This document summarizes a presentation on menopause management strategies. It discusses common symptoms women experience related to menopause like sleep disturbances, genitourinary changes, and sexual dysfunction. It reviews non-hormone and hormone-based treatment approaches and the evidence for their risks and benefits based on recent studies. Specific management strategies are provided for symptoms like sleep issues, vaginal dryness, and low sexual desire. The presentation aims to help providers make individualized clinical decisions for managing menopause symptoms.
Some women experience few or no menopause symptoms, while others experience mild or severe symptoms that affect their sleep, daily life, and sense of well-being. Menopause symptoms eventually subside as hormone levels even out, but postmenopause changes like low estrogen levels can continue over time and cause signs like thinning skin. Common menopause symptoms include hot flashes, sleep issues, mood changes, loss of sexual interest, headaches and heart palpitations, but preexisting conditions may worsen during this time.
Prememenustrual dysphoric disorder and post menopausal syndromePavan kulkarni
Premenstrual Dysphoric Disorder (PMDD) and Post Menopausal Syndrome are discussed. PMDD is characterized by severe depression, tension and irritability before menstruation. Hormonal fluctuations are believed to play a role through effects on brain chemistry. Diagnosis involves tracking symptoms. SSRIs are effective treatments. Post Menopause brings risks of vasomotor symptoms, urogenital atrophy, osteoporosis and psychological issues due to declining estrogen levels. Hormone replacement therapy can help manage many symptoms. Lifestyle changes and nutritional supplements also provide benefits.
Perimenopause is the 1-10 year period before menopause where hormone levels fluctuate greatly. Common symptoms include hot flashes, night sweats, changes in periods, and vaginal dryness. Treatment options include lifestyle changes like exercise and diet, as well as hormone therapy. However, hormone therapy increases risks of certain health issues. It is important for women's health during this time to focus on preventing osteoporosis through weight-bearing exercise, calcium/vitamin D supplements, and not smoking. While perimenopause symptoms can disrupt daily life, many women feel a sense of renewal after reaching postmenopause.
Allison Taylor, MD, with the Center for Women's Health in Wichita, KS, presented about perimenopause and hormone therapy during a Women's Connection July 9, 2013, at Corporate Caterers. The event is sponsored by Via Christi Health.
This document discusses menopause and the options for hormone replacement therapy (HRT). It covers the physiology of menopause, effects of declining estrogen levels, and risks like hot flashes, bone loss, and cardiovascular disease. It presents both benefits and risks of HRT, as well as non-hormonal options and lifestyle interventions like diet, exercise and supplements that can help manage menopause symptoms and health risks. The key decision is choosing treatments that improve quality of life based on each woman's individual symptoms, risk factors and medical history.
Menopause is a normal process, but many women experience severe symptoms due to a decline in estrogen levels and increased systemic inflammation. Symptoms can include hot flashes, memory problems, weight gain, and increased risk of diseases. While hormone replacement addresses estrogen loss, it does not stop inflammatory processes that can damage tissues over time. Alternative approaches using customized nutritional supplements and herbs can help restore health by stopping these damaging inflammation mechanisms within three months. This allows women to have a smoother menopausal transition and recover their quality of life without long-term symptoms or dependency on medications.
Holly Thacker, Update on: Menopause, Hormone Therapy, Sex, Politics, and the ...Cleveland HeartLab, Inc.
This document provides an overview and summary of a presentation on menopause, hormone therapy, cardiovascular health, and women's health issues. It discusses the aftermath of the Women's Health Initiative study 12 years later, compares risks of hormone therapy to other medications, and examines risk/benefit ratios of hormone therapy for cardiovascular disease. It also addresses politics surrounding women's health issues and "war on women" narratives related to hormone therapy. The presentation aims to provide an updated perspective on these issues based on newer research findings.
This document discusses menopause and hormone replacement therapy. It begins by defining menopause as the permanent stoppage of menstruation due to declining ovarian function. It then discusses the stages of menopause including perimenopause and the changes in hormones like FSH and estrogen that occur. The document notes that menopause is a natural process but can cause both short term symptoms and long term health issues if estrogen is not replaced. It evaluates the risks and benefits of different treatment options for menopause including lifestyle changes, alternative therapies, medical treatments, and hormone replacement therapy.
Some women experience few or no menopause symptoms, while others experience mild or severe symptoms that affect their sleep, daily life, and sense of well-being. Menopause symptoms eventually subside as hormone levels even out, but postmenopause changes like low estrogen levels can continue over time and cause signs like thinning skin. Common menopause symptoms include hot flashes, sleep issues, mood changes, loss of sexual interest, headaches and heart palpitations, but preexisting conditions may worsen during this time.
Prememenustrual dysphoric disorder and post menopausal syndromePavan kulkarni
Premenstrual Dysphoric Disorder (PMDD) and Post Menopausal Syndrome are discussed. PMDD is characterized by severe depression, tension and irritability before menstruation. Hormonal fluctuations are believed to play a role through effects on brain chemistry. Diagnosis involves tracking symptoms. SSRIs are effective treatments. Post Menopause brings risks of vasomotor symptoms, urogenital atrophy, osteoporosis and psychological issues due to declining estrogen levels. Hormone replacement therapy can help manage many symptoms. Lifestyle changes and nutritional supplements also provide benefits.
Perimenopause is the 1-10 year period before menopause where hormone levels fluctuate greatly. Common symptoms include hot flashes, night sweats, changes in periods, and vaginal dryness. Treatment options include lifestyle changes like exercise and diet, as well as hormone therapy. However, hormone therapy increases risks of certain health issues. It is important for women's health during this time to focus on preventing osteoporosis through weight-bearing exercise, calcium/vitamin D supplements, and not smoking. While perimenopause symptoms can disrupt daily life, many women feel a sense of renewal after reaching postmenopause.
Allison Taylor, MD, with the Center for Women's Health in Wichita, KS, presented about perimenopause and hormone therapy during a Women's Connection July 9, 2013, at Corporate Caterers. The event is sponsored by Via Christi Health.
This document discusses menopause and the options for hormone replacement therapy (HRT). It covers the physiology of menopause, effects of declining estrogen levels, and risks like hot flashes, bone loss, and cardiovascular disease. It presents both benefits and risks of HRT, as well as non-hormonal options and lifestyle interventions like diet, exercise and supplements that can help manage menopause symptoms and health risks. The key decision is choosing treatments that improve quality of life based on each woman's individual symptoms, risk factors and medical history.
Menopause is a normal process, but many women experience severe symptoms due to a decline in estrogen levels and increased systemic inflammation. Symptoms can include hot flashes, memory problems, weight gain, and increased risk of diseases. While hormone replacement addresses estrogen loss, it does not stop inflammatory processes that can damage tissues over time. Alternative approaches using customized nutritional supplements and herbs can help restore health by stopping these damaging inflammation mechanisms within three months. This allows women to have a smoother menopausal transition and recover their quality of life without long-term symptoms or dependency on medications.
Holly Thacker, Update on: Menopause, Hormone Therapy, Sex, Politics, and the ...Cleveland HeartLab, Inc.
This document provides an overview and summary of a presentation on menopause, hormone therapy, cardiovascular health, and women's health issues. It discusses the aftermath of the Women's Health Initiative study 12 years later, compares risks of hormone therapy to other medications, and examines risk/benefit ratios of hormone therapy for cardiovascular disease. It also addresses politics surrounding women's health issues and "war on women" narratives related to hormone therapy. The presentation aims to provide an updated perspective on these issues based on newer research findings.
This document discusses menopause and hormone replacement therapy. It begins by defining menopause as the permanent stoppage of menstruation due to declining ovarian function. It then discusses the stages of menopause including perimenopause and the changes in hormones like FSH and estrogen that occur. The document notes that menopause is a natural process but can cause both short term symptoms and long term health issues if estrogen is not replaced. It evaluates the risks and benefits of different treatment options for menopause including lifestyle changes, alternative therapies, medical treatments, and hormone replacement therapy.
- Menopause is defined as the permanent end of fertility and occurs on average at age 51, marking 12 consecutive months without a menstrual period.
- Symptoms include hot flashes, night sweats, sleep disturbances, mood changes, and vaginal changes.
- Hormone replacement therapy (HRT) is often used to treat menopausal symptoms but comes with risks like blood clots, breast cancer, and uterine cancer.
- Lifestyle changes like exercise and diet can help prevent long-term problems like osteoporosis and heart disease that are associated with menopause.
Menopause: Symptoms, Concerns, and Management StrategiesSummit Health
Menopause is defined as the permanent cessation of menstruation after 12 months without a period. The average age of menopause in North America is 51. During perimenopause, the years leading up to menopause, women experience fluctuations in hormone levels including rising FSH and decreasing estrogen and progesterone. Common symptoms include hot flashes, night sweats, vaginal dryness, sleep disturbances, and mood changes. Estrogen deficiency after menopause can also lead to increased risks of bone loss, cardiovascular disease, and skin aging over the long term.
Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome that affects 3-8% of women, causing severe mood changes, anxiety, and impairment in functioning during the luteal phase of the menstrual cycle each month. While the exact causes are unknown, it likely involves an interaction between fluctuating hormone levels and central neurotransmitters like serotonin. Selective Serotonin Reuptake Inhibitors (SSRIs) are effective treatments for PMDD symptoms, suggesting serotonin involvement, though their mechanism of action is complex and not solely due to serotonin reuptake inhibition. PMDD diagnosis requires prospective tracking of symptoms and exclusion of other conditions.
Menopause is defined as the absence of menstrual periods for at least 12 months. It typically occurs between ages 45-55, though can happen as early as age 30. Menopause is caused by a loss of responsiveness of the ovaries to hormones like FSH and LH, causing lower estrogen and progesterone levels. Common symptoms include irregular periods, hot flashes, mood changes, and increased risk for osteoporosis and heart disease. Treatment options include hormone replacement therapy, antidepressants, lifestyle changes, and lubricants to relieve vaginal dryness.
The survey found that over half of women experienced issues like inability to orgasm, vaginal dryness, and loss of libido during menopause. While some HRT users saw benefits, many did not, and over a third said their relationships were strained by menopause symptoms. Women received limited advice on alternatives from doctors and often turned to other sources like books and the internet to research options besides HRT.
Menopause is defined as the permanent cessation of menstruation and occurs naturally around age 51. It marks the end of a woman's reproductive years. The decline in ovarian function leads to lower estrogen levels and various symptoms. Common symptoms include hot flashes, night sweats, vaginal dryness, and increased risk of osteoporosis and heart disease. Hormone replacement therapy can help treat some menopausal symptoms but also carries risks like breast cancer if taken long term. Lifestyle changes like exercise, calcium/vitamin D supplements, and avoiding smoking are recommended to prevent health issues associated with menopause.
This document discusses how risks of various health conditions increase during perimenopause and menopause. It lists common symptoms of declining estrogen levels such as hot flashes and weight gain. Weakened adrenal function can exacerbate symptoms if the adrenals cannot compensate for lost estrogen production. The transition is smoother when adrenal function is strong. The document also notes that menopause is associated with increased pro-inflammatory cytokines and outlines six factors that can cause systemic inflammation during perimenopause with devastating effects on aging and tissue breakdown. Hormone replacement does not address these inflammatory mechanisms once triggered.
This document discusses premenstrual syndromes including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). PMDD is a severe form of PMS characterized by more severe emotional symptoms that interfere with daily life. The causes of PMS and PMDD are not fully understood but likely involve interactions between ovarian hormones and neurotransmitters. Diagnosis involves documenting cyclic symptoms related to the luteal phase of the menstrual cycle. Treatments include lifestyle changes, supplements, medications like SSRIs, and in rare cases surgery.
Tibolone is an effective treatment for managing menopause symptoms. It provides relief from vasomotor symptoms like hot flashes and night sweats comparable to conventional hormone therapy. It also improves urogenital symptoms and has benefits for bone and sexual health. Tibolone has a lower risk of side effects like vaginal bleeding and breast pain compared to estrogen plus progestin therapy. It does not increase the risk of endometrial hyperplasia or breast cancer. Tibolone is a good alternative to conventional hormone therapy for managing menopause symptoms with fewer side effects.
This document discusses menopause and aging. It notes that midlife is between ages 45-65 and can be difficult. Menopause occurs when periods stop permanently, usually between ages 40-60, due to decreasing estrogen. During menopause, women experience changes like hot flashes and sleep issues. Medical options like hormone therapy help manage symptoms but also have risks. Aging well involves preventative measures like exercise, nutrition, and avoiding smoking. Support groups provide emotional support during this transition.
This document provides information on menopause, including its definition, causes, symptoms, effects, diagnosis, and treatment options. It can be summarized as follows:
1. Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian follicles, with an average age of onset being 51 years. It can occur prematurely before age 45 due to various causes.
2. Short term symptoms include hot flashes, mood swings, sleep problems, and vaginal dryness. Long term risks include osteoporosis and increased risk of heart disease.
3. Diagnosis is based on cessation of periods for 12 months and elevated FSH levels. Treatment options include hormone
The document discusses menopause and provides information on its symptoms such as depression, incontinence, and weight gain. It promotes the benefits of hormone replacement therapy (HRT) to protect women's health and addresses lifestyle factors like nutrition, exercise, and avoiding smoking and alcohol. The document advertises resources and support services for women going through menopause.
2014 :Updated information on Hormone Replacement TherapyHesham Al-Inany
This document provides an overview of hormone replacement therapy (HRT) and discusses its risks and benefits. It summarizes that:
1) HRT remains the most effective therapy for relieving menopausal symptoms like hot flashes, but comes with some health risks.
2) The risks of HRT, like breast cancer and cardiovascular disease, depend on factors like a woman's age, time since menopause, and type of HRT regimen used. Younger postmenopausal women who use HRT have a reduced risk of cardiovascular disease.
3) Different progestogen components and routes of administration in HRT regimens can impact health risks like thromboembolism and stroke differently.
Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian activity, occurring naturally or induced by surgery or medications. It typically occurs between ages 45-55. The document discusses the hypothalamic-pituitary-ovarian axis and changes that occur during perimenopause and menopause, including symptoms. Evaluation of menopausal women includes assessments of risk factors, symptoms, and quality of life to guide lifestyle and medical management options.
The document discusses strategies for women to thrive during and after menopause. It describes common menopause symptoms like hot flashes and provides lifestyle recommendations to support hormone balance and health. These include following a Mediterranean diet, exercising regularly, managing stress, and considering herbal remedies and supplements. The goal is for women to feel fit, fun, and fabulous at any age during and after the menopause transition through a whole-person approach to health.
Hormone replacement therapy outlines the definitions, physiological changes, symptoms, diagnosis, and treatment options associated with menopause. It discusses indications and contraindications for HRT and provides details on different HRT regimens. Side effects of estrogen and progestogen are listed. Large studies on HRT like the Heart and Estrogen/Progestin Replacement Study and the Women's Health Initiative Study are summarized, noting their findings on risks and benefits of HRT use.
Mrs. A presented to the menopausal clinic distressed about her symptoms of menopause. She was experiencing hot flashes throughout the day and night, depression, irritability, and poor sleep. Her children had grown and left home, leaving her feeling lonely. The document then provides information on menopause, its stages and symptoms, and treatment options including hormone replacement therapy and lifestyle modifications.
Menopause: how to balance your hormones and live vibrantlyVandna Jerath, MD
Vandna Jerath, MD discusses menopause, hormonal imbalance, how to balance hormones, and living vibrantly for a health seminar at Parker Adventist Hospital in Parker, CO. She outlines a number of treatment modalities including hormone replacement therapy (HRT), bioidentical hormone replacement therapy (BHRT), and alternative therapy. She reviews the latest women's health updates related to menopause and vulvovaginal atrophy as well as her current practice usage of BioTE hormone pellet therapy and MonaLisa Touch vaginal laser revitalization treatment.
This document summarizes an informational session on hormone therapy given by Dr. Ann Stanger. It discusses the symptoms of perimenopause and menopause. It reviews findings from the Women's Health Initiative study on hormone therapy and notes limitations. It also discusses testing and treating hormone imbalances using bioidentical hormones like estradiol, progesterone, and testosterone through various administration routes.
This document summarizes evidence-based guidelines on hormone replacement therapy. It discusses that HRT can effectively treat hot flashes and vaginal atrophy but may increase risks of breast cancer, heart disease, and blood clots if used long-term. Larger studies like the Women's Health Initiative found these health risks outweighed benefits for chronic disease prevention. Recommendations are that HRT only be used at lowest effective doses for shortest time to treat menopausal symptoms.
This document discusses treating women transitioning to menopause, focusing on hormone therapy (HT) options. It begins by defining menopause and perimenopause, then discusses common symptoms like hot flashes and vaginal atrophy. It reviews the STRAW staging system for classifying menopause. Treatment options for symptoms include various forms of HT like oral pills, patches, and local vaginal therapies. Studies like KEEPS found HT can help reduce symptoms when started in newly menopausal women. Guidelines support HT for relieving vasomotor symptoms in recently menopausal women.
Atrophic vaginitis under treated under diagnosed(f)Shambhu N
Atrophic vaginitis is underdiagnosed and undertreated in postmenopausal women. It affects around 80% of postmenopausal women, with around 20% experiencing symptoms. Local estrogen therapy is effective at treating atrophic vaginitis symptoms by improving vaginal health and reducing pH levels. Treatment options include low dose vaginal creams, rings, or tablets containing estradiol or other estrogens.
- Menopause is defined as the permanent end of fertility and occurs on average at age 51, marking 12 consecutive months without a menstrual period.
- Symptoms include hot flashes, night sweats, sleep disturbances, mood changes, and vaginal changes.
- Hormone replacement therapy (HRT) is often used to treat menopausal symptoms but comes with risks like blood clots, breast cancer, and uterine cancer.
- Lifestyle changes like exercise and diet can help prevent long-term problems like osteoporosis and heart disease that are associated with menopause.
