The Center for Population Research of the National Institute of Child Health and Human Development began operations in August 1968 and is engaged in research dealing with health-related popula tion problems. We organize and support projects for the develop ment of new contraceptives and in the broad field of population research in the social sciences o The Center also supports a variety of projects dealing with the mechanism of action and medical effects of contraceptives now in use, particularly oral contraceptives and intrauterine devices. These studies were initiated several years ago at the specific direction of Congresso We were pleased, therefore, with the opportunity to help organize and support this important and timely conference on the "Metabolic Effects of Gonadal Hormones and Contraceptive Steroids," the subject of which forms an integral part of the Center's research program. April, 1969 Philip Ao Corfman Director Center for Population Research National Institute of Child Health and Human Development v PREFACE Progress in science is often associated with either a "sixth sense" or an inevitable timeliness. Both factors, perhaps, led the members of the Endocrinology Study Section of the National Institutes of Health to propose, in 1966, that an expanded view of the effects of gonadal hormones, in general, and the contra ceptive steroids, in particular. was needed. There had been ample evaluations of the clinical symptomatology, contraceptive efficacy, and effects on the reproductive system, but there was a dearth of information on their multiple systemic'metabolic effects.
Contraception is the most comprehensive exploration of the newest technologies in the area of contraception. Edited by renowned authorities Dr. Donna Shoupe and Dr. Florence Haseltine, with chapters written by leaders in the field, this book comprises the most up-to-date, practical and clinical information available and presents a thorough examination of clinical efficacy, side effects, mechanisms of action, and benefits of all types of contraception, including: - chapters on the IUD, the new subdermal implant Norplant, injectables, the diaphragm, condoms, sponge, female sterilization, vasectomy, and more - discussions of cutting edge contraceptive technologies, including the new progestin oral contraceptive pills, contraceptive vaginal rings, and RU 486, - an important chapter on AIDS and contraception. This book will serve as an invaluable reference providing useful, instructive background information and pertinent clinical applications for the physician, resident, and researcher. At such an exciting time for contraceptive technology, no one in the field can afford to be without this text.
Nearly one-half of an American woman's life is spent after the cessation of reproductive function. A woman of 40 years has an additional life expectancy of nearly 40 years; a woman of 75, over 11 years. This pattern of longevity is likely to continue, so that by the year 2000, it has been estimated, 30 percent of the female population will be postmenopausal. While it is difficult to separate the results of aging from those of estrogen deprivation, it is important that we try to do so, since the results of the latter are amenable to treatment. The medical infirmities resulting from estrogen deprivation take a high toll among postmenopausal women. Nearly 200,000 hip fractures occur annually in this group, resulting in 15,000 deaths and a high morbidity rate. Sleep disorders, compromised sexuality, psychomotor alterations of the climacterium, and urinary tract disorders all contribute to a lowered quality of life. Appropriate treatment of these disturbing postmenopausal conditions requires an understanding of the underlying bio chemical, endocrinologic, psychologic, and pathophysiologic al terations of estrogen deprivation. Toward this end, the reader will find herein chapters dealing with estrogen metabolism in the postmenopausal female, end-organ response to estrogen deprivation, and bone metabolism and osteoporosis. Next, the reader will find chapters dealing with specific or gans, organ systems, or conditions related to the quality of life; for example, sexuality, urinary tract problems, sleep disorders, the breast, sports and exercise, the climacteric, and the psycho biology of the menopause.
The decision taken during the First International Congress on the Menopause in June 1976 to repeat the exercise 2 years later turned out to be a good one. In the last few years much work has been done on the subject of the menopause. I t is, of course, a subject of many facets, but of particular importance recently has been the work done as a result of the reports appearing in 1975 and 1976 alleging an increase in the incidence of endometrial carcinoma in women who had used oestrogens, and of other effects, some beneficial others deleterious, reportedly seen when oestrogens were administered. 1978 seemed the right time to re-assess the situation, and the Second Inter national Congress on the Menopause provided a good platform. The congress was held in Jerusalem in June 1978. It took the form of a series of 12 workshops, each of which, within a prescribed framework, was planned and presided over by a moderator experi enced in that particular field. The 12 moderators were free to organize their sessions in whichever way they wished, and to invite whoever they wished to present papers and to join in the discussions. In addition the workshops were open to anyone who wished to attend.
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