patterns and changes for persons of all ages from 1996 to 2008, and for women aged 50 to ≥80 years from 2003 to 2008 in Australia and 1996 to 2008 in Canada. Results: In both geographic settings, MHT dispensing increased 1996–2001, peaked in 2001, and declined substantially thereafter (67% reduction in MHT prescriptions for Australia; 64% reduction for Manitoba, Canada to 2008). From 2003 to 2008, the number of MHT prescriptions declined among all age groups in both settings, with the highest declines among women in their 50s. Concurrently, bisphosphonate dispensing increased until 2005 (2001–2005: 260% increase in the number of prescriptions in Australia; 125% increase in Manitoba) and stabilized thereafter, in both settings. Annual bisphosphonate dispensing rates increased 4.1–10.9% for women in their 70s and 80s in Australia and Manitoba during the period studied. Conclusions: Based on dispensed prescriptions data, more recent guidelines for MHT and bisphosphonates use for postmenopausal osteoporosis, which were updated during the study period (and are still consistent with the current guidelines), appear to have been broadly adhered to in both settings. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the longitudinal impact of evidence changes on menopausal hormone therapy (MHT) use in Australia. Methods: We analyzed two datasets of subsidized and total MHT use (2000-2016) using segmented regression analysis to explore the impact of the Women's Health Initiative (WHI) 2002 and 2007 studies. Analyses were stratified by class, route, and strength. Use was measured in defined daily dose/1000 women/day (DDD/1000/day) or packs/1000 women/month (packs/1000/month). Results: The drop in total MHT use after the WHI 2002 was substantial. The biggest decreases in class, route, and strength were estrogens (28.99 DDD/1000/day, 95% confidence interval [CI] 23.97, 34.01), oral (46.07 DDD/1000/day, 95% CI 41.13, 51.01), and medium strength (34.95 packs/1000/month, 95% CI 30.17, 39.73), respectively. However, vaginal use remained stable (-1.83 DDD/1000/day, 95% CI -3.83, 0.17). Profiles of total and subsidized use were similar over time. Utilization levels were relatively unchanged after 2007. Decreased utilization contributed to product discontinuation, with a lag of up to 4 years. Product discontinuation in 2009 further decreased utilization. Discussion and conclusions: MHT use remained low after 2002 despite evidence favoring its use in women younger than 60 years or within 10 years postmenopause. Continued low use could relate to the WHI 2002 media coverage, therapy objectives, key stakeholder uncertainty, health policies, and medicine availability. [ABSTRACT FROM AUTHOR]

Objectives: Turner syndrome (TS), resulting from complete/partial X chromosomal monosomy, is associated with multiple co-morbidities and increased mortality. Although multidisciplinary management is recommended, TS women's health care is sub-optimal. This study evaluates a multidisciplinary adult TS service.Methods: Retrospective cohort study of 82 patients attending the quarterly TS clinic from December 2003 to December 2014. Evaluation included (1) demographics, (2) TS standardized co-morbidity screening, and (3) estrogen therapy use. Data analysis involved frequency statistics, T tests and polychoric correlation analysis.Results: Median age at TS diagnosis was 14 years (range 0-65 years), with 12% of women aged >18 years. Median age at initial consultation was 31 years (range 16-65 years). Only 14% of patients were transition program referrals. XO karyotype occurred in 30%. Primary amenorrhea predominated; however, 37% of TS women were not taking estrogen therapy. The proportion of patients not previously screened (44-76%) and those with positive screening diagnoses (5-53%) varied according to co-morbidity. The mean (± standard deviation) number of co-morbidities identified increased following TS clinic screening (7.0 ± 2.6 post-screening vs. 4.4 ± 2.3 pre-screening; p < 0.0001). Polychoric correlation analysis identified particular co-morbidity groupings (including metabolism-related) and increased co-morbidities with primary amenorrhea.Conclusion: A multidisciplinary adult TS clinic improves health surveillance with increased identification of co-morbidities and initiation of estrogen therapy. [ABSTRACT FROM AUTHOR]

Aim: The prevalence of asthma worldwide among older children varies between 10 and 20%. One of the most effective therapies to treat asthma and prevent exacerbations is inhaled corticosteroids (ICSs). Systemic corticosteroids are known to decrease bone mineral density and increase the risk of fractures among children, but little is known about the effect of ICSs on fracture risk in children with asthma. The aim of this study was to investigate the fracture rates in children with asthma using ICSs.Methods: A survey on fracture history and risk, bone health and asthma was administered by a researcher to children aged 6-18 years attending a tertiary care children's hospital in Melbourne, Australia over a 6-month period. Fracture risks were compared in children on low or high dose ICS with those not on any ICS and non-asthmatics.Results: A total of 216 healthy control participants were compared with 211 children with asthma - 22% (n = 46) on low dose ICS therapy, 44% (n = 94) on high dose ICS and 34% (n = 71) not on any ICS. There was no difference in the incidence of fractures between children with asthma (24.6% n = 53) and healthy controls (24% n = 51) (χ2  = 0.132; P = 0.717). There were no differences in fracture incidence in the sub-groups of children with asthma (P = 0.695).Conclusion: ICS use was not associated with fracture risk in children with asthma. [ABSTRACT FROM AUTHOR]