Menopause: Symptoms, Concerns, and Management StrategiesSummit Health
Menopause is defined as the permanent cessation of menstruation after 12 months without a period. The average age of menopause in North America is 51. During perimenopause, the years leading up to menopause, women experience fluctuations in hormone levels including rising FSH and decreasing estrogen and progesterone. Common symptoms include hot flashes, night sweats, vaginal dryness, sleep disturbances, and mood changes. Estrogen deficiency after menopause can also lead to increased risks of bone loss, cardiovascular disease, and skin aging over the long term.
Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome that affects 3-8% of women, causing severe mood changes, anxiety, and impairment in functioning during the luteal phase of the menstrual cycle each month. While the exact causes are unknown, it likely involves an interaction between fluctuating hormone levels and central neurotransmitters like serotonin. Selective Serotonin Reuptake Inhibitors (SSRIs) are effective treatments for PMDD symptoms, suggesting serotonin involvement, though their mechanism of action is complex and not solely due to serotonin reuptake inhibition. PMDD diagnosis requires prospective tracking of symptoms and exclusion of other conditions.
Menopause is defined as the absence of menstrual periods for at least 12 months. It typically occurs between ages 45-55, though can happen as early as age 30. Menopause is caused by a loss of responsiveness of the ovaries to hormones like FSH and LH, causing lower estrogen and progesterone levels. Common symptoms include irregular periods, hot flashes, mood changes, and increased risk for osteoporosis and heart disease. Treatment options include hormone replacement therapy, antidepressants, lifestyle changes, and lubricants to relieve vaginal dryness.
The survey found that over half of women experienced issues like inability to orgasm, vaginal dryness, and loss of libido during menopause. While some HRT users saw benefits, many did not, and over a third said their relationships were strained by menopause symptoms. Women received limited advice on alternatives from doctors and often turned to other sources like books and the internet to research options besides HRT.
Menopause is defined as the permanent cessation of menstruation and occurs naturally around age 51. It marks the end of a woman's reproductive years. The decline in ovarian function leads to lower estrogen levels and various symptoms. Common symptoms include hot flashes, night sweats, vaginal dryness, and increased risk of osteoporosis and heart disease. Hormone replacement therapy can help treat some menopausal symptoms but also carries risks like breast cancer if taken long term. Lifestyle changes like exercise, calcium/vitamin D supplements, and avoiding smoking are recommended to prevent health issues associated with menopause.
This document discusses how risks of various health conditions increase during perimenopause and menopause. It lists common symptoms of declining estrogen levels such as hot flashes and weight gain. Weakened adrenal function can exacerbate symptoms if the adrenals cannot compensate for lost estrogen production. The transition is smoother when adrenal function is strong. The document also notes that menopause is associated with increased pro-inflammatory cytokines and outlines six factors that can cause systemic inflammation during perimenopause with devastating effects on aging and tissue breakdown. Hormone replacement does not address these inflammatory mechanisms once triggered.
This document discusses premenstrual syndromes including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). PMDD is a severe form of PMS characterized by more severe emotional symptoms that interfere with daily life. The causes of PMS and PMDD are not fully understood but likely involve interactions between ovarian hormones and neurotransmitters. Diagnosis involves documenting cyclic symptoms related to the luteal phase of the menstrual cycle. Treatments include lifestyle changes, supplements, medications like SSRIs, and in rare cases surgery.
Tibolone is an effective treatment for managing menopause symptoms. It provides relief from vasomotor symptoms like hot flashes and night sweats comparable to conventional hormone therapy. It also improves urogenital symptoms and has benefits for bone and sexual health. Tibolone has a lower risk of side effects like vaginal bleeding and breast pain compared to estrogen plus progestin therapy. It does not increase the risk of endometrial hyperplasia or breast cancer. Tibolone is a good alternative to conventional hormone therapy for managing menopause symptoms with fewer side effects.
This document discusses menopause and aging. It notes that midlife is between ages 45-65 and can be difficult. Menopause occurs when periods stop permanently, usually between ages 40-60, due to decreasing estrogen. During menopause, women experience changes like hot flashes and sleep issues. Medical options like hormone therapy help manage symptoms but also have risks. Aging well involves preventative measures like exercise, nutrition, and avoiding smoking. Support groups provide emotional support during this transition.
This document provides information on menopause, including its definition, causes, symptoms, effects, diagnosis, and treatment options. It can be summarized as follows:
1. Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian follicles, with an average age of onset being 51 years. It can occur prematurely before age 45 due to various causes.
2. Short term symptoms include hot flashes, mood swings, sleep problems, and vaginal dryness. Long term risks include osteoporosis and increased risk of heart disease.
3. Diagnosis is based on cessation of periods for 12 months and elevated FSH levels. Treatment options include hormone
The document discusses menopause and provides information on its symptoms such as depression, incontinence, and weight gain. It promotes the benefits of hormone replacement therapy (HRT) to protect women's health and addresses lifestyle factors like nutrition, exercise, and avoiding smoking and alcohol. The document advertises resources and support services for women going through menopause.
2014 :Updated information on Hormone Replacement TherapyHesham Al-Inany
This document provides an overview of hormone replacement therapy (HRT) and discusses its risks and benefits. It summarizes that:
1) HRT remains the most effective therapy for relieving menopausal symptoms like hot flashes, but comes with some health risks.
2) The risks of HRT, like breast cancer and cardiovascular disease, depend on factors like a woman's age, time since menopause, and type of HRT regimen used. Younger postmenopausal women who use HRT have a reduced risk of cardiovascular disease.
3) Different progestogen components and routes of administration in HRT regimens can impact health risks like thromboembolism and stroke differently.
Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian activity, occurring naturally or induced by surgery or medications. It typically occurs between ages 45-55. The document discusses the hypothalamic-pituitary-ovarian axis and changes that occur during perimenopause and menopause, including symptoms. Evaluation of menopausal women includes assessments of risk factors, symptoms, and quality of life to guide lifestyle and medical management options.
The document discusses strategies for women to thrive during and after menopause. It describes common menopause symptoms like hot flashes and provides lifestyle recommendations to support hormone balance and health. These include following a Mediterranean diet, exercising regularly, managing stress, and considering herbal remedies and supplements. The goal is for women to feel fit, fun, and fabulous at any age during and after the menopause transition through a whole-person approach to health.
Hormone replacement therapy outlines the definitions, physiological changes, symptoms, diagnosis, and treatment options associated with menopause. It discusses indications and contraindications for HRT and provides details on different HRT regimens. Side effects of estrogen and progestogen are listed. Large studies on HRT like the Heart and Estrogen/Progestin Replacement Study and the Women's Health Initiative Study are summarized, noting their findings on risks and benefits of HRT use.
Mrs. A presented to the menopausal clinic distressed about her symptoms of menopause. She was experiencing hot flashes throughout the day and night, depression, irritability, and poor sleep. Her children had grown and left home, leaving her feeling lonely. The document then provides information on menopause, its stages and symptoms, and treatment options including hormone replacement therapy and lifestyle modifications.
Menopause: how to balance your hormones and live vibrantlyVandna Jerath, MD
Vandna Jerath, MD discusses menopause, hormonal imbalance, how to balance hormones, and living vibrantly for a health seminar at Parker Adventist Hospital in Parker, CO. She outlines a number of treatment modalities including hormone replacement therapy (HRT), bioidentical hormone replacement therapy (BHRT), and alternative therapy. She reviews the latest women's health updates related to menopause and vulvovaginal atrophy as well as her current practice usage of BioTE hormone pellet therapy and MonaLisa Touch vaginal laser revitalization treatment.
This document summarizes an informational session on hormone therapy given by Dr. Ann Stanger. It discusses the symptoms of perimenopause and menopause. It reviews findings from the Women's Health Initiative study on hormone therapy and notes limitations. It also discusses testing and treating hormone imbalances using bioidentical hormones like estradiol, progesterone, and testosterone through various administration routes.
This document summarizes evidence-based guidelines on hormone replacement therapy. It discusses that HRT can effectively treat hot flashes and vaginal atrophy but may increase risks of breast cancer, heart disease, and blood clots if used long-term. Larger studies like the Women's Health Initiative found these health risks outweighed benefits for chronic disease prevention. Recommendations are that HRT only be used at lowest effective doses for shortest time to treat menopausal symptoms.
This document discusses treating women transitioning to menopause, focusing on hormone therapy (HT) options. It begins by defining menopause and perimenopause, then discusses common symptoms like hot flashes and vaginal atrophy. It reviews the STRAW staging system for classifying menopause. Treatment options for symptoms include various forms of HT like oral pills, patches, and local vaginal therapies. Studies like KEEPS found HT can help reduce symptoms when started in newly menopausal women. Guidelines support HT for relieving vasomotor symptoms in recently menopausal women.
Atrophic vaginitis under treated under diagnosed(f)Shambhu N
Atrophic vaginitis is underdiagnosed and undertreated in postmenopausal women. It affects around 80% of postmenopausal women, with around 20% experiencing symptoms. Local estrogen therapy is effective at treating atrophic vaginitis symptoms by improving vaginal health and reducing pH levels. Treatment options include low dose vaginal creams, rings, or tablets containing estradiol or other estrogens.
This document discusses menopause and management options. It begins by defining menopause as the permanent cessation of menstruation resulting from loss of ovarian activity, typically between ages 45-55. It then outlines some of the main consequences of menopause like vasomotor symptoms, sexual dysfunction, osteoporosis, and cardiovascular risks. The document discusses treatment options like lifestyle changes, hormone replacement therapy, and alternative therapies. It provides details on hormone replacement regimens and duration of treatment for various symptoms and conditions.
