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Replacement Therapy
Sandra E. Brooks, MD, FACS, FACOG
Associate Professor
Director, Div GYN Oncology
Dept. Obstetrics and Gynecology
University of Maryland School of Medicine
What is Menopause?
Reproductive Tract:
Symptoms: cessation of menses, hot flashes,
decreased vaginal lubrication
Signs: vaginal epithelial atrophy, decreased
size of uterus, cervix, or ovaries
Urinary Tract:
Symptoms: urgency, frequency, nocturia
Signs: urothelial atrophy, hypertonic unstable
bladder
Breasts:
Symptoms: decreased tenderness
Signs: decreased size, fewer benign cysts
Osteoporosis
decreased trabecular bone density due to increased
osteoclastic activity
Cardiovascular Disease
the most common cause of death in women
rate of CVD increases steadily reaching parity with
men by age 70
lipid profile changes:
increased LDL
decreased HDL
WHI Study
16,080 Women age 50-79
No prior hysterectomy
8506
Premarin 0.625 mg/d
Provera 2.5mg/d
7574
Control
Placebo
WHI Study
HRT increased Risk of Heart Disease
Coronary
Stroke
41% I
DVT
207%
PE 213%
Objective:
Methods:
Study Population:
222 women aged 45 years and older
Experimental Group
unopposed 17- estradiol (1 mg/d)
Control Group
placebo
Conclusions of HERS
No overall benefit of hormone
treatment
Unexpected pattern of increased risk
during the first year of follow-up
7 other randomized clinical trials
conclude:
HRT does not reduce risk of adverse
event in women with heart disease
Response to WHI
Important
Women
to note:
Contraindications to HRT
Pregnancy or Breastfeeding.
Liver disease
Undiagnosed vaginal bleeding.
History of certain cancers.
History of deep vein thromboses
or other blood clotting disorders.
Return of periods
Irregular vaginal bleeding/spotting
Headache
Nausea
Breast tenderness
Bloating (progesterone)
Weight gain (progesterone): generally only 2-3 pounds can be
blamed on the hormones: the rest is decreased metabolism
associated with menopause, increased caloric intake and/or
decreased exercise.
May exacerbate depression (progesterone)
Enlargement of uterine fibroids
Exacerbation of endometriosis
Fluid retention (may exacerbate asthma, epilepsy, migraine, heart
disease, kidney disease)
Spotty darkening of the skin
Alternatives to HRT
PHYTOESTROGENS
Herbal Preparations
Herbal Preparations
Ginkgo biloba:
This herb is commonly used as a mood elevator or to
improve memory and other cognitive functions. It has also
been documented to cause bleeding problems in several
individuals, with or without other medicines. Speak with
your physician if you plan to take this herb, especially if
you are taking medicines for bleeding or clotting problems
or for arthritis.
Wild yam:
This has been touted as a natural source of natural
progesterone. It contains diosgenin, which is not
converted to active hormones in the body however, and it
has been shown to have NO effects on estrogen or
progesterone receptors.
Vaginal Lubricants: There are numerous non-prescription
vaginal lubricants on the market such as K-Y Jelly and
Vagisil . Never use a water insoluble preparation in the
vagina, e.g. Vaseline .
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