Rationale Screening has been found to reduce breast cancer mortality at a population level in Australia, but these studies did not address local settings where numbers of deaths would generally have been too low for evaluation. Clinicians, administrators, and consumer groups are also interested in local service outcomes. We therefore use more common prognostic and treatment measures and survivals to gain evidence of screening effects among patients attending 4 local hospitals for treatment. Aims and objectives To compare prognostic, treatment, and survival measures by screening history to determine whether expected screening effects are occurring. Methods Employing routine clinical registry and linked screening data to investigate associations of screening history with these measures, using unadjusted and adjusted analyses. Results Screened women had a 10-year survival from breast cancer of 92%, compared with 78% for unscreened women; and 79% of screened surgical cases had breast conserving surgery compared with 64% in unscreened women. Unadjusted analyses indicated that recently screened cases had earlier tumor node metastasis stages, smaller diameters, less nodal involvement, better tumor differentiation, more oestrogen and progesterone receptor positive lesions, more hormone therapy, and less chemotherapy. Radiotherapy tended to be more common in screening participants. More frequent use of adjunctive radiotherapy applied when breast conserving surgery was used. Conclusions Results confirm the screening effects expected from the scientific literature and demonstrate the value of opportunistic use of available registry and linked screening data for indicating to local health administrations, practitioners, and consumers whether local screening services are having the effects expected. [ABSTRACT FROM AUTHOR]

Background Requests for assistance in menstrual management and menstrual suppression are a common, emotive and sometimes controversial aspect of adolescent disability care. Aims To review the uptake and outcomes of menstrual suppression among adolescent patients with developmental delay. Methods A retrospective review of the medical records of adolescent females with intellectual disability referred for menstrual management to the Paediatric and Adolescent Gynaecology Clinic, Children's Hospital at Westmead, Sydney, for the three-year period between January 1, 2010 and January 1, 2013. Results Eighty adolescent patients with developmental delay were identified. A third ( n = 28) of the patients were pre-menarcheal at first review with parent/caregivers seeking anticipatory advice. Of the post-menarcheal patients, the median age of menarche was 12 years (range 10-15 years). First and second line interventions were documented as were reasons for change where applicable. The combined oral contraceptive pill ( COCP) was the most frequently used therapy (67%), and 19 patients in total had a levonorgestrel releasing intrauterine system ( LNG- IUS) inserted (31%). Our study population differs from similar previously published groups in the marked absence of the use of depot medroxyprogesterone acetate or the subdermal etonogestrel releasing device. Conclusion As a paediatrician, it is important to address menstrual management issues and allay caregiver concerns with appropriate advice. Our study supports the use of the COCP as sound first line management in achieving menstrual suppression. The LNG- IUS appears to be a favourable second line option. Further investigation into longer-term outcomes and potential complications of device insertion is recommended. [ABSTRACT FROM AUTHOR]

Study question: Does exposure to menopausal hormone therapy (MHT) in mid-aged women alter their risk of cardiovascular disease (CVD) mortality and all-cause mortality?Summary answer: MHT soon after menopause is unlikely to increase the risk of CVD mortality or all-cause mortality and may have a protective effect for women with hysterectomy/oophorectomy.What is known already: The balance of benefits and risks of MHT are currently unclear and may differ according to when treatment starts and whether women have an intact uterus.Study design size, duration: A total of 13 715 participants from the mid-aged population-based cohort (born 1946-1951) of the Australian Longitudinal Study on Women's Health (ALSWH) were followed from 1998 to 2013.Participants/materials setting methods: The measures included cardiovascular and all-cause mortality, exposure to MHT and menopausal status (based on 3-yearly self-reports). Electronic prescriptions data on MHT were also available from mid-2002 onwards. At each follow-up survey wave, participants were classified as: an existing user of MHT, an initiator of MHT or a non-initiator of MHT.Main results and the role of chance: After adjusting for confounding variables, existing users of MHT had a reduced risk (hazard ratio 0.63; 95% CI, 0.43-0.92) of CVD mortality compared with non-initiators. Insufficient evidence of an association was identified for initiators of MHT (0.66; 0.35-1.24). For all-cause mortality, risks were reduced for both initiators (0.69; 0.55-0.87) and existing users (0.80; 0.70-0.91). In a subgroup analysis, women with hysterectomy/oophorectomy had lower risks of CVD mortality for both initiators (0.14; 0.02-0.98) and existing users (0.55; 0.34-0.90), but no evidence of an association was found for women whose MHT commenced during or after menopause. Similarly for all-cause mortality, only the women with hysterectomy/oophorectomy had lower risks for both initiators (0.47; 0.31-0.70) and existing users (0.69; 0.58-0.82).Limitations, reasons for caution: Limitations include the observational nature of the study, the small number of deaths, MHT use being self-reported and the classification of menopausal status also being based on self-reported information.Wider implications of the findings: Women considering MHT soon after menopause can be reassured that the treatment is unlikely to increase their risk of CVD mortality or all-cause mortality.Study funding/competing interest(s): The Australian Longitudinal Study on Women's Health is funded by the Australian Department of Health. G.D.M. is funded by the Australian Research Council Future Fellowship. L.C. was funded by a China scholarship council (CSC) graduate scholarship. All authors report no conflict of interest.Trial registration number: N/A. [ABSTRACT FROM AUTHOR]

