One of the most important roles of any practicing physician is to diagnose and treat diseases. However, in modern times and with the advances in Medicine, it is known that many diseases are preventable and result from risk factors that can be identified and modified. Since the majority of deaths are due to errors in lifestyle the modern medical doctor, other than [Citation1] treating diseases, must concentrate his efforts in Preventing Medicine [Citation2,Citation3]. This requires knowledge, persistence, persuasive talents and time spent with each person. People are much more receptive to take a prescribed medicine than to adopt by themselves profound changes in their life style a condition sine qua non for a better health that allows a compression of morbidity in later age [Citation4].
Women are better candidates for this type of preventive medicine than men. When they reach mid age they go to see a doctor to help them get rid of the troublesome symptoms of their climacteric (hot flushes, night sweats, irritability, etc.).
Men are more resistant to consult a doctor to see if they are in good health.
Our society is ageing rapidly and thus many more aged women will seek medical help. Their main concern is to avoid to become old and to keep some signs of their previous youth. A physician does not have any anti-ageing tools. He cannot prevent people from ageing but he can help them to prevent premature senescence. For that, his major weapon is the teaching of Life Style Medicine (Preventive Medicine!) [Citation5] which is supported by this tripod: proper nutrition, exercise, and mental health.
When a midaged women consults a doctor because of their annoying vasomotor symptoms it is not uncommon that this physician will concentrate his attention only in that problem, prescribing appropriate hormonal treatments that resolve the problem. Many of them do not feel that they should do more than measuring weight and blood pressure, asking for a mammography and a pelvic ultrasound.
Without them noticing it that woman is secretly appointing them as their family physician and the most important supporter for her most intimate problems. This is a frequent occurrence that requires from that doctor sufficient time to listen empathically to her and capacity to encourage her to start living with the tripod of preventive medicine.
The study of the climacterium has been overemphasized mainly due to the influence of the pharmaceutical industry. Many well-known epidemiological studies have been published with often wrong conclusions, often misinterpreted by the media and the medical professionals and with very bad consequences in women’s health [Citation6].
Some menopauselogists have even created a Menopausal Medicine …[Citation7,Citation8].
I don’t agree! There are only two Medicines: a Bad and a Good one!
There is nothing special about a hormonal treatment (HT). If there are no contraindications it should be prescribed within 10 years after the menopause. It is used only for the relief of symptoms and not for the prevention of diseases (bone, CV). Bioidentical hormones are to be preferable (estradiol and natural progesterone) avoiding progestins (MPA, NETA, etc.). The route of administration must be selected in each case. Duration of treatment depends on the woman’s needs. Again, if there are no incoming contraindications, and if symptoms return after the suspension of a HT it may continue after 5 years with adequate monitoring [Citation9–12].
I also have rejected, a long time ago, Hormone Replacement or Substitution Therapy. It is simply a Hormonal Therapy with well-known benefits for climacteric women. Replacements are what one sees with thyroid hormones, insulin, cortisone, etc.
Therefore, and in conclusion, I think that those who accept to care for a climacteric woman must, first, be empathic human beings able to have time to listen and to support, second, have a good knowledge of Internal Medicine, and finally, be good specialists in gynecology and endocrinology. If they have these qualities they can be sure that they shall be well rewarded for having been good people and good clinicians.
This is a Holistic Medicine, the cure of the whole person [Citation13].
Sir W. Osler once said that to know the disease a person has is as important as to know the person who has the disease.
Declaration of interest
The author reports no conflict of interest.
References
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