This document summarizes special considerations for women with epilepsy across the reproductive years, including effects on sexuality, mood, menstruation, fertility, bone health, pregnancy, breastfeeding, and menopause. It discusses how epilepsy and antiepileptic drug use can impact these areas through mechanisms like hormonal changes, drug interactions, teratogenic risks, and bone loss. Management involves counseling, supplementation, contraception guidance, monitoring for side effects, and registry participation for pregnant patients.
This document discusses various women's health issues and disorders and how yoga can help address them. It covers:
1) Common health disorders women face such as PMS, dysmenorrhea, amenorrhea, and issues related to pregnancy, menopause, and infertility.
2) How stress physically and psychologically impacts the body.
3) Yoga practices like Surya Namaskar and meditation that aim to relax the body, slow the breath, and calm the mind for stress management.
The document provides information on yoga techniques for treating various women's health disorders and menstrual issues. It outlines integrated yoga modules involving breathing practices, yoga poses, relaxation techniques, and meditation/pranayama that can help with conditions like heavy or painful periods, irregular cycles, PMS, infertility, menopause, and incontinence. The modules are designed to stimulate, relax, and balance the body and mind.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Based on the information provided:
- The woman is 40 years old, which is below the typical age of menopause (around 50 years).
- She has not had any periods for 1 year.
To diagnose menopause in this woman:
1. I would do a beta human chorionic gonadotropin (hCG) test to rule out pregnancy.
2. I would check a follicle stimulating hormone (FSH) level. An FSH level over 35 mIU/ml would support the diagnosis of menopause.
3. I would do an ultrasound of the pelvis to examine the ovaries and rule out other potential causes of amenorrhea like polycystic
This document discusses menopause, providing information on its epidemiology, physiology, signs and symptoms, diagnosis, management, and the pharmacist's role. It defines menopause as the permanent cessation of menses for 12 consecutive months due to declining estrogen levels. The average age of menopause is around 52 in the US and 50 in Nigeria. Symptoms include hot flashes, vaginal dryness, and bone loss. Treatment involves lifestyle changes, hormonal therapies like estrogen, and medications for specific symptoms. The pharmacist's role is to educate patients on management options and their risks and benefits.
The document discusses various women's reproductive disorders and the menstrual cycle. It describes the internal female genital organs and the two phases of the menstrual cycle. It then discusses menstrual disorders like amenorrhea, dysfunctional uterine bleeding, and dysmenorrhea. It provides information on the causes and treatments of these disorders. The document also covers other topics related to women's health issues like infertility, early pregnancy loss, menopause, and premenstrual syndrome.
The document discusses how menopause affects women's lives and relationships. It notes that divorce rates are higher when women are in their 40s-60s, which some attribute to lower oxytocin levels during menopause that change a woman's thinking from "we" to "me." It also discusses how menopause symptoms like hot flashes and mood swings can negatively impact work productivity. Finally, it provides testimonials from women who found relief from menopause symptoms like hot flashes and night sweats using the natural supplement Err 731.
Menopause role of isoflavones by dr alka mukherjee nagpur m.s.indiaalka mukherjee
Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(-)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women
Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed.
Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit.
It’s packed with nutrition
Soy is low in saturated fat and calories. It’s also high in these beneficial nutrients:
• fiber
• protein
• omega-3 fatty acids
• antioxidants
It may help to reduce your risk of heart disease
Eating tofu and other soy-based foods a few times a week can help you cut back on some animal-based protein sources, such as steak or hamburger, that are high in saturated fat and cholesterol.
Dr Ayman Ewies - Mirena: why 50% of women dislike it?AymanEwies
1) The study found a high discontinuation rate of Mirena, with 50% of women stopping use before the recommended 5 years due to adverse effects like bleeding and pain.
2) Many women reported progestogenic side effects such as headaches, weight gain and depression, which led to early removal for 44% of participants.
3) Satisfaction with Mirena was low, with only 50% of women reporting being satisfied with the device.
This document provides information about Premature Ovarian Insufficiency (POI) from Dr. Sunita Chandra. It defines POI, discusses its incidence and mechanisms. It covers the aetiology, clinical presentation, diagnosis, and long-term management of POI through hormone treatment. Hormone treatment aims to mimic natural hormone levels and is generally continued until the average age of natural menopause to prevent long-term health issues. Treatment approaches may differ for those with POI before or after puberty.
Dr. Ann Steiner, Clinical Professor of OBGYN at Penn Medicine, discusses the changes that happen as a woman's body goes through menopause, as well as treating symptoms that result from these hormonal changes.
CHRONIC PELVIC PAIN can affect men, MORE common (60%) in women, lifelong vs. acquired, generalized vs. situational, psychological factors, physical Contact SlenderImage@gmail.com for Consulting & Speaking - P.Anderson 323-486-3770
The document discusses several topics related to neuroendocrinology and the menstrual cycle in females with epilepsy:
1. It describes the interaction between the nervous system and endocrine system, and how hormones can impact seizure frequency in females.
2. Several phases of the menstrual cycle are outlined, and how hormone fluctuations in these phases can influence seizures.
3. Issues females with epilepsy may face related to their reproductive health, bone health, and mental health are summarized.
4. Treatment approaches for catamenial epilepsy are provided, though it is noted this condition remains difficult to control.
This document provides an overview of sexually transmitted infections (STIs) for clinicians. It discusses the most common bacterial, viral and parasitic STIs including their epidemiology, diagnosis and treatment recommendations. Screening and prevention strategies are also reviewed, including behavioral counseling, vaccination, condom use and expedited partner therapy. The impacts of STIs on women's reproductive health are highlighted.
This document discusses the differential diagnosis and management of vulvovaginal disorders. It begins by categorizing common conditions into infections (trichomoniasis, bacterial vaginosis, vulvovaginal candidiasis), skin conditions (fungal vulvitis, contact dermatitis, vulvar dermatoses), and psychogenic causes. It then provides detailed guidelines on evaluating, diagnosing, and treating specific infections like trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. It also reviews vulvar conditions like lichen sclerosus, contact dermatitis, and classifications of vulvar dermatoses.
This document provides information about migraine in women. Some key points:
- Migraine is 3 times more common in women than men. Hormonally-associated migraines affect 12 million women in the US.
- Migraines are often associated with changes in hormone levels, such as during menstruation, pregnancy, use of oral contraceptives, and menopause.
- Diagnosis of migraine involves evaluating symptoms such as headache duration/intensity, nausea, light/sound sensitivity, visual/sensory disturbances (aura).
- Treatment involves both acute symptomatic relief and preventive medications, though choices are more limited during pregnancy/breastfeeding due to safety.
This document discusses 5 case studies involving GI disorders in women. The first case involves a 32-year-old woman with 5 years of diarrhea and abdominal pain. The next best step is reassurance without further testing, as her symptoms are consistent with irritable bowel syndrome. The second case involves a 38-year-old woman with vomiting after gastric bypass surgery, where an internal hernia is the most likely cause. The third case involves a pregnant woman referred for irritable bowel syndrome, where testing her for celiac disease is the next best step. The fourth case involves constipation, where pelvic floor dysfunction is the most likely diagnosis given her exam findings. The fifth case involves a 58-year-old woman with diarrhea
Here are my recommendations for the 56 year old woman with subclinical hypothyroidism:
1. Her diagnosis is subclinical hypothyroidism based on an elevated TSH of 7.1 and normal free T4.
2. Given her age (56), fatigue, and 3-4 lb weight gain, I would recommend a trial of levothyroxine therapy. Treatment is reasonable for patients with TSH >10 or positive thyroid antibodies, which she does not have data for. However, treatment may modestly improve her lipids and symptoms.
3. She should be monitored every 6 months with TSH checks to ensure her TSH is maintained between 0.5-2.0 and that she does not
The document announces the Women's Health 2012 Congress hosted by the NIH Office of Research on Women's Health. It will feature scientific poster awards for Women's Health and Sex Differences Research. The congress focuses on women's health issues and research.
The document discusses how the Affordable Care Act (ACA) aims to improve access to preventive health services for women by requiring new health plans to cover recommended preventive services without cost sharing. This includes services for cancer screening, chronic disease prevention and management, vaccinations, healthy behaviors counseling, pregnancy-related care, and reproductive health services. The new rules apply to new private health plans starting in 2010 and 2012, with some exemptions for grandfathered and religious plans. Implementation will consider factors like network restrictions, separate billing for visits and services, and ensuring adequate provider training and capacity.
The document summarizes the charge given by the Institute of Medicine to convene a committee of experts to review women's preventive health services and identify gaps. The committee was tasked with recommending services to be included in comprehensive national guidelines. After reviewing evidence, the committee made 8 recommendations, including screening for gestational diabetes, HPV testing, counseling on STIs and HIV, contraception services, lactation support, interpersonal violence screening, and annual well-woman visits.