For a significant minority of women, menopausal symptoms can be very unpleasant; however, many are worried about taking menopausal hormone therapy ( MHT) for fear of causing breast cancer. Micronised progesterone ( mP4) has been available in Europe since the 1990s and clinical trials have shown that 100 mg oral daily, 200 mg oral sequentially or 100 mg vaginal every second day effectively protect the endometrium from the stimulatory effects of oestrogen. MHT containing mP4 has a significantly lower breast cancer risk than those containing progestins. Micronised progesterone does not appear to attenuate the cardiovascular benefits of oestrogen. Pharmaceutical grade, body identical MHT is now available in Australia. [ABSTRACT FROM AUTHOR]

Background High-quality, evidence-based guidelines can improve the quality of health care and facilitate standardisation of practice within and across healthcare organisations. Limited information is known regarding existing antenatal corticosteroid ( ACS) guideline practices within organisations across Australia and New Zealand. Aims To assess existing ACS clinical practice guidelines ( CPG). To describe current organisational practice related to the production, implementation and renewal of CPG. Design A cross-sectional survey of hospital practice using an online questionnaire. Methods Clinical Managers at 27 secondary and 25 tertiary maternity hospitals, that contribute data to the Australia and New Zealand Neonatal Network, were approached from May to September 2015 and completed the questionnaire on behalf of their organisation. Results Of the hospitals surveyed, 93% reported having a CPG or protocol. Of these, 89% of CPG included recommendations on a single course of ACS, 37% on the use of repeat course/s and 41% on use prior to elective caesarean section at term. Variation in the recommendations provided existed between countries and depending on the level of neonatal care provided. A guideline development group existed in 85% of hospitals. The preferred tools to facilitate implementation of a CPG include: email with a link to the hospital intranet, education sessions and an opinion leader. Only 28% of respondents reported auditing the use of ACS administration. Conclusions There is significant variation in the recommendations provided by current ACS CPGs. Utilisation of a single ACS CPG reflective of the current available evidence base may limit this variation. [ABSTRACT FROM AUTHOR]

The article presents a study by Harriet M. Gunn, Ida Rinne, Hanna Emilsson, Melissa Gabriel, Ann M. Maguire, and Katharine S. Steinbeck on male and female childhood cancer survivors (CCS) at the oncology Long-Term Follow-Up (LTFU) Clinic in Australia in relation to the risk of primal gonadal insufficiency.

To date, people with intersex variations have been mainly studied via small-scale clinical research, with only a small amount of reflective commentary contributed by sociocultural scholars. This paper reports on findings from a 2015 online Australian survey of 272 people with intersex variations, which aimed to redress the gap in research on this groups’ experiences and perspectives concerning education. Participants ranged in age from 16 to 87 years, and represented all Australian states and territories. Most had experienced two medical treatment interventions related to their intersex variation: commonly reported interventions included hormonal treatment and genital surgery delivered to participants when they were aged under 18 years of age. Participants reported various physical and psychological impacts from these treatments. Well-being risks were high; most of the group had engaged in suicidal ideation, particularly when individuals first found out about their variation. This impacted on their schooling – almost one-fifth of survey respondents had received no high school certification due to their early dropout and the overwhelming majority did not attend schools with inclusive puberty/sex education provision or counselling. Most survey participants had not disclosed their intersex variation to staff, although more than half had done so to their classmates. Many had experienced bullying. Only one-quarter of participants rated their overall education experiences positively. Participants suggested improvements to schools’ information provision and support features. [ABSTRACT FROM PUBLISHER]

Background: Greater trochanteric pain syndrome (GTPS) is pathology in the gluteus medius and minimus tendons and trochanteric bursa that causes debilitating tendon pain and dysfunction, particularly in post-menopausal women. Limited evidence in clinical studies suggests hormone changes after menopause may have a negative effect on tendon. This protocol describes a randomised controlled trial comparing the effectiveness of menopausal hormone therapy (MHT) and exercise therapy in reducing pain and dysfunction associated with GTPS in post-menopausal women.Method: One hundred and sixteen post-menopausal women will be recruited and randomised to receive one of two exercise programs (sham or targeted intervention exercise) and transdermal creams (MHT cream containing oestradiol 50mcg and norethisterone acetate 140mcg or placebo cream). Interventions will be 12-weeks in duration and outcomes will be examined at baseline, 12-weeks and 52-weeks. The primary outcome measure will be the VISA-G questionnaire and secondary outcomes measures will include three hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, Lateral Hip Pain questionnaire), a global change in symptom questionnaire (using a 15-point Likert scale) and a quality of life measure (AQoL-8D questionnaire). Data will be analysed using the intention to treat principle.Discussion: This study is the first randomised controlled trial to compare the effectiveness of menopausal hormone therapy therapy alone, and with the combination of exercise therapy, to treat pain and dysfunction associated with GTPS. This study has been pragmatically designed to ensure that the interventions in this study can be integrated into policy and clinical practice if found to be effective in the treatment of GTPS in post-menopausal women. If successful, there is potential for this treatment regimen to be explored in future studies of other persistent tendon conditions in the post-menopausal population.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001157662 Registered 31 October 2014. [ABSTRACT FROM AUTHOR]

