Skip to main content
UploadLanguage (EN)Support
BusinessMobileSocial MediaMarketingTechnologyArt & PhotosCareerDesignEducationPresentations & Public SpeakingGovernment & NonprofitHealthcareInternetLawLeadership & ManagementAutomotiveEngineeringSoftwareRecruiting & HRRetailSalesServicesScienceSmall Business & EntrepreneurshipFoodEnvironmentEconomy & FinanceData & AnalyticsInvestor RelationsSportsSpiritualNews & PoliticsTravelSelf ImprovementReal EstateEntertainment & HumorHealth & MedicineDevices & HardwareLifestyle
MH
Uploaded byMegan Handley
PPTX, PDF12,899 views

Menopause Presentation

Menopause is the permanent cessation of menstrual periods, occurring on average at age 51. Hormone therapy can relieve menopausal symptoms but carries risks like endometrial cancer and blood clots. Options include oral or transdermal estrogen with or without progestin. Non-hormonal treatments include black cohosh, exercise, and lifestyle changes. Hormone therapy is generally recommended for short-term use to treat moderate to severe symptoms.

Downloaded 454 times
MENOPAUSE Presented by: Megan Handley Pharm.D. Candidate Class of 2015 University of Arizona College of Pharmacy
OBJECTIVES Background Staging of menopause Hormone therapy Over the counter options Non-pharmacological treatment options Conclusions
BACKGROUND  Mean age: 51 years  95% of women become menopausal between 45 & 55 years of age  Permanent cessation of menstrual periods (12 months of amenorrhea)  Perimenopause (transition phase) begins on average 4 years before the final menstrual period  Diagnosis of menopausal transition is made in women:  >45 years old  Irregular menstrual cycles  Menopausal symptoms  Serum follicle-stimulating hormone is often measured, however the result offers no additional information
SYMPTOMS hot flashes vaginal dryness sleep disturbances new-onset depression cognitive changes (memory loss) changes in sexual function joint pain menstrual migraines breast pain
STAGES OF MENOPAUSE Late Reproductive Years -serum inhibin B -FSH may  slightly -luteal phase progesterone  Perimenopause –change in intermenstrual interval –bleeding pattern changes –dramatic FSH & estradiol fluctuations (FSH >25 IU/L) –serum inhibin B  –ovarian antral follicle count  -vasomotor symptoms Menopause –permanent cessation of menses –FSH  over several years after the final period. -vasomotor symptoms
HORMONE THERAPY  Goal: to relieve menopausal symptoms & treat vulvovaginal atrophy during perimenopause & early menopause  Indications:  moderate to severe vasomotor symptoms  moderate to severe symptoms of vulvar & vaginal atrophy  prevention of postmenopausal osteoporosis  Disease prevention:  Osteoporosis  Dementia  Cardiovascular disease  Risks are plentiful, but short-term use (≤5 years) does not seem to be associated with significant risk
RISKS OF HORMONE THERAPY  Endometrial cancer  Venous thromboembolic disease:  Increased risk within 1-2 years after initiation of hormone therapy  Smoking cessation  Breast cancer  Increased breast density with progestogens via proliferation of estrogen-dependent mammary tissue, making it more difficult to detect breast cancer early with a mammogram  Family history  Duration of exposure  Ovarian cancer  >10 years estrogen therapy  Cerebrovascular accidents
CONTRAINDICATIONS OF HORMONE THERAPY Breast cancer Estrogen- sensitive malignant conditions Undiagnosed genital bleeding Untreated endometrial hyperplasia Previous idiopathic or current venous thromboembolism Active or recent arterial thromboembolic disease Untreated hypertension Active liver disease Porphyria cutanea tarda
ESTROGEN  Oral, transdermal, topical, intravaginal creams & tablets, vaginal rings, injections  Dose-related effects on hot flashes. Use lowest dose necessary to provide relief of symptoms or bone protection  Oral  Favorable effects on lipid profiles   in serum triglycerides & C-reactive protein   in testosterone concentrations  Dose (17β-estradiol): 0.5-1mg /day  Dose (ethinyl estradiol): 0.01-0.02mg /day  Conjugated equine estrogens: 0.3-0.625mg /day  Transdermal  Risk of venous thromboembolism, hypertriglyceridemia & stroke are lower than oral therapy  Contain 17β-estradiol (14-100μg/day)  Starting dose: 0.025mg patch monthly. If hot flashes still present in 1month,  to 0.0375mg & reassess 1month later
ESTROGEN: LOCAL/VAGINAL  Indications: atrophy, sexual function, dyspareunia, atrophic vaginitis  Wash hands before use, insert with vaginal applicator, clean applicator in warm, soapy water & rinse  Conjugated estrogens (Premarin cream): Start with 0.5g vaginally twice weekly (usually 3weeks on /1week off). Do not exceed 2g/day.  Estradiol  Estrace cream: 2-4g daily for 1-2weeks, gradually reduce to half initial dose for 1- 2weeks  Maintenance dose:1g 1-3 times weekly may be used after restoration of vaginal mucosa  Vagifem tablets: insert one10mcg tablet daily for 2weeks then one tablet twice weekly  Estragyn (estrone) cream: 2-4g intravaginally daily  Continuously or 25days on/5days off.  Attempts to discontinue or taper should be made at 3-6month intervals
