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Menopausal Hormonal Therapy

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Published in: Medicine
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This presentation talks in detail about the goals of menopausal hormonal therapy. I delve into the criteria for therapy and different management options.

Noor U / Dubai

6 years of teaching experience

Qualification: Bachelor of Medicine, Bachelor of Surgery (MBBS) IGCSE and A level Cambridge Intl School Dubai

Teaches: Science, Medicine, Biology, Chemistry, SAT, USMLE, Pharmacology, Physics

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  1. enopausal Hormone Therap Noor
  2. 53 yr old lady: wants to start hormone replacement therapy
  3. Objectives Definition Goals of therapy Patient selection Risk factors, contraindications Preferred regimens
  4. What is menopause? Stages: Terminology: Duration of Stage: Menstntal Cycles: Endo c rine: -5 Early variable regular -4 Reproductive variable regular -3 t FSH -2 Final Menstrual Penod (EMP) -1 +2 Menopausal "fransition Early Late* Perimenopause variable variable 22 ski pped cycl h cycles and ( 7 days anin val of no a 26-0 day t FSH Postmenopause Early* 4 yrs yr until demise normal FSH t FSH •Stages likely to be characterized by symptoms
  5. Definition Definition — Menopausal hormone therapy (MH T) is the broad term used to describe both unopposed estrogen use for women who have undergone hysterectomy, and combined estrogen-progestin therapy (EPT) for women with an intact uterus who need a progestin to prevent estrogen-associated endometrial hyperplasia
  6. Goals The primary goal of MHT is to relieve vasomotor symptoms (hot flashes). Other symptoms associated with perimenopause and menopause that respond to estrogen include sleep disturbances, depression/anxiety, and, in some cases, joint aches and pains. Estrogen is also indicated for the management of genitourinary syndrome of menopause (GSM); however, low-dose vaginal estrogen should be used rather than systemic estrogen. Vasomotor symptoms (most effective treatment) Vaginal dryness, dyspareunia Urogenital atrophy
  7. Patient Selection HOW TO DECIDE IF A PATIENT IS A GOOD CANDIDATE FOR MHT? Healthy, peri/postmenopausal women with moderate to severe vasomotor symptoms impacting sleep, quality of life, or ability to function, and who are within 10 years of menopause (or years of age), MHT IS SUGGESTED History of breast cancer, CHD, a previous venous thromboembolic (VT E) event or stroke, active liver disease, unexplained vaginal bleeding, high-risk endometrial cancer, or transient ischemic attack— >CONTRAINDICATED
  8. pa ABSOLUTE Suspicion of pregnancy Breast cancer Endometrial cancer Acute liver disease Uncontrolled hypertension Previous venous thromboembolism event Thrombophilia Otosclerosis RELATIVE Abnormal bleeding Uterine fibroids (large) Benign breast disease Family history of V TE Chronic, stable liver disease Migraine with aura
  9. Risks and benefits Of menopausal hormone therapy (MHT) of 1000 S of 12.5 10 10 12.5 15 Lung (50-59 age)
  10. Patient Selection CVD risk assessment Evaluating CVD risk in women contemplating MHT 10-year CVD risk Low Moderate (5 to 10%) High Years since menopause onset < I O years MHT ok MHT ok (choose transdermal) Avoid MHT CVO risk calculated by ACC/AHA Cardiovascular Risk Calculator. Methods to calculate risk and risk Stratification Vary among countries. CVO: cardiovascular disease; MHT: therapy; ACC: American College Of Cardiology; AHA: American Heart Association. • High risk includes known myocardial infarction (MI), stroke, peripheral artery disease, etc.
  11. Preferred regimens HT can be prescribed as local (creams, pessaries, rings) or systemic therapy (oral drugs, transdermal patches and gels, implants). Hormonal products available in such preparations may contain the following ingredients: • Estrogen alone • Combined estrogen and progestogen • Selective estrogen receptor modulator (SERM) • Gonadomimetics, such as tibolone, which contain estrogen, progestogen, and an androgen The estrogens most commonly prescribed are conjugated estrogens that may be equine (CEE) or synthetic, micronized 17ß estradiol, and ethinyl estradiol. The progestins that are used commonly are medroxyprogesterone acetate (MPA) and norethindrone acetate. The various schedules of hormone therapy include the following: Estrogen taken daily Cyclic or sequential regimens: Progestogen is added for 10-14 days every 4 weeks Continuous combined regimens: Estrogen