This paper presents for the first time the results of research conducted in 2001 titled Australian Transgender Survey 2001 (ATS2001). Sixty-six transgender Australians participated in a qualitative research methodology—namely, an online survey—and were asked to reflect on their sex/gender and transgender identities and lived experiences, especially in regard to their views on hormone therapy, sex reassignment surgery, and the medical profession. Participants were also asked about their aspirations for the future of transgenderism in Australia. This project was unable to mirror the findings of other research, thus, making a unique contribution to the extant literature. ATS2001 indicates that participants are satisfied with the results of sex reassignment surgery while simultaneously being critical of the medical profession. Participants were also asked to reflect on their aspirations for the future. Some aspirations, such as uniformity across Australian states and territories with regard to recognition of one's sex/gender and a reduction in the cost of "sex reassignment surgery," have not been realized. Other aspirations have been realized, such as the passage of anti-discrimination laws, being able to change the sex/gender on official documents, being able to marry, and social acceptance and adoption of sex/gender categories other than man, woman, and transgender, have occurred. [ABSTRACT FROM AUTHOR]

Aim To assess the performance of a proxy for estrogen receptor ( ER) status in breast cancer patients using dispensing data. Methods We derived our proxy using 167 patients. ER+ patients had evidence of at least one dispensing record for hormone therapy during the lookback period, irrespective of diagnosis date and ER- had no dispensing records for hormone therapy during the period. We validated the proxy against our gold standard, ER status from pathology reports or medical records. We assessed the proxy's performance using three lookback periods: 4.5 years, 2 years, 1 year. Results More than half of our cohort (62%) were >50 years, 54% had stage III/ IV breast cancer at recruitment, (46%) were diagnosed with breast cancer in 2009 and 23% were diagnosed before 2006. Sensitivity and specificity were high for the 4.5 year lookback period (93%, 95% CI: 86-96%; and 95%: 83-99%), respectively) and remained high for the 2-year lookback period (91%: 84-95%; and 95%: 83-99%). Sensitivity decreased (83%: 75.2-89%) but specificity remained high (95%: 83-99%) using the 1-year lookback period and the period is long enough to allow sufficient time for hormone therapy to be dispensed. Conclusion Our proxy accurately infers ER status in studies of breast cancer treatment based on secondary health data. The proxy is most robust with a minimum lookback period of 2 years. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the influences on accessibility of compounded progesterone therapy for Australian women. Study design: A cross-sectional survey of a stratified sample of Australian women who use progesterone only products using the ‘Perspectives on Progesterone’ questionnaire. Main outcome measures: Principle components analysis (PCA) to determine components of access to progesterone treatment and multi-way analysis of variance to compare groups. Results: Women using compounded progesterone were likely to have made at least one lifestyle adaptation (73%), and to have tried and stopped using at least one complementary and alternative medicine therapy (63%) or conventional hormone therapy (41%). PCA revealed six components of access to progesterone treatment: affordable, values natural treatments and is concerned about other treatments, conventionally available, perceived knowledge, values information gathered from a variety of sources, and rural & disadvantaged. The multifaceted nature of progesterone use illustrates that there are multiple aspects to use of non-conventional medicines. Women looking for non-conventional treatment are neither stupid nor uninformed, their understandings, based on experience and research, need to be addressed by health professionals while assessing their condition prior to discussing the risks and benefits of non-conventional medicines. Conclusion: Access to compounded progesterone is multifaceted, and many of the women who use it have tried other treatments first. Despite the clinical ambivalence towards progesterone as an alternative for women who may have tried and rejected other treatments, including conventional hormone therapy, the women described in this paper are using it. [Copyright &y& Elsevier]

Objective: This paper explores women's experiences of drought in Australia. Despite the significance of drought for rural life in Australia, there is little research seeking to understand its psychological consequences. There is also a need to recognise gendered experiences of drought and for research that addresses its long-term effects as people age in prolonged drought-affected areas. Design: The study explores longitudinal qualitative data collected by the Australian Longitudinal Study on Women's Health. Free-text comments ( n = 217), collected via mailed survey at five time points (1996, 1998, 2001, 2004, 2007) from the same 77 women, were subjected to a narrative analysis. Participants: Participants from the Australian Longitudinal Study on Women's Health who were aged 45-50 when the study began in 1996. Results: Findings indicate that drought has an impact on women as they age, particularly in reference to menopause, access to support systems and retirement. Conclusion: This study concludes that the experience of drought cannot be disentangled from the realities of gender and ageing. [ABSTRACT FROM AUTHOR]

The article reports on risk factors for glaucoma. It presents a novel glaucoma risk-factor reference guide of patient history-related risks of developing glaucoma, based on evidence strength and level of concern in the literature included in the review. It mentions that this reference guide assist primary health care providers during regular health assessments, to efficiently and effectively identify individuals who are potentially at high risk of glaucoma.