PROGESTINS  Intact uterus: need progestin+estrogen to prevent endometrial hyperplasia  Oral, transdermal, transvaginal, intrauterine  Adverse effects: mood swings, bloating, fluid retention, sleep disturbance  Cyclic: 10-14days/month (produces monthly menstrual periods)  Continuous: progestogen+estrogen daily (amenorrhea, breakthrough bleeding)  Micronized progesterone: 100mg PO daily or 200mg PO for 10-12days/month  Norethindrone: 0.35mg PO daily or 5mg PO for 10-12 days/month  Levonorgestrel (Mirena): intrauterine device releasing 20mcg/day  Medroxyprogesterone acetate: 2.5mg PO daily or 5-10mg PO for 10-12days/month  Abnormal bleeding necessitates careful monitoring of the endometrium with ultrasonography & biopsy
PRESCRIPTION THERAPIES
OTC/HERBAL TREATMENTS  Phytoestrogens: sterol molecules produced by plants, weak estrogenic activity  Soy  Inconsistent trial results, no long-term safety & efficacy trials completed  Food sources preferred (tofu, soy sauce, soybean oil, soy milk)  Avoid over dosage with supplements  Women with personal or strong family history of hormone-dependent cancers, thromboembolic or cardiovascular events should not use soy products  Black cohosh (Remifemin)  Trials yielded inconsistent results  Rare case reports of hepatitis associated with preparations containing black cohosh  No safety trials have been conducted for longer than 6months  ProFema: vitamins, minerals, black cohosh, spirulina, kelp, digestive plant enzymes, etc. ($40/month)  Estroven: vitamins, minerals, natural extracts, isoflavones (soybeans), black cohosh ($15/month)
NON-PHARMACOLOGICAL TREATMENTS Avoid spicy foods Avoid stress triggers Cool environment (fans, air conditioning, light/layered clothing) Relaxation therapy Cognitive behavioral therapy Placebo effect Weight loss Exercise Hypnosis
ANDROGEN DEFICIENCY  Symptoms: low libido, decreased sexual response, depression, insomnia, headache, poor concentration, decreased lean body mass, fatigue  Adverse effects: acne, hirsutism, voice, deepening, ↓ in high-density lipoprotein levels  Variation in normal ranges of serum testosterone levels, DHEA, DHEAS, & androstenedione. Makes diagnosis of androgen deficiency difficult.  Patients who continue to have symptoms on estrogen replacement alone  Use of androgens other than testosterone (DHEA, DHEAS, androstenedione) cannot be recommended due to uncontrolled amounts of medication in OTC preparations.  Methyltestosterone dose not to exceed 2.5mg daily  Estratest:1.25mg esterified estrogens & 2.5mg methyltestosterone, 0.625mg esterified estrogens & 1.25mg methyltestosterone
CONCLUSIONS  Hormone therapy is prescribed during perimenopause & early menopause for relief of symptoms & treatment of vaginal atrophy  Progestational agent should be used in women with an intact uterus & can be administered with estrogen  Hormone therapy dose may be reduced with increasing age  Hormone therapy results in benefits on bone protection & possibly dementia  Risks of endometrial cancer, breast cancer, ovarian cancer, vascular & thromboembolic disease with hormone therapy  Clonidine, antidepressants, & anticonvulsants may have benefit  OTC preparations have inconsistent trial results & often interact with other medications  Androgen deficiency symptoms despite estrogen therapy may warrant addition of methyltestosterone to estrogen treatment
QUESTIONS?
REFERENCES  National Institutes of Health. The 2012 hormone therapy position statement of the North American Menopause Society. Menopause 2012; 19:257.  American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice 2006; 12:315-30.  Martin KA, Barbieri RL. Treatment of menopausal symptoms with hormone therapy. UpToDate. 2014. Accessed February 2015.  Beral V, Million Women Study Collaborators. Ovarian cancer and hormone- replacement therapy in the Million Women Study. Lancet. 2007;369:1703- 1710.  Menopausal hormone therapy and cancer risk. American Cancer Society. 2014.http://www.cancer.org/cancer/cancercauses/othercarcinogens/medicaltr eatments/menopausal-hormone-replacement-therapy-and-cancer-risk. Accessed February 2015.  Sattar N, Forouhi NG, Wild RA. C-rective protein and hormone replacement therapy. Circulation. 2000; 102:e96-7.  US Food and Drug Administration. Questions and Answers for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm135339.ht m5. (Accessed February 2015).  Anderson GL, Clebowski RT, Aragaki AK, et al. Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomised placebo-controlled trial. Lancet Oncol. 2012 Mar 6