Treatment of Menopause
5 years post-WHI report results - ANS -1. 65% of women stopped HRT in 2002
2. 1 in 4 women subsequently returned to therapy -> still offers best relief of symptoms, willing
to take risks to get benefits, follow-up reports of WHI, uncertainty of what results mean
\absolute contraindications for HT - ANS -1. endometrial cancer
2. breast cancer
3. undiagnosed vaginal bleeding
4. recent VTE
5. active liver disease
\adverse effects associated with estrogens - ANS -1. bleeding (return to regular periods)
2. breast tenderness
3. bloating
4. premenstrual-like symptoms
5. nausea
6. headache
\adverse effects associated with progestins - ANS -1. breast tenderness
2. weight gain
3. edema
4. PMS-like syndrome
5. depression
6. irritability
7. headache
\alternatives to ET/HT - ANS -1. herbs
2. supplements
3. BHRT (bioidentical hormones)
4. regimens promoted by celebrities
\androgens ADRs - ANS -virilization, fluid retention, effects on lipoproteins
\androgens and menopause - ANS -1. deficiency may occur in menopause
2. symptoms include: fatigue, decreased sense of well-being, sexual function changes
\argument against BHT being safer and more efficacious than MHT - ANS -1. MHT is approved
by FDA as safe and efficacious following large clinical trials
2. manufacturers are federally regulated to ensure the purity, quality, and safety of their products
(quality control over purity and dosing accuracy is responsibility of the compounder)
3. wealth of clinical studies and publications on MHT (current lack of clinical data for BHT)
\argument for BHT being safer and more efficacious than MHT - ANS -1. "natural" products are
preferred over synthetic
2. chemically identical to hormones in the body
3. custom made with a broad selection of doses and combinations
4. "high touch" therapy
\associated symptoms of menopause - ANS -1. mood swings
2. depression
, 3. insomnia
4. migraines
5. formication
6. arthralgia
7. myalgia
8. decreased libido
9. sexual dysfunction
10. cognitive symptoms
\benefits more likely to outweigh risks for ... ((2013 Recommendations for HT)) - ANS
-symptomatic women <60yrs or within 10 yrs after menopause
\bioidentical hormone therapy (BHT) compounds are tailored to ... - ANS -women's individual
hormone needs -> individualized doses, dosage forms and mixtures not available commercially
\bottom line for BHT vs MHT - ANS -1. we will not be able to adequately compare the risks and
benefits of MHT vs. BHT until appropriate scientific evidence is gathered
2. in the meantime, all of the available treatments and evidence regarding these treatments
should be made known and available to each patient
\clonidine for vasomotor symptoms - ANS -non-hormonal therapy
1. 0.1-0.2mg produced variable results
2. bothersome ADRs
\common androgen regimen for menopause - ANS -1. esterified estrogen + 1.25 or 2.5mg
methyltestosterone
2. long term safety and efficacy studies are lacking (some efficacy in studies of surgically
menopausal women in short term regimens)
\common menopausal symptoms - ANS -1. hot flashes
2. amenorrhea
3. decreased BMD
4. urogenital atrophy
\commonly compounded BHT - ANS -combinations and strengths of
1. Bi-est - 80% estriol + 20% estradiol
2. Tri-est - 80% estriol + 10% estradiol + 10% estrone
3. other common components = testosterone, progesterone, DHEA, pregnenolone, or
androstendione
4. dosage forms = suppositories, troches, transdermal, vaginal, capsules
\continuous HT schedule - ANS -1. estrogen + progestin every day (better compliance)
2. irregular bleeding for 6-12mo
\cyclic HT schedule - ANS -1. estrogen + progestin for 12d minimum
2. newly diagnosed or bleeding problems
\decision to start HT is an individual decision in terms of ... - ANS -QOL, health priorities, and
risk factors such as age, time since menopause and risk of VTE, stroke, ischemic heart disease
and breast cancer
\decision to use HT is whose choice? - ANS -patient choice in conjunction with health
professional (for patients who can't or choose not to use hormones, look at alternatives)
\Duavee use - ANS -1. for treatment of vasomotor symptoms in women with a uterus
2. can also be used to prevent osteoporosis in women with significant risk factors