Four women, who previously had undergone multiple unsuccessful in vitro fertilisation (IVF) cycles because of failure of implantation of good quality embryos, were identified as having coexisting uterine adenomyosis. Endometrial biopsies showed that adenomyosis was associated with a prominent aggregation of macrophages within the superficial endometrial glands, potentially interfering with embryo implantation. The inactivation of adenomyosis by an ultra-long pituitary downregulation regime promptly resulted in successful pregnancy for all women in this case series. [ABSTRACT FROM AUTHOR]

Abstract: The purposes of this study were to analyse trends in hip fracture (HF) epidemiology over a 13-year period (1994–2007) in the Australian Capital Territory (ACT), to assess the potential impact of concurrent changes in hormone replacement therapy (HRT) and bisphosphonate use and to present a new prediction of HFs in Australia up to 2021. Annual sex- and age-specific incidence rates (per 100,000 population) were determined and standardized using the Australian 2006 population. The projected number of HFs was estimated by two models applying age- and sex-specific HF rates averaged for 2002–2006 (model 1) or continuously changing as observed in this period (model 2, Poisson regression) to the projected population. In 2006 compared to 2001, the population ≥60 years in the ACT increased by 19.7%. Over the last 5 years the average annual incidence HF rate compared to the previous 3-year period decreased in females ≥60 years of age by 28.3%. Between 2001 and 2006 the number of prescriptions for HRT dispensed in the ACT declined by 54.6, while the number of prescriptions for bisphosphonate increased by 245%, accompanied by a decline in standardized incidence of HF rates of 36.4%, mainly in women (42.1%). This represents an annual cost for bisphosphonates per one prevented HF, of $A45,250 or $A576 person/year. Compared to 2006 the total number of HFs in Australia according to model 1 will increase in 2011 by 20.1% and in 2021 by 58.8%, but according to model 2 will decrease by 15.5% in 2011 and 27.5% in 2021. Our data suggest that the previously predicted rising trend in HFs in elderly women reversed, but did not so for men. This was coincident with a significant fall in HRT use and increased prescribing of bisphosphonates, which is cost-effective. However caution should be used in attributing causation as this is an ecological study. If trends in HF observed in 2002–2006 continue, the absolute number of HFs in Australia in 2011–2021 will stabilise or decline (which is more likely), despite the rapid ageing of the population. [Copyright &y& Elsevier]

Objective To describe the prevalence of menopausal hormone therapy (HT) in 2008 and trends over the last 17 years in an Australian population. Methods Data were obtained from nine representative population face-to-face interview surveys of the South Australian population from 1991 to 2008. The surveys used consistent method and quality control procedures. In 2008, demographic data, HT use and eight dimensions of health, using the SF-36 health survey questionnaire, were measured. Participants Over 3000 South Australian adults were interviewed in their own home by trained health interviewers in each of the surveys; in the 2008 survey, 1555 women participated, of whom 953 were over age 40. Results After a peak in use in the 2000 survey, HT use fell from 2003 and has continued to decline in 2008. In 2008, current use over age 50 of registered conventional HT products is now 11.8%, with a further 4.0% using non-registered alternative 'hormonal' products. Current HT use is highest between the ages of 50 and 59 years, where 13.4% use conventional HT and 7.7% use unconventional alternative hormones. Use of these unregistered hormonal products was rare in previous surveys. Median and mean length of conventional HT use were 10.0 and 10.5 years, respectively. HT users continued to have a demographic profile similar to those in previous surveys, i.e. they were better educated, employed, partnered, had a higher income and were less inclined to use complementary and alternative medicines. Conclusions There has been a continuing decline in both the overall prevalence and length of use of conventional HT from 2003, probably in association with negative media about HT. Of medical concern is that about one-quarter of women using HT around menopause now chooses unregistered hormonal mixtures that are untested for long-term safety and efficacy. [ABSTRACT FROM AUTHOR]

Purpose: To review the clinical features, treatment, outcome and survival of metastatic tumors of the orbit. Materials and Methods: Retrospective, non-comparative, chart review of 80 patients with orbital metastasis treated in four tertiary orbital centres in Australia. Results: The study included 80 patients of which, 44 were male with a mean age of 60 years. Orbital involvement commonly presented late in a multisystemic disease; however, the orbit was the first presentation in 15% of the cases. Diplopia (48%), pain (42%), and visual loss (30%) were the commonest symptoms at presentation; whereas proptosis (63%), strabismus (62%), and visual loss (41%) were the most frequent clinical signs. Computed tomography commonly showed a solid enhancing mass (42 cases) located within the orbital fat (43%), or enlarging an extraocular muscle (28%). Breast carcinoma (29%), melanoma (20%), and prostatic cancer (13%) were the most frequent histological types. Treatment was often multi-disciplinary and modalities included radiotherapy, chemotherapy, hormone therapy, surgery, and immunotherapy. Survival was limited to 1.5 years after diagnosis independent of the histological type, with 29% of patients alive after 17 months follow-up. Conclusions: A high index of suspicion and appropriate intervention with histological diagnosis can help in the management and quality of life in patients with metastatic orbital disease. Overall survival is limited and we encountered statistical limitations proving differences in the survival based on the sub-type of primary tumour involved. Metastatic orbital melanoma presented a higher incidence when compared with previous studies, probably due to the increase frequency of skin found in the Australian population. [ABSTRACT FROM AUTHOR]