This document summarizes key aspects of the Affordable Care Act (ACA) and how it benefits women's health and preventive care. It discusses how the ACA expands insurance coverage to over 34 million Americans, strengthens consumer protections, and requires insurers to cover preventive services for women at no additional cost. Specifically, it outlines services that must be covered for pregnant women, various cancer and disease screenings, counseling services, contraception and sterilization coverage, lactation support, and violence screening. It also notes that some existing "grandfathered" health plans are exempt from some ACA requirements but still must cover certain new benefits.
Dr. Iglesia has no conflicts of interest to disclose. The objectives of the document are to develop effective treatment plans, communicate treatment goals, minimize medication side effects, and describe new therapies for overactive bladder in women. Overactive bladder affects millions of Americans, especially women, and prevalence increases with age. New therapies aim to change stereotypes about overactive bladder and provide realistic information about prevalence and severity. Behavioral interventions like pelvic floor exercises and bladder training can be effective treatment approaches.
The document discusses cervical cancer screening guidelines and strategies, comparing the use of Pap tests, HPV tests, and primary HPV screening. It provides information on the epidemiology of HPV and progression to cervical cancer, as well as data from studies showing that primary HPV screening can detect more high-grade cervical lesions than cytology alone.
The document discusses depression in women and improving outcomes. Major depression has a significant public health impact and is the leading cause of disability among women worldwide. Women experience depression rates 1.5-2.5 times higher than men ages 15-54. Key ways to improve outcomes include considering differential diagnoses, treating to remission, measuring symptom improvement, using evidence-based interventions personalized to the individual woman, and providing self-help resources.
This document discusses strategies for managing obesity in women. It notes that obesity is influenced by multiple factors including genetics, environment, diet, physical activity, and life events. Key life events that can influence weight gain include pregnancy, menopause, and aging. Maternal obesity increases health risks for both mother and child during pregnancy and the child's future obesity risk. Abdominal obesity, as measured by waist circumference, is a better predictor of health risks than BMI alone. Managing obesity requires addressing its underlying causes through lifestyle changes.
This document is an in memoriam for Trudy L Bush, a professor of epidemiology and preventive medicine at the University of Maryland who passed away in 2001. It summarizes her landmark research on the effects of hormones on various body systems, her trailblazing leadership in the field of women's health, and her tireless commitment to medical education relating to women's health and menopause. The document honors her memory with an annual lecture series.
Evidence based management of cardiovascular disease in women plmiami
1. Evidence Based Management of Cardiovascular Disease in Women discusses the leading causes of death in Americans and how cardiovascular disease is the number one killer of women.
2. The document reviews gender differences in atherosclerosis, such as plaque erosion being more common in women than plaque rupture seen in men, making diagnosis of cardiovascular disease more difficult in women.
3. Prevention strategies discussed include reducing atherosclerosis, preventing plaque rupture and erosion, limiting thrombosis, and recognizing the presence of cardiovascular disease in women.
This document discusses care of cancer survivors and outlines the following key points in 3 sentences:
1) Approximately 3% of the population are cancer survivors, with many being elderly and having multiple comorbidities. 2) Both cancer-related and general medical needs must be addressed in cancer survivors, including surveillance for recurrence, late effects of treatment, and new primary cancers as well as screening and management of comorbidities. 3) The role of primary care physicians in providing ongoing care for cancer survivors along with survivorship care plans is reviewed.
This document discusses factors that influence peak bone mass attained during adolescence and young adulthood. It notes that genetics account for 80% of variability in peak bone mass, and lists several genes associated with bone mineral density and fracture risk. Nutrition, physical activity, body composition, endocrine status like age of menarche, and use of birth control also impact peak bone mass. Regular weight-bearing exercise and adequate calcium, vitamin D, and protein intake during growth can help increase bone mass accrual and attain a higher peak.
This document summarizes best practices in lesbian health based on a presentation by Dr. Patricia Robertson. It finds that lesbians have higher rates of smoking, childhood abuse, obesity, and certain STIs. They have lower rates of Pap smears and mammograms due to cost and prior adverse experiences. The document recommends screening lesbians appropriately, discussing family planning options, ensuring legal protections for partners, and advocating for lesbian health in the community. Providers should encourage disclosure of sexual orientation to provide culturally competent care.
Lee P. Shulman is the Anna Ross Lapham Professor of Obstetrics and Gynecology and Chief of the Division of Clinical Genetics at Northwestern University. He discloses advisory roles and speaking engagements with several genetic testing companies. His research focuses on inherited cancer risk assessment and genetic testing for hereditary cancer syndromes. He provides an overview of the genetics of cancer including tumor suppressor genes and oncogenes, as well as specific hereditary cancer syndromes like BRCA1/2, Lynch syndrome, and Cowden syndrome that increase cancer risk, especially for women's cancers.
This document summarizes evidence-based care of women with rheumatoid arthritis (RA). It discusses that RA is a chronic inflammatory disorder that principally affects the synovial joints. It is characterized by a proliferative response in the synovium leading to bone and cartilage destruction. The document reviews who is affected by RA, common articular features, characteristic deformities, and extra-articular manifestations. It also discusses the natural history of RA and whether there are any gender differences. Current management approaches from 2012 are presented, including early diagnosis, prompt initiation of traditional DMARDs, and appropriate use of biological DMARDs.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of blood–borne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
3. Objectives
Following this presentation, participants will be able to:
1. Identify common symptoms women experience
related to menopause
2. Differentiate the risks and benefits of various
therapies for menopause-‐related symptoms as
identified in recent research
3. Apply evidence from recent studies in making
individualized clinical decisions for managing
menopause-‐related symptoms
4. Physiologic Changes in the
Natural Menopausal Transition
Variable cycle length1
Endocrinologic milieu shifts
Inhibin2-‐4
FSH2-‐4
Variable changes in E15
Testosterone: no significant change3,6
1. Treolar et al. Int J Infertil. 1967;12:77. 4. Lenton et al. J Clin Endocrinol Metab. 1991;73:1180.
2. Burger. Hum Reprod. 1993;8(suppl 2):129. 5. Santoro et al. J Clin Endocrinol Metab. 1996;81:1495.
3. Burger et al. J Clin Endocrinol Metab. 1995;80:3537. 6. Bancroft et al. Clin Endocrinol. 1996;45:577.
5. Dilemma in Diagnosing Menopause
Clinical symptoms are the best guide to diagnosing
menopause
Natural menopause can be diagnosed after 12
consecutive months of amenorrhea that has no other
obvious pathologic/physiologic cause
Biochemical tests alone are not reliable guides to an
accurate diagnosis
FSH levels are not reliable predictors of menopause
because FSH levels are variable in perimenopausal
women
Creinin MD. Fertil Steril. 1996;66:101; Gebbie AE et al. Contraception. 1995;52:221.
6. Management for Selected
Symptoms
Sleep
GU Changes & Sex
Memory and Cognition
Vasomotor Symptoms
9. Management Strategies for Sleep
Disturbances
(Frequently related to hot flashes)
Reduce hot flashes
Keep room cool, fan
Wicking sleepwear
Avoid all stimulants
Good bedtime practices (sleep hygiene)
Sleep retraining
Many women use CAMs
Estrogen
10. Estrogen Improves Sleep
Decreases the frequency of
Night sweats1-‐4
Periods of night awakenings3,4
Reduces sleep latency1,2
Improves sleep in menopausal women
with insomnia, even in the absence of vasomotor
symptoms4
Increases the percentage of REM sleep1,5
May alleviate sleep apnea3,4
1Schiff I, et al. Maturitas. 1980;2:179-83.
2Scharf MB, et al. Clin Ther. 1997;19:304-11.
3Erlik Y, et al. JAMA. 1981;245:1741-4.
4Polo-Kantola P, et al. Am J Obstet Gynecol. 1998;178:1002-9.
5Antonijevic IA, et al. Am J Obstet Gynecol. 2000;182:277-82.
12. Genitourinary Changes After
Menopause
Genitourinary Atrophy*
Vaginal Dysfunction Urinary Dysfunction
(pain with penetration/
sexual dysfunction)
Most inevitable, least publicized consequence of estrogen loss
100% of women affected not bothersome for all women
Up to 45% of older women suffer from urinary incontinence
High prevalence of sexual dysfunction in menopause clinics
Weinberger. Clin Obstet Gynecol. 1995;38:175; Sarrel. Obstet Gynecol Clin North Am. 1987;14:49;
Elia et al. Obstet Gynecol Surv. 1993;48:509.
13. Sexual Physiologic Changes with
Aging
Time to achieve vaginal lubrication,
Vaginal lubrication
Vaginal elasticity, rugation, color
Petechiae and bleeding after minor trauma
in lactobacilli
Vaginal pH
Vulnerability to urogenital pathogens
Superficial vaginal epithelial cells
Collagen and adipose in vulva
Labial involution and clitoral exposure
Vagina thinner and paler
Bachmann et al. In: Lobo, ed. Treatment of the Postmenopausal Woman:
Basic and Clinical Aspects. 2nd ed. New York: Lippincott Williams & Wilkins; 1999:195.
14. Sexual Function Declines with
Menopause and Aging
Sexual libido
Sexual responsivity
Sexual activity
Vaginal dyspareunia
partner
Dennerstein et al. Fertil Steril. 2001;76:456.