5 years post-WHI report results - ANS -1. 65% of women stopped HRT in 2002
2. 1 in 4 women subsequently returned to therapy -> still offers best relief of symptoms, willing
to take risks to get benefits, follow-up reports of WHI, uncertainty of what results mean
\absolute contraindications for HT - ANS -1. endometrial cancer
2. breast cancer
3. undiagnosed vaginal bleeding
4. recent VTE
5. active liver disease
\adverse effects associated with estrogens - ANS -1. bleeding (return to regular periods)
2. breast tenderness
3. bloating
4. premenstrual-like symptoms
5. nausea
6. headache
\adverse effects associated with progestins - ANS -1. breast tenderness
2. weight gain
3. edema
4. PMS-like syndrome
5. depression
6. irritability
7. headache
\alternatives to ET/HT - ANS -1. herbs
2. supplements
3. BHRT (bioidentical hormones)
4. regimens promoted by celebrities
\androgens ADRs - ANS -virilization, fluid retention, effects on lipoproteins
\androgens and menopause - ANS -1. deficiency may occur in menopause
2. symptoms include: fatigue, decreased sense of well-being, sexual function changes
\argument against BHT being safer and more efficacious than MHT - ANS -1. MHT is approved
by FDA as safe and efficacious following large clinical trials
2. manufacturers are federally regulated to ensure the purity, quality, and safety of their products
(quality control over purity and dosing accuracy is responsibility of the compounder)
3. wealth of clinical studies and publications on MHT (current lack of clinical data for BHT)
\argument for BHT being safer and more efficacious than MHT - ANS -1. "natural" products are
preferred over synthetic
2. chemically identical to hormones in the body
3. custom made with a broad selection of doses and combinations
4. "high touch" therapy
\associated symptoms of menopause - ANS -1. mood swings
2. depression
, 3. insomnia
4. migraines
5. formication
6. arthralgia
7. myalgia
8. decreased libido
9. sexual dysfunction
10. cognitive symptoms
\benefits more likely to outweigh risks for ... ((2013 Recommendations for HT)) - ANS
-symptomatic women <60yrs or within 10 yrs after menopause
\bioidentical hormone therapy (BHT) compounds are tailored to ... - ANS -women's individual
hormone needs -> individualized doses, dosage forms and mixtures not available commercially
\bottom line for BHT vs MHT - ANS -1. we will not be able to adequately compare the risks and
benefits of MHT vs. BHT until appropriate scientific evidence is gathered
2. in the meantime, all of the available treatments and evidence regarding these treatments
should be made known and available to each patient
\clonidine for vasomotor symptoms - ANS -non-hormonal therapy
1. 0.1-0.2mg produced variable results
2. bothersome ADRs
\common androgen regimen for menopause - ANS -1. esterified estrogen + 1.25 or 2.5mg
methyltestosterone
2. long term safety and efficacy studies are lacking (some efficacy in studies of surgically
menopausal women in short term regimens)
\common menopausal symptoms - ANS -1. hot flashes
2. amenorrhea
3. decreased BMD
4. urogenital atrophy
\commonly compounded BHT - ANS -combinations and strengths of
1. Bi-est - 80% estriol + 20% estradiol
2. Tri-est - 80% estriol + 10% estradiol + 10% estrone
3. other common components = testosterone, progesterone, DHEA, pregnenolone, or
androstendione
4. dosage forms = suppositories, troches, transdermal, vaginal, capsules
\continuous HT schedule - ANS -1. estrogen + progestin every day (better compliance)
2. irregular bleeding for 6-12mo
\cyclic HT schedule - ANS -1. estrogen + progestin for 12d minimum
2. newly diagnosed or bleeding problems
\decision to start HT is an individual decision in terms of ... - ANS -QOL, health priorities, and
risk factors such as age, time since menopause and risk of VTE, stroke, ischemic heart disease
and breast cancer
\decision to use HT is whose choice? - ANS -patient choice in conjunction with health
professional (for patients who can't or choose not to use hormones, look at alternatives)
\Duavee use - ANS -1. for treatment of vasomotor symptoms in women with a uterus
2. can also be used to prevent osteoporosis in women with significant risk factors