Introduction. No previous population-based studies have used validated instruments to measure female sexual dysfunction (FSD) in Australian women across a broad age range. Aim. To estimate prevalence and explore factors associated with the components of FSD. Main Outcome Measures. Sexual Function Questionnaire measured low sexual function. Female Sexual Distress Scale measured sexual distress. Methods. Multivariate analysis of postal survey data from a random sample of 356 women aged 20–70 years. Results. Low desire was more likely to occur in women in relationships for 20–29 years (odds ratio 3.7, 95% confidence intervals 1.1–12.8) and less likely in women reporting greater satisfaction with their partner as a lover (0.3, 0.1–0.9) or who placed greater importance on sex (0.1, 0.03–0.3). Low genital arousal was more likely among women who were perimenopausal (4.4, 1.2–15.7), postmenopausal (5.3, 1.6–17.7), or depressed (2.5, 1.1–5.3), and was less likely in women taking hormone therapy (0.2, 0.04–0.7), more educated (0.5, 0.3–0.96), in their 30s (0.2, 0.1–0.7) or 40s (0.2, 0.1–0.7), or placed greater importance on sex (0.2, 0.05–0.5). Low orgasmic function was less likely in women who were in their 30s (0.3, 0.1–0.8) or who placed greater importance on sex (0.3, 0.1–0.7). Sexual distress was positively associated with depression (3.1, 1.2–7.8) and was inversely associated with better communication of sexual needs (0.2, 0.05–0.5). Results were adjusted for other covariates including age, psychological, socioeconomic, physiological, and relationship factors. Conclusions. Relationship factors were more important to low desire than age or menopause, whereas physiological and psychological factors were more important to low genital arousal and low orgasmic function than relationship factors. Sexual distress was associated with both psychological and relationship factors. Hayes RD, Dennerstein L, Bennett CM, Sidat M, Gurrin LC, and Fairley CK. Risk factors for female sexual dysfunction in the general population: Exploring factors associated with low sexual function and sexual distress. J Sex Med 2008;5:1681–1693. [ABSTRACT FROM AUTHOR]

For many years, radical feminists have been warning about the dangers inherent in the use of Hormone Replacement Therapy. Until the release of the Women''s Health Initiative results in 2002, these warnings were dismissed and discredited. In this article I summarise these recent debates. In addition, I also draw upon findings from my doctoral research, the first study in Australia to examine lesbians'' experiences of menopause, to highlight how lesbian voices and radical feminist analyses of the medicalisation of midlife are overlooked and dismissed. For the purpose of this article, I restrict my critique to the issue of Hormone Replacement Therapy. Throughout this article I challenge negative, stereotypical views of lesbians at menopause and suggest that listening to lesbians adds a new dimension to the presently narrow, heterosexist and medicalised view of women at midlife. [Copyright &y& Elsevier]

Background: The administration of antenatal corticosteroids to women at risk of preterm birth is an important component of care for such women. However, inevitably, attempts to maximise the number of women who receive corticosteroids ahead of preterm birth will also expose women perceived at risk who subsequently deliver at term. These women have not been previously quantified. Aims: To describe antenatal corticosteroid prescribing practices at a single institution over a seven-year period. Methods: Interrogation of an electronic birthing outcome system supplemented by hand-searching of medical records, recording all women birthing before 34 weeks and all women with a hospital admission before 34 weeks but birthing after 34 weeks. The number of women receiving antenatal corticosteroids in each of these groups was recorded, and trends between groups and over time were analysed using logistic regression. Results: While the total number of women receiving antenatal corticosteroids in our institution has risen over the last seven years, the proportion of women receiving antenatal corticosteroids who deliver between 24 and 35 weeks has increased inconsistently and modestly (average increase 12% per year (95% CI: 6–19%, P < 0.001). In contrast, the number of women receiving antenatal corticosteroids who subsequently deliver after 34 weeks has increased consistently, with an average increase rate of 21% per year (95% CI: 16–25%, P < 0.001). Conclusions: Increasing numbers of women birthing after 34 weeks in our hospital are receiving antenatal corticosteroids before 34 weeks. The long-term implications of this are not currently clear. [ABSTRACT FROM AUTHOR]

Synopsis: In April 2004, the Family Court of Australia made the decision that a 13-year-old girl, said to be suffering from gender identity disorder (GID), should be treated as a boy and embark upon a course of female hormone treatment to suppress menstruation. The treatment is expected to change to the administration of male hormones at 16, and surgery after she reaches 18. This decision is in line with a developing trend internationally to normalise the phenomenon of sex reassignment. I shall argue that gender identity disorder is a social construction created by the medical profession, and that it is culturally and historically specific. By imposing a diagnosis and treatment that will cause irreversible changes to an adolescent underaged girl''s body, this decision should be seen as judicial child abuse rather than an enlightened decision in the child''s best interests. [Copyright &y& Elsevier]

