The use of hormones, given as a continuous estrogen and cyclic progestogen formulation after a formal calibration/run-in period, may have a beneficial effect on psychosocial distress experienced by women towards the end of their reproductive function.

Background. The new tumor‐associated mucin assay, cancer‐associated serum antigen (CASA), was assessed with the CA 125 assay for use in the management of patients with epithelial ovarian cancer. Methods. CASA and CA 125 were assessed retrospectively for use in (1) monitoring 28 patients with Stage 3 or 4 ovarian carcinoma during therapy, (2) predicting the outcome of 41 second‐look laparotomies (SLL), and (3) predicting the survival outcome by measuring these levels after surgery but before chemotherapy in 65 patients with Stage 3 disease. Results. Of 20 patients with recurrence after an initial response, the presence of CASA levels detected recurrence in 65% before clinical detection; CA 125, 50%; and the combination of CASA and CA 125, 80%. Six patients whose disease was in long‐term remission did not have elevations of either marker. When used to predict the results of SLL, the positive predictive values of CASA and CA 125 were 77% and 100%, respectively. The negative predictive values for CASA and CA 125 were 71% and 66%, respectively. CASA detected 50% of positive SLL where microscopic disease only was found; the CA 125 test did not. Multivariate analysis of survival rates using levels of CASA and CA 125, age, residual disease, tumor type and grade, or the presence or absence of cisplatin in the chemotherapeutic regimen found that postoperative CASA levels ranked above all prognostic factors except age. CASA levels may be more accurate than surgical reporting of residual disease or they may define a subset of patients with biologically more aggressive ovarian carcinoma. Conclusions. The CASA test is sensitive to ovarian carcinoma, and both CASA and CA 125 are more useful when used in conjunction.

Objective: To determine whether hormone treatment of women during the menopause transition induces changes in body weight, blood pressure, lipoprotein levels, antithrombin Ill activity, and the endometrium. Design: Prospective, randomised, placebo‐controlled, double‐blind, 12‐month study, with crossover at 6 months. Setting: Outpatient clinic of a city hospital. Participants: 105 apparently healthy women in the menopause transition (40–52 years), with menstrual function, who were experiencing minor menopausal symptoms, were selected from the general population by advertising. Interventions: Active arm ‐ oral conjugated oestrogens (0.625 mg daily) and cyclic medroxyprogesterone acetate (10mg daily) on Day 14–27 of each menstrual cycle; placebo arm ‐ placebos of both medications. Main outcome measures: Excess change from baseline associated with active compared with placebo treatment for all variables; effect of order of treatment. Results: Baseline biochemical values were similar for both treatment‐order groups, but baseline blood pressures and body weights were higher in the group receiving placebo first. With treatment, there were no differences in overall values for body weight and blood pressure (P>0.4), and order of treatment had no significant influence (P>0.3). There were no differences in total and low density lipoprotein cholesterol levels, overall or with order of treatment. Active treatment increased high density lipoprotein (HDL) cholesterol levels (overall and when placebo was given first; P=0.001), and triglyceride levels (when active treatment was given first; P=0.03). There was no overall treatment effect, but a significant order‐of‐treatment effect, on antithrombin Ill activity (mean levels were decreased by active treatment to a greater extent when it was given first; P=0.02). The endometrium showed only physiological changes regardless of treatment. Conclusions: The lack of significant excess change in anthropometry, lipoprotein levels, antithrombin Ill activity, and endometrial histology in women given hormone treatment compared with placebo is reassuring. The increase in HDL cholesterol level is an extra benefit. Our study provides conclusive evidence that hormone treatment does not produce weight gain in women during the menopause transition.