15. Sexual Dysfunction in Women
Includes desire, arousal, orgasmic, and pain
disorders
Can be caused by:
physiological changes of menopause
breakdown in interpersonal relationships
family, societal and religious beliefs
Medications, partner problems, aging
A detailed patient history is required to
diagnose sexual dysfunction
Basson R, et al. J Urol. 2000;163:888-93.; Laumann EO, et al. JAMA. 1999;281:537-44; Basson R. Menopause. 2004;11(6 pt
2):714-25; and Dennerstein L, et al. Fertil Steril. 2005;84:174-80.
17. Management Strategies for Sexual
Dysfunction/Complaints
Lubricants/moisturizers
Hormone therapy (FDA approved for vaginal dryness, off
label use for sexual dysfunction)
Local estrogen cream, ring, tablet
Systemic estrogen ring, patch, cream, gel, mousse, spray, oral
tablet
Estrogen + progestin
Estrogen + androgen (+/-‐ progestin)
Androgen
18. Vaginal Lubricants and
Moisturizers
OTC water-‐based vaginal lubricants (short acting)
and moisturizers (longer acting)
Women may need both
Vitamin E oil, olive oil
Product selection is based on individual preference
19. Efficacy of Low-‐dose Vaginal Estriol on
Urogenital Symptoms
Treatment Group (n = 44) Control Group (n = 44)
Before After Before After P-
Variables Treatment Treatment Treatment Treatment Value*
Clinical
Vaginal dryness 100% 20.5% 100% 90.9% <.001
Dyspareunia 86.4% 20.5% 84.1% 86.4% <.001
Urogenital atrophy 100% 27.3% 100% 93.2% <.01
Urodynamic
MUP (cm H20) 50.82 6.15 62.15 8.64 52.35 6.30 49.40 6.54 <.05
MUCP (cm H20) 45.25 7.20 56.87 9.23 44.77 6.86 43.32 6.32 <.05
PTR (%) 72.52 10.31 88.85 9.66 70.75 9.08 70.77 9.04 <.05
*P-value is comparison between treatment and control groups. MUP = maximum urethral pressure; MUCP =
mean maximum urethral closure; PTR = abdominal pressure transmission ratio.
Adapted from Dessole S, et al. Menopause. 2004;11:49-56.
20. Vaginal Epithelium & Estrogen
6 weeks of
estrogen
Without estrogen - atrophic With estrogen1
Vagina/urethra highest concentration of estrogen receptors2
Most efficient response with local application3,4
1. Freedman. Unpublished data. 3. Elia et al. Obstet Gynecol Surv. 1993;48:509.
2. Losif et al. Am J Obstet Gynecol. 1981;141:817. 4. Weinberger. Am Clin Obstet Gynecol. 1995;38:175.
21. Sexual Function
Population-‐based cohort of 438 Australian
women, 45-‐55 years of age, who were still
menstruating at baseline
Hormonal levels, age, menopausal status, partner
status, and feelings for partner were measured
and evaluated
The authors concluded that prior function and
relationship factors are more important than
hormonal determinants of sexual function for
women in midlife
Dennerstein L, et al. Fertil Steril. 2005;84:174-80.
22. Comparative Efficacy of Oral Esterified Estrogen
With or Without MTestosterone in Postmenopausal Women
With Hypoactive Sexual Desire
Mean Change in Sexual Desire Scores
1.0
EE/MT
Mean Change
0.8 EE
0.6 *
0.4
0.2
0.0
Baseline 4 8 12 16
MT = methyltestosterone.
*P < .02. Study Week
Lobo RA, et al. Fertil Steril. 2003;79:1341-52.
23. Testosterone Transdermal Patch vs Placebo:
Total Satisfying Sexual Activity
3.0 Testosterone
Placebo *
*
4-Week Mean Change
2.5 *
*
from Baseline
2.0 *
1.5
1.0
0.5
0.0
0 4 8 12 16 20 24
Weeks
*P
Simon J, et al. J Clin Endocrinol Metab. 2005;90:5226-33.
24. Testosterone Transdermal Patch vs
Placebo: Personal Distress
0 Testosterone
Placebo
4-Week Mean Change
-5
from Baseline
-10
-15
*
-20
*
-25
* *
-30
0 4 8 12 24
Weeks
*P
Simon J, et al. J Clin Endocrinol Metab. 2005;90:5226-33.
26. Physiology of Memory Changes
Frequently due to sleep interruptions
Stress is a powerful mediator
Forgetfulness among women and men
similar at midlife
27. Cognitive Changes With Age
60 Verbal meaning
Spatial orientation
55 Inductive reasoning
Mean T score
Number
50 Word fluency
45
40
35
25 32 39 46 53 60 67 74 81 88
Age (years)
Longitudinal estimates of mean T scores for single markers of the primary mental ability in men and women
Schaie. Am Psychol. 1994;49:304.
28. Management Strategies for
Memory/Cognition
Treatment aimed at restoring sleep, reducing
stress
Diet, exercise, relaxation techniques
Use of memory aids
Maintain mental acuity games, puzzles, etc
Stress management strategies
? HT + / -‐
29. Effects of Estrogen on
Neuronal Function
Neurotransmission
Neuroprotection
Neurite Branching
Synaptogenesis
Trophic
Factor
Cerebral Blood Flow Expression
Adapted from Birge SJ. Menopause Management. 2000;July/August:13-21.
30. CEE Promotes Cellular Mechanisms
of Memory
Neuronal outgrowth Synapse formation
No CEE Prior to CEE
After CEE
CEE
treatment
treated
Brinton et al. Neurobiol Aging. 2000;21:475.
31. Cerebral Blood Flow (SPECT):
48-‐Yr-‐Old Healthy Menopausal Woman
During a Hot Flush CEE
SPECT, single photon emission computed tomography.
Greene. Neurobiol Aging. 1998;19:757.
32. ET/HT May Protect Against
Cognitive Decline
ET/HT users perform better than nonusers on tests
of memory and other cognitive functions1-‐4
ET/HT modulates brain activation patterns during
cognitive testing3-‐5
As women age, ET/HT increases blood flow
to cerebral and hippocampal brain structures
involved in memory3
May prevent AD with early intervention
ET = estrogen therapy; HT = hormone therapy. 1Jacobs DM, et al. Neurology. 1998;50:368-73. 2Maki PM, et al. Am
J Psychiatry. 2001;158:227-33. 3Resnick SM, et al. Horm Behav. 1998;34:171-82. 4Maki PM, Resnick SM.
Neurobiol Aging. 2000;21:373-83. 5Shaywitz SE, et al. JAMA. 1999;281:1197-202.
33. Improved Memory
Gerontology Research Center at NIH National
Institute on Aging1
50-‐ to 89-‐year-‐old postmenopausal
women; n=103
HRT improved verbal learning and memory tests
Cache County Study2
1357 men & 1889 women
incidence > after age 80 in women and exceeded risk for
men (HR 2.11, 1.22-‐3.86)
>10 years HRT
1Maki et al. Am J Psychiatry. 2001;158:227-233;
2Zandi et al. JAMA. 2002;288:2123-2129.
34. WHIMS Outcomes
Outcome E+P Placebo RR (95%CI)
n = 2,229 n = 2,303
Probable dementia 40 21 2.05 (1.21-3.48)
Mean (SD) F/U yrs 4.01 (1.21) 4.06 (1.18)
Rate per 10,000 woman
yrs 45 22
Mild Cognitive Impairment 56 55 1.07 (0.74-1.55)
Mean (SD) F/U yrs 3.99 (1.23) 4.04 (1.20)
Rate per 10,000 woman
yrs 63 59
Shumaker S et al. JAMA. 2003;289:2651-2662
35. Critical Window & Dementia?
US HMO Study
26% risk reduction for dementia when HT used
during midlife only
48% risk increase for dementia when HT used
only later in life
??provide a bridge for observation vs
WHIMS results
Whitmer RA, et al (2010). Timing of hormone therapy and dementia: the critical window theory revisited. Ann
Neurol. EPUb
37. SWAN Study: Reported Prevalence
of Vasomotor Symptoms
Ages 40 to 55 Years African American
50 Hispanic
Hot Flushes/Night Sweats
Caucasian
% of Women Reporting
Chinese
40
Japanese
30
20
10
0
Race/Ethnicity
Gold EB, et al. Am J Epidemiol. 2000;152:463-73.
38. Hot Flushes May Continue Years
After Menopause
50 Number of years women report having hot flushes as
45 estimated by a survey of 501 self-‐selected women who
have experienced hot flushes.1
40
Number of subjects
35
30
25
20
15
10
5
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 28 29 30 32 36 38 41 44
Years
Hot flushes are reported in 58% to 93% of postmenopausal women 2,3
1Kronenberg. Ann NY Acad Sci. 1990;592:52; 2Thompson et al. J Biosoc Sci. 1973;5:71;
3Berg et al. Maturitas. 1988;10:192.
39. The Vasomotor Cascade
Night sweats
Interrupted sleep
Fatigue
Irritability, mood changes
Kronenberg. Ann NY Acad Sci. 1990;592:52-86.
Beers et al, eds. The Merck Manual of Diagnosis and Therapy. 17th ed. 1999.