Objective To investigate the associations between C-reactive protein (CRP), homocysteine levels, use of hormone therapy (HT) and other factors. Methods A 12-year prospective study of 438 Australian-born women (Melbourne Women's Midlife Health Project), who at baseline were aged 45-55 years, had menstruated in the previous 3 months and were not taking HT. Fasting blood was collected in the 11th follow-up year for CRP, homocysteine, estradiol and follicle stimulating hormone (FSH) levels. Physical measurements and face-to-face interviews obtained information on health and lifestyle variables. Results A total of 258 women (mean age 60 years) participated in the 11th follow-up year. Multiple regression analysis found that CRP levels were positively associated with body mass index (p < 0.001), HT use (p < 0.01), and negatively associated with statin use (p < 0.005) and exercising {p < 0.05). In postmenopausal women currently not using HT (w= 173) and after adjusting for body mass index, exercise and smoking, CRP was negatively associated with FSH levels (β= -0.32, p < 0.05). Homocysteine levels were positively associated with smoking (p < 0.001) and negatively associated with HT use [p < 0.05). Conclusion In middle-aged Australian-born women, HT use was associated with increased CRP and decreased homocysteine levels. High CRP levels were also associated with high relative weight, low exercise levels and no statin medication. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was two-fold: to assess climacteric symptoms and provide normative data for the Greene Climacteric Scale during the menopause transition, and to investigate the prevalence of climacteric symptoms in a representative sample of postmenopausal Australian women. Method A cohort of 500 premenopausal, perimenopausal and postmenopausal women aged 40–80 years participated in the Longitudinal Study of Ageing in Women (LAW study) at the Royal Brisbane and Women's Hospital, Brisbane, Australia. In year 1 of the study (2001), all participants completed the Greene Climacteric Scale and information regarding their menopausal status and the use of hormone therapy (HT) was obtained through a clinical interview with a qualified medical practitioner. Results The 50–59-year age group achieved the highest scores on the vasomotor and the depression scales in comparison to other age groups. Significant differences were also evident on the vasomotor and the depression scales on the basis of menopausal status, especially in perimenopausal women. Approximately 10% of women in the 60–79-year age group continued to experience vasomotor symptoms. Conclusion Vasomotor symptoms, as assessed by the Greene Climacteric Scale, are common during the menopause transition and remain elevated for some years in a minority of older postmenopausal women. The norms presented in this study are appropriate for use in an Australian population. [ABSTRACT FROM AUTHOR]

The main aim of the present study was to explore the midlife experience for women living in Australia and Japan. The specific objectives of the study included: (i) comparing menopausal symptoms between the two groups; and (ii) comparing the factor structure of symptoms and exploring their relationship to menopausal status. Postal questionnaires were distributed to two structured, random population based samples of midlife women aged 45–60 years; consisting of 712 women living in Australia and 1502 women living in Japan. Analysis showed significant differences in menopausal symptoms related to psychological symptoms ( P < 0.001), including anxiety ( P < 0.001) and depression ( P < 0.001), somatic symptoms ( P < 0.001), and vasomotor symptoms ( P < 0.01). The analysis, which excluded hormone replacement therapy (HRT) users, found that there were significant differences seen across menopausal status in the following symptoms: difficulty in sleeping ( P < 0.01), difficulty in concentrating ( P < 0.01), feeling dizzy or faint ( P < 0.001), loss of interest in most things ( P < 0.01) and loss of feeling in hands or feet ( P < 0.001). In the postmenopausal stage specifically, significant differences were seen in the areas of feeling tense or nervous ( P < 0.01), feeling unhappy or depressed ( P < 0.01), parts of body feeling numb or tingling ( P < 0.05), headaches ( P < 0.01), and sweating at night ( P < 0.05). Our analysis revealed that the experience of menopause for women is different between Australian and Japanese women. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the impact of the Women's Health Initiative (WHI) on the use and perception of hormone therapy (HT) in well-informed and altruistic women who had volunteered for a similar long-term study of HT (Women's International Study of long Duration Oestrogen after Menopause, WISDOM).Methods: A total of 840 South Australian WISDOM participants were sent questionnaires asking about their source of information about the WHI, interpretation of the 2002 WHI findings, perception of HT as a risk factor for breast cancer, attitudes towards doctors and the media and intent to use HT in the future.Results: Altogether, 618 participants (74%) responded. Written and verbal information provided by WISDOM were rated as the most helpful sources of information about the WHI. Participants were aware of the increase in breast cancer and decrease in fractures seen with combined estrogen/progestogen hormone therapy (EPT) but were less convinced about the other major findings, including cardiovascular disease and dementia. HT was rated as an important risk factor for breast cancer. Participants valued medical research and were more likely to question therapies without evidence. After WHI and WISDOM, most were willing to participate in a subsequent trial and most past HT users resumed therapy.Conclusions: There are sufficient recruits for future long-term HT studies if they are given sufficient quality information and individual counselling. Our study also suggests that women who are appropriately informed may choose to take long-term HT despite a more conservative approach advised by some agencies. [ABSTRACT FROM AUTHOR]

