Complications of laparoscopy: a prospective multicentre observational study

Sir, We were grateful to Professor Barlow for highlighting our research on women’s health during the menopause (Vol 104, August 1997)’ in his recent commentary (Vol 104, August 1997)2 and support his request for multidisciplinary co-operation in this area. As he rightly says, the psychological symptoms experienced by women study members aged 47 years in the MRC National Survey of Health and Development appear in part to reflect underlying factors which were detectable a decade earlier and suggest there is continuity of health in adult life. Professor Barlow also suggests that our study found that the increased problems among women taking hormone replacement therapy could be accounted for by predisposing factors noticeable at 36 years of age. So far we have no evidence that this is so, as we report in the discussion: “One hypothesis is that the relationship between psychological symptoms and HRT use may not be related to the experience of menopause per se but occur because HRT users have been more susceptible to these symptoms, or more inclined to report symptoms, at each life stage. However this hypothesis was not supported in this study which found no evidence that eventual HRT users had been more anxious and depressed at 36 years (data not shown), although both factors were important and independent predictors of psychological symptoms at 47 years.” As we are still following these women up and taking a full HRT history we plan to examine in detail the pattern of HRT use in this cohort, its relationship to current symptomatology, and whether long term users differ from the rest of the cohort, either in terms of earlier psychological difficulties or in ways which may have an effect on their future disease risk. This cohort are already heavy users of HRT by the age of 50 years two-fifths of women have tried taking HRT and over one-fifth have taken it for two years or more.