Baker et al. J Psychosom Res. 1997;43:359-369.
40. Physiology of The Hot Flash
No inherent health hazard
Related to reduced thermoneutral zone
Many women have a prodrome
Aura followed by measurable increase in
heat over entire body surface
increase skin temp and conductance
followed by decrease in core body temp
41. Could Hot Flashes be Protective?
Hazard Ratio
Ductal carcinoma1
Inv Lobular carcinoma1 OR
Inv Ductal-Lobular carc1
Stroke2
CVD2 HR
Death2
0.5 1.0 1.5
Huang, Y et al. (2011). Relationship between menopausal symptoms and risk of postmenopausal breast cancer.
Cancer Epidemiol Biomarkers Prev; 20(2); 1 10; Szmuilowicz, E. D., J. E. Manson, et al. (2011). Vasomotor
symptoms and cardiovascular events in postmenopausal women. Menopause. available at:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21358352
42. Vasomotor Management Strategies
Complementary and Alternative Medicine
Lifestyle Strategies
Behavioral Therapies
Paced respirations
Mindfulness Program
Acupuncture
Non-‐hormonal Medications
Hormone Therapy: ET EPT
43. Lifestyle Strategies
Diet Exercise
Avoidance of Regular Frequency
caffeine Aerobic
sugar
Breathable Fabrics
alcohol
Cotton
Increase Water
Linen
Low Fat
Layers
Vegetables, Protein
Avoid High Neck
Stress Management
Air flow / Fans
Alexander, et al. Menopause. 2003:10(6), 601; Irvin. Mind, Body & Menopause Study. 1996; Kronenberg & Fugh-‐
Berman. Ann Intern Med. 2002;137:805-‐813.
44. Relaxation Techniques
Paced respirations
Acupuncture
Mindfulness program1
No difference in frequency of HF
Sig decrease in stress, improved sleep, and less
bother from HFs in tx group
1Carmody, J. F., S. Crawford, et al. (2011). "Mindfulness training for coping with hot flashes: results of a randomized trial."
Menopause. published oinline:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21372745
45. Paced Respirations
Reduces frequency and severity of HF
Study used elaborate respiration monitoring
4-‐7-‐9 breathing is effective -‐ ??stress
mediation
Freedman RR, et al. Biochemical and thermoregulatory effects of treatment for menopausal hot flashes. Menopause.
1995;2:211 218; Freedman RR, Woodward S. Behavioral treatment of menopausal hot flushes: Evaluation by ambulatory
monitoring. Am J Obstet Gynecol. 1992;167(2):436 439.; Irvin JH, et al. The effects of relaxation response training on
menopausal symptoms. J Psychosom Obstet Gynaecol. 1996;17(4):202 207.; and Carson KM, et al. Yoga program
decreases hot flashes in breast cancer survivors: Results from a randomized trial. Presented at the Second IAYT
Symposium on Yoga Therapy and Research, March 6-9, 2008, Los Angeles, Calif.
46. Acupuncture for HFs
Well accepted CAM
Known to provide relaxation and pain relief
Of 8 studies published 1995-‐20081-‐8:
3 showed significant decrease in HF severity1, 2, 3
1 showed significant decrease in HF frequency for both tx
and sham groups4
3 showed beneficial effects on mood1, 3, 5 1 showed no
difference4
1Cohen SM, et al. Can acupuncture ease the symptoms of menopause? Holist Nurs Pract. 2003;17(6):295 299. 2Nir Y, et al.
Acupuncture for postmenopausal hot flashes. Maturitas. 2007;56(4):383 395. 3Huang MI, et al. A randomized controlled pilot
study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertil Steril.
2006;86(3):700 710. 4Avis NE, et al. A randomized, controlled pilot study of acupuncture treatment for menopausal hot
flashes. Menopause. 2008;15(6):1070 1078. 5Wyon Y, et al. Effects of acupuncture on climacteric vasomotor symptoms,
quality of life, and urinary excretion of neuropeptides among postmenopausal women. Menopause. 1995;2:3 12. 6Deng G, et
al. Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. J Clin Oncol.
2007;25(35):5584 5590. 7Vincent A, et al. Acupuncture for hot flashes: a randomized, sham-controlled clinical study.
Menopause. 2007;14(1):45 52. 8Wyon Y, et al. A comparison of acupuncture and oral estradiol treatment of vasomotor
symptoms in postmenopausal women. Climacteric. 2004;7(2):153 164.
47. Acupuncture for HFs
In head to head trial with venlafaxine
Women with hormone receptor-‐positive breast cancer
No difference in HF improvement between two arms
Conclusion: acupuncture as effective as venlafaxine,
Possibly safer and with fewer side effects
Walker EM, Rodrigues AI, kohn B et al. Acupuncture versus vanlafaxine for the management of vasomotor symptoms in
patietns with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol 2010;28:634-640.
48. Phytoestrogens for HFs
Efficacy Side-effects & Cautions
Isoflavones Not effective or mixed results in six Generally well tolerated
trials of red clover1 Long-term use of soy
Effective or mixed results in four of 11 extracts (>5 years) can
trials of soy extract1 increase risk for
Not effective in meta-analysis of five endometrial hyperplasia3
trials of red clover extract and not No increase in
effective in additional trial of red clover proliferation seen with 6
extract (not in meta-analysis due to months use4,5
differences in study design)2
Not effective in seven of nine trials of
dietary soy2
Not effective in four of nine trials of soy
extracts2
Not effective in six trials using other
phytoestrogens2
1Nelson HD, et al. JAMA. 2006;295(17):2057 2071. 2Lethaby AE, et al. Cochrane Database Syst Rev. 2007(4):CD001395.
3Unfer V, et al. Fertil Steril. 2004;82(1):145 148, 265. 4Balk JL, et al. J Soc Gynecol Investig. 2002;9(4):238 242. 5Kaari C, et
al. Maturitas. 2006;53(1):49 58. (table frm: Alexander. Advance for NPs. 2009;17(7):31-36.)
49. Botanicals for HF
Botanical Efficacy Side-effects & Cautions
Black cohosh Effective in 5 of 9 trials1 Headache, short-term dizziness,
gastrointestinal symptoms
Caution for possible liver toxicity (may
relate to contaminants in product as
opposed to black cohosh itself)
Ginseng Not effective in 2 trials1 Headache, gastrointestinal symptoms,
sleep disruptions
May interact with warfarin
Dong quai Effective in 1 trial Can cause photosensitivity
(combo w/ chamomile)2 May interact with warfarin
Not effective in 1 trial3
Oil of evening No significant decrease May potentiate seizure side effects in
primrose in one trial4 some medications (e.g., phenothiazines)
1Ihenacho. Drug Ther Bull. 2009;47(1):2 6. 2Hirata JD, et al. Fertil Steril. 1997;68(6):981 986. 3Kupfersztain C, et al. Clin Exp
Obstet Gynecol. 2003;30(4):203 206. 4Chenoy R, et al. Effect of oral gamolenic acid from evening primrose oil on menopausal
flushing. BMJ. 1994;308(6927):501 503. (table frm: Alexander. Advance for NPs. 2009;17(7):31-36.)
50. Non-Hormonal Medications for
Hot Flashes
SSRIs or SNRIs effective, 4 of 6 trials
Clonidine effective, 4 of 7 trials
Gabapentin effective, 2 of 2 trials
Isoflavone extracts -‐ mixed results, no
difference 6 trials red clover, improvement in
3 of 7 trials soy extracts
Effects are less than for Estrogen
Nelson, Vesco, et al. JAMA. 2006;295(17):2057-20716
51. Non-hormonal Medications for
Treating Hot Flushes
Drug Starting Dose % Reduction in Cost, $
Flushes*
Estrogen 0.625mg/d oral 80-100 23
conjugated estrogen
or equivalent
Megestrol 20mg/d 80 25
Venlafaxine or 75mg/d 60 78
Paroxetine 10mg/d (12.5 CR)
Clonidine 0.1mg/d 40 10
*Based on published randomized trials in which treatment with placebo reduced the severity and frequency oh hot flushes 20 to 40%
Cost data based on prices from a national chain pharmacy
Other estrogen preparations such as 17B estradiol, 1.0mg orally. And transdermal estradiol, 0.05mg) are equally effective
Grady. JAMA. 2002;287:2130.
52. E and E+P Reduce Hot Flashes
HOPE Study)
Placebo Placebo
10 10
0.625 mg 0.625/2.5 mg
0.45 mg 0.45/2.5 mg
0.3 mg 0.45/1.5 mg
Adjusted Mean Number*
Adjusted Mean Number*
8 8
0.3/1.5 mg
6 6
4 4
2 2
0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 13
Cycle Cycle
*Adjusted for baseline
Mean hot flushes at baseline = 12.3 (range 11.3 13.8)
Utian et al. FETil Steril. 2001;75:1065.
