Sven O. Skouby, MD, DSc. 

Abstract | CV

Abstract

Controversial History of Sex-Hormones

By
Sven O. Skouby, MD, 
Dep OB/GYN, Frederiksberg Hospital, University of Copenhagen, Denmark.

The development of hormonal contraception has led to a socio-economic development, which is a real revolution for both the individual woman and society. Looking back forty years after the introduction of oral contraception (OC) no other pharmacological compound has been used by so many individuals over such a long period of time. In spite of criticism linked to perceived potential side effects and several pill scares induced by newspaper headlines, the pill was and remains the contraceptive method of choice for most women. One of the major keys to this success has been a continuous development of new types of pills and hormones that have improved the method’s tolerability and safety. The pill we know to day has evolved from an overdosed product for the treatment of “menstrual disturbances” to a fine-tuned lifestyle product. It offers a safe convenient, reversible method of fertility regulation and in addition confers important non-contraceptive health benefits.

Hormonal replacement therapy (HRT) has a clear place in the treatment of climacteric symptoms although its long-term use is under continued evaluation. More and more women will present to their health care provider with menopausal symptoms perceived as intruding on life quality. Reliable estimates show that 10% of the global female population is currently either going through menopause or have already gone through it, and at least another 2 % will reach this stage of life in the next decade Solving the problems of rising health costs and population aging requires application of a modern approach to menopausal health evolved in recent years from an improved understanding of the complex changes that occur during this transition in a woman's life. Increasing knowledge about the mechanism of estrogen action is essential in this context and represents one of the most significant scientific advances today. Traditionally, the primary indication for HRT is to treat women suffering from the hypo-estrogenic symptoms. Publicity about the possible ability of HRT to prevent chronic conditions, such as osteoporosis, CHD, Alzheimer disease, and colorectal cancer, has contributed to increased HRT use. This is despite also information or perception of possible harmful effects, first and foremost increased risk of breast cancer. Most recently the HRT paradigm on the balance of benefits and harms has been impacted by puzzling information from several major randomized clinical trials. On a growing list these studies have not shown any cardiovascular benefits in women with established CHD. The situation in women without CHD manifestations is less clear, because fewer data from the randomized studies exist.
To some extent epidemiological information has therefore added complexity and uncertainty to prescription of both OCs and HRT. As a consequence, there is a need to clarify and reiterate beneficial aspects of hormonal treatment, and also to identify those women who may be at risk for adverse effects, although few in absolute numbers. For obvious reasons epidemiology and clinical research should go hand in hand to improve reproductive health in women from puberty through to the postmenopausal period.

CV

Professor in Gynecological Endocrinology, University of Copenhagen, Chief Gynecologist, Department of Obstetrics and Gynecology, Frederiksberg Hospital, Copenhagen. Postdoctoral residency in Diabetology, Endocrinology and Reproductive Medicin. Member of the advisory board of the Danish Society of Obstetrics and Gynecology. Founder and President of the European Society of Contraception (ESC), the European Sex Steroid Foundation, and the Scandinavian Menopause Society. Secretary General of the European Menopause and Andropause Society (EMAS). During the last 20 years organizer and chairman for a number of national and international congresses, workshops and consensus meetings on reproductive health care in general and sex steroid and metabolism in particular. Member of FIGO Expert Advisory Panel on Contraception and Menopause. 

Special research interests:
Gynecological endocrinology and reproductive medicine. Especially the impact of sex steroids on metabolism and vascular function. Head of the Gynecological Endocrinological Research Laboratory at the Department of Obstetrics and Gynecology, Frederiksberg Hospital, University of Copenhagen