OBGYN - Menopause and HRT
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(Created page with '=Menopause and Hormone Replacement Therapy= ==Menopause== *Loss of reproductive capability *Marked decline in ovarian hormone production ===Terminology=== *Perimenopause: *Men…') |
m (moved OBGYN - Menopause and AUB to OBGYN - Menopause and HRT) |
Current revision as of 00:22, 15 December 2011
[edit] Menopause and Hormone Replacement Therapy
[edit] Menopause
- Loss of reproductive capability
- Marked decline in ovarian hormone production
[edit] Terminology
- Perimenopause:
- Menopausal Transition (climacteric):
- Menopause:
[edit] Phases of Menopause
[edit] Physiology
- Decreasing number of follicles
- Variable follicular phase length
- Decreasing incidence of ovulation
[edit] Endocrinology
- Decreasing inhibin
- Increasing FSH
- Variable estradiol levels
- Estrone replaces estradiol as the predominant estrogen
- Testosterone gradually declines with age
[edit] Symptomatology
- Menstrual cycle changes
- Declining fertility
- Neuroendocrine complaints
- Multiple organ system changes
[edit] Differential Expression of ER-alpha and ER-beta
[edit] Is menopause an estrogen deficiency disease?
[edit] Benefits of ERT
[edit] Vasomotor Symptoms
[edit] Urogenital Atrophy
- Atrophic vaginitis
- Frequent UTI
- Incontinence
- Is the decline in estrogen associated with chronic diseases of aging, i.e., cardiovascular disease, Alzheimer’s Disease, osteoporosis, cancer?
[edit] Osteoporosis
[edit] Possible Cardiovascular Protection
- Incidence of Cardiovascular Disease: Relation to Menopause Status
- CVD is the leading cause of death among women
- Observational Studies of CVD Risk and ERT/HRT
- WHI: Revised Results
- Hypothetical Pathogenetic Sequence
[edit] Possible Effect on Memory, Alzheimer’s Disease
- Estrogen and Cognition
- Estrogen receptors are found in brain regions involved with cognition
- Cerebral cortex
- Hippocampus
- Basal forebrain
- Estrogen increases cholinergic responsivity after menopause
- These findings suggest that estrogen may affect cognitive function
- Estrogen receptors are found in brain regions involved with cognition
- Mechanisms:
**
- Estrogen / Hormone Therapy and AD Risk:
- What WHIMS and WHISCA Cannot Address=====
- Whether there is a critical period of initiation of ET/HT for prevention of
- Cognitive aging
- AD
- Whether dose and types of HT and duration of treatment may have different effects
- Whether there is a critical period of initiation of ET/HT for prevention of
[edit] Colon Cancer
- Relative Risk of CRC among HRT pts:
[edit] Reservations about ERT
[edit] Contraindications
- Known or suspected cancer of the breast
- Known or suspected estrogen-dependent neoplasia
- Known or suspected pregnancy
- Undiagnosed abnormal genital bleeding
- Active thrombosis or thromboembolic disorders
- A past history of thrombosis, thrombophlebitis or thromboembolic disorders associated with estrogen use
[edit] Endometrial Cancer
- RR of Endometrial Cancer for HRT pts
[edit] Breast Cancer
- Perceived leading cause of death in women is breast cancer.
- Risk of Breast Cancer with HRT:
- Breast cancer mortality with HRT:
- Relative risk of breast cancer:
[edit] Cardiovascular Disease and Thromboembolic Events
[edit] Evaluating the Menopausal Patient
- History and physical exam
- Menopausal stage
- Symptoms, impact on QOL
- Medical diagnoses, medications
- Relevant risks, contraindications
- Labs, studies
- Mammogram
- r/o pregnancy
- Evaluate abnormal bleeding
- Evaluate relevant risks
[edit] Potential Treatment Options
- Lifestyle modifications
- Therapies for specific complaints
- Approaches for vasomotor symptoms
- Education
- Environmental modification
- Behavioral modification
- Nonprescription therapies
- Prescription therapies
[edit] Hormonal Agents for Menopausal Therapy
- Estrogens
- Oral
- Transdermal: patches, gels, creams, spray
- Vaginal: creams, rings, tablets
- Progestogens:
- Oral
- Intrauterine system
- Vaginal: gel, insert
- Combination estrogen / progestogen:
- Oral
- Transdermal
[edit] Hormonal Regimens for Menopausal Therapy
[edit] General Principles of Menopausal ET / EPT
- Identify the reason for treatment
- Include a progestin if the uterus is present
- Use the lowest dose for the shortest time necessary to correct the problem
- Re-evaluate regularly for safety, efficacy, side effects