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A long and winding road: reflections on the evolution of menopause medicine over a professional lifetime.

D. Barlow

Published 2018 in Menopause

ABSTRACT

searches had to be carried out by librarians who could access I n this final editorial in the journal’s 25th anniversary series I have been asked to reflect on the changes I have seen in the field of menopause medicine over the lifetime of the journal. In doing this I shall briefly go back further to include important elements of change from before 1994 that set the scene for the arrival of the journal. My professional journey in menopause medicine spans more than 40 years from the start of my thesis research on the effects of the surgical menopause in Glasgow in 1977 where I was subsequently involved with the pioneering Glasgow estrogen osteoporosis studies of David MacKay Hart and Bob Lindsay. I then spent 20 years at the University of Oxford where I had the opportunity to work with Margaret Rees (now Executive Director of the European Menopause and Andropause Society [EMAS]) and with Martin Vessey. Oxford also provided stimulating access to Iain Chalmers, David Sackett, and Muir Gray, each of whom made fundamental contributions to how we look at evidence and provide best health care. My time at Oxford included appointments as Editor-in-Chief of ‘‘Human Reproduction,’’ Chair of the British Menopause Society and of the National Osteoporosis Society and President of the EMAS. Returning to the University of Glasgow as Dean of Medicine I worked with Mary Ann Lumsden (Past-President of the International Menopause Society). At the outset I had not appreciated that menopause medicine was so relatively new to the international stage but when I attended my first menopause conference in Ostend, in 1981, this was only the third ‘‘International Conference on the Menopause’’; the first having been in Montpelier in 1976, and at the second in Jerusalem, in 1978, the International Menopause Society was founded. At that time I was not aware of national menopause societies and certainly the British and North American Societies were not yet in existence. It is perhaps worth reminding younger readers that back then many elements that we have long been able to take for granted lay in the future. There was no real concept of ‘‘evidencebased medicine’’; systematic review or meta-analysis of trials; no Cochrane Collaboration and little in the way of clinical guidelines. Not only was there no Internet or online access to publications but we were still some years away from being able to search for literature personally by electronic means. We had to look for publications manually in huge hardback library volumes of the Index Medicus, which had been published in this manual form since 1879. Literature

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