54. Milestones in Hormone Therapy
1940-‐2000
Breast cancer risk
Identified (Berkquist)
1989
Robert Wilson and Endometrial cancer
Feminine forever 1962 risk defined HERS WHI CEE arm
1975 1998 halted 2004
1940 1950 1960 1970 1980 1990 2000
DES approved 1941 DES banned for Wyeth files for CVD WHI CEE +
Conjugated equine human use 1975 prevention indication for MPA halted
estrogens (CEE) 1942 Premarin 2002
* HERS = Heart and Estrogen/Progestin Replacement Study
55. HT and CVD
Meta analysis 1993 (Grady et al)
Application to FDA for CEE as cardiopreventive
in healthy women
FDA requested RCT
First trial designed 2nd prevention (HERS)
Second designed for primary prevention (WHI)
HERS and WHI designed as statin trials
57. Heart and Estrogen/progestin Replacement
Study (HERS)
Study design: Randomized, double-‐blind, placebo-‐ controlled,
secondary prevention
Subjects: 2763 postmenopausal women,
<80 years old (mean age, 66.7 years)
with CAD
Intervention: CEE 0.625 mg + MPA 2.5 mg daily
or placebo
Follow-‐up: HERS I 4.1 years
HERS II open-‐label 2.7 years
1 end point: Nonfatal MI or CHD death
CAD = coronary artery disease; MI = myocardial infarction; CHD = coronary heart disease.
Hulley S, et al. JAMA. 1998;280:605-13.
Grady D, et al. JAMA. 2002;288:49-57.
58. Effect of HT vs Placebo on Second CHD
Events (HERS I and II)
HT Placebo
50
40
30
20
10 HERS HERS II
0
1 2 3 4 5 6 to 8
Years
Writing group for the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II) JAMA.
2002;288:49.
59. Papworth HRT Atherosclerosis Study
(PHASE)
RCT of 255 postmenopausal women with
angiographically confirmed coronary disease
Randomized to 17 -‐estradiol with or without NETA
(n=134) or placebo (n=121) for 4 years
Primary outcome: hospital admission with unstable
angina, proven MI, or death
15.6 / 100 patient-‐years (EPT all)
12.6 / 100 patient-‐years (placebo)
RR 1.23 (95% CI: 0.82-‐1.86; p=0.3)
Event rates were highest in first 2 years
Clarke S et al. Abstract. Eur Heart J, 2000; 21:212.
60. CEE/MPA Arm
Study design: Randomized, double-‐blind, placebo-‐
controlled, primary prevention trial
Subjects: 16,608 postmenopausal women
without vasomotor symptoms
50 to 79 years old (mean age, 63.3
years)
Intervention: CEE 0.625 mg + MPA 2.5 mg daily
or placebo
Follow-‐up: 5.2 years (average) terminated
early (8.5 years planned)
1° end point: Nonfatal MI or CHD death
Writing Group for the Women's Health Initiative Investigators. JAMA. 2002;288:321-33.
62. Gap Hypothesis: British
Million Women Study
ET and EPT use Overall
No risk if start 5 yr after menopause ET RR =
1.05, 95% CI = 0.89 to 1.24 EPT RR = 1.53, 95% CI =
1.38 to 1.70
risk if start at or before menopause ET RR =
1.43, 95% CI = 1.35 to 1.51 EPT RR = 2.04, 95% CI =
1.95 to 2.14
Incidence among women aged 50 59 yrs
Never users = 0.30 % (95% CI = 0.29% to 0.31%) Current ET* =
0.43% (95% CI = 0.42% to 0.45%) Current EPT* = 0.61% (95% CI =
0.59% to 0.64%)
*initiated use <5 years after menopause
Beral V et al (2011). Breast Cancer Risk in Relation to the Interval Between Menopause and Starting
Hormone Therapy. J Natl Cancer Inst 2011;103:296 305.
63. Breast Cancer Risk is Important
Re-‐analysis of the WHI E-‐only arm data
Risk analysis is important
Women at low risk for breast cancer do not have
increased risk with ET
Risk factors: family hx (esp 1st or 2nd degree), +BRCA-‐1/2,
dense breasts, bx = atypical hyperplasia, radiation,
obesity, alcohol use, inactivity
Risk mediators: early age of full-‐term pregnancy, long-‐
term breast feeding, +exercise, no hx fibrocystic breast dz.
Archer DF. IMS Press Release, Dec 13, 2010; Ragaz J et al. (2010) Dual estrogen effects on breast cancer:
endogenous estrogen stimulates, exogenous estrogen protects. Further investigation of estrogen
chemoprevention is warranted. San Antonio Breast Cancer Symposium, abstract # 1410.
64. WHI ET Arm and Breast CA: 10.7 Yr
Follow-‐up Data
23% risk of invasive breast CA in ET group
versus placebo after 10.7 years (3.5 yrs use)
(HR 0.77, CI 0.62 0.95)
No significant effects overall for CHD, DVT,
CVA, hip fx, colorectal ca, or total mortality
LaCroix AZ, Chlebowski RT, Manson JE et al. Health outcomes after stopping conjugated equine estrogen among
postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA 2011;305:1305-1314.
65. Breast Cancer in
Primary CHD Prevention Trials
Hormone Therapy1,2 Lipid Lowering3
CHD 0.68 (0.48-0.96) 0.89 (0.69-1.09)
Total Mortality 0.61 (0.39-0.95) 0.95 (0.62-1.46)
No. Additional
No. of Patients Breast Cancer
(Annualized %) Cases per 10,000
Hazard Women per Year
Study Placebo Statin Ratio 95% CI of Stain Use
Statins meta4 64 (0.23) 81 (0.30) 1.33 (0.79-2.26) 7
Statins meta5 124 (0.29) 132 (0.31) 1.04 (0.81-1.33) 2
WHI-EP6 150 (0.33) 199 (0.42) 1.24 (adj 0.97-1.59) 9
WHI-E7* 161 (0.42) 129 (0.34) 0.82 (0.65-1.04) -8
*Adherence adjusted = 0.67 (0.47-0.97) 1Salpeter S, et al. J Gen Intern Med 2004;19:791-804.
*Ductal carcinoma = 0.71 (0.52-0.99) 2Salpeter S, et al. J Gen Intern Med 2006;21:363-366.
3Walsh JME, et al. JAMA 2004;21:363-366.
4Dale KM, et al. JAMA 2006;295:74-80.
5Stefanos, et al. J Clin Oncol 2005;23:8606-8612.
6Chlebowski RT, et al. JAMA 2003;289:3243-3253.
7Stefanick ML, et al. JAMA 2006;295:1647-1657.
66. Latest Epidemiological News on Breast
Cancer and EPT:
Breast CA incidence -‐ Canada study:1
incidence 2002 after WHI
incidence again 2005/6,
??EPT promotes tumor growth but not causative
WHI EPT Br CA Mortality, ~ 11 yr follow-‐up (~5
years on therapy):2
of 10,000 women, 1.3 deaths/yr on placebo
of 10,000 women, 2.6 deaths/yr on EPT
1Prithwish et al. Breast cancer incidence and hormone replacement therapy in Canada. J Natl Cancer Inst 2010; 102:1489-1495.
2Chlewbowski et al. (2010). Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA
304(15): 1684-92
67. Time Effects of HT and CVD: WHI ET Arm
10.7 Yr Follow-‐up Data
Women aged 50 59:
40% to 50% risks for HD endpoints in tx grp
Of 10,000, tx grp had 12 fewer MIs, 13 fewer deaths,
18 fewer AEs
Women aged 70 79:
risks for HD endpoints in tx grp
Of 10,000, tx grp had 16 more MIs, 19 more deaths,
48 more AEs
LaCroix AZ, Chlebowski RT, Manson JE et al. Health outcomes after stopping conjugated equine estrogen among
postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA 2011;305:1305-1314.
68. Time Effect with Estrogen ??
Meta analysis of observational studies
beneficial effects on heart disease if ET/HT
started at time of menopause (Salpeter, et al, 2004)
WHI data analysis of women initiating therapy
at time of menopause had protective
cardiovascular effects (Hsia, et al, 2006)
Early versus Late Intervention Trial with
Estrogen (ELITE) trial, Kronos Early Estrogen
69. On the Horizon
Estrogen with Bazedoxifene (BZA)
Tissue-‐Selective Estrogen Complex (TSEC)
Protects bone
Reduces menopause-‐related symptoms (
HFs, vaginal dryness, sexual function)
No increase in endometrial or breast cancer
Lewiecki EM. Bazedoxifene and bazedoxifene combined with conjugated estrogens for the management of
postmenopausal osteoporosis. Expert Opin Investig Drugs. Oct 2007;16(10):1663-1672.
Ronkin et al. Endometrial effects of bazedoxifene acetate, a novel selective estrogen receptor modulator, in
postmenopausal women. Obstet Gynecol. Jun 2005;105(6):1397-1404.
71. Weighing the Benefits vs Risks
of HT
Barriers
Examples
Tolerability Benefits
Fears Examples
Misperceptions Vasomotor
Risks Sexuality
QOL
Osteoporosis
72. Resources
NIH -‐ National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
The Hormone Foundation
http://www.hormone.org/
http://nccam.nih.gov/
National Osteoporosis Foundation
http://www.nof.org/
Herbal Product Information
http://consumerlabs.com
North American Menopause Society
http://www.menopause.com
73. Acknowledgements
Some slides courtesy of:
NAMS (purchased slide set)
NOF
NPWH
Council on Hormone Education
Colleagues
Used with permission, copyright held by
original authors