Objective: To continue surveillance of hormone therapy (HT) use in an Australian population and to assess the impact of the Women's Health Initiative (WHI) and associated reports on HT use 16 months after the results of the WHI were first reported.Methods: Data were obtained from the 2003 South Australian Health Omnibus Survey, which involves a representative, population face-to-face interview survey. Data were compared to five surveys undertaken between 1991 and 2000, which had consistent methods and quality-control procedures. A total of 907 interviews were conducted with women over 40 years in their own homes by trained health interviewers.Results: In association with the timing of media reporting of the WHI, current HT use rates dropped from 28% in women over 50 years in 2000 to an estimated 10.2% in 2002. By October 2003, current use rates had returned to 18.8% in this age group. The media had been the main influence in the women's decision-making. Half of those who restarted therapy changed to another type of HT. Only 2.8% changed to an alternative/complementary therapy.Conclusions: Nearly two-thirds (64%) of those currently using HT in 2002 stopped therapy, mostly in response to the media reporting of the WHI. Nearly half of those who stopped HT in 2002 have since restarted. Media reporting greatly influences the use of hormonal therapies. [ABSTRACT FROM AUTHOR]

In this population-based study, we evaluated the association between exposure to hormone therapy (HT), bone mineral density (BMD) and the prevalence of non-vertebral fractures. The study was set in a region located in southeastern Australia where complete fracture ascertainment was determined from radiological reports. Current HT use for at least 6 months was ascertained in women with non-vertebral fractures [median age 70.9 years; inter-quartile range (IQR) 66.5–75.9 years] and randomly selected controls (median age 70.8 years; IQR 65.2–75.0 years). Current HT use was documented in 20 of 262 cases and 49 of 364 controls. The odds ratio (OR) for non-vertebral fracture associated with HT use was 0.53 (95% CI 0.31–0.92). HT use was associated with 2.6–7.5% higher BMD at axial and appendicular sites. HT use is associated with a halving of risk for non-vertebral fractures and higher BMD. [ABSTRACT FROM AUTHOR]

This paper provides specific guidelines on the management of tuberculosis infection and disease, covering general principles, recommended drug regimens and discuss the evidence to support these. It also covers use of corticosteroids, intermittent therapy, directly observed therapy and an approach to the management of a patient with drug-resistant tuberculosis. [ABSTRACT FROM AUTHOR]

Wisdom was a multicenter, randomized, placebo-controlled clinical trial of postmenopausal hormone therapy that began recruitment in 1999 in the U.K. and in 2000 in Australia and New Zealand. The trial was prematurely cancelled in 2002 after the initial publication of results in the Women's Health Initiative (WHI). This report summarizes the outcomes in 5,692 women (26% of the target number of 22,300) who started treatment. Treatment arms were similar to those in the WHI: daily combined estrogen-progestin with 0.625 mg conjugated equine estrogens (CEE) and 2.5 or 5.0 mg medroxyprogesterone acetate or estrogen only with 0.625 mg CEE daily. The women taking combined estrogen-progestin had significantly increased rates of cardiac events and venous thrombosis. The numbers were much smaller in the estrogen-only arm, but there was a similar trend. Rates for stroke and breast cancer were no different comparing treatment and placebo groups. All but two of the 11 cardiovascular events in treated women were in participants over age 64 who had one or more recognized cardiovascular risk factors. The authors concluded that the results were similar to those in the WHI, reflecting the impact of starting or restarting hormone therapy in older women. [ABSTRACT FROM AUTHOR]

Examines the effects of Hormone Replacement Therapy (HRT) to sensitivity of mammographic screening in Australia. Decrease of sensitivity of screening mammography to HRT users; Detection of cancers by screening among HRT users; Need to develop an advice for mammographic screening of women using HRT.

The article discusses about the ultrasound guidance in corticosteroid injection for plantar fasciitis and extends further discussion over, Is single ultrasound guided corticosteroid injection an effective treatment for plantar fasciitis?, resulting in safe and effective short term treatment for plantar fasciitis, providing better pain relief than placebo at four weeks. Further the paperadds, harms and potencial funding is presented in the article.

New empirical evidence on the long-term effects of oestrogen treatment for tall adolescent girls has shown that the intended psychosocial benefit of the treatment may not have been realised. This paper describes recent trends in the prevalence of the treatment and the results of a large Australian cohort study evaluating girls assessed between 1959 and 1993 for excessive growth. The paper concludes that oestrogen treatment to prevent extreme tallness should belong to the past, not to the future. [ABSTRACT FROM AUTHOR]

Reports on the case of an Australian girl who will be allowed to take hormone treatment as a possible prelude to sex-change surgery. Statement that after she turns 18 she will be allowed to consider gender reassignment surgery; Background information on the child; Death of her father when she was young; Comments made by Georgina Beyer, a transsexual member of parliament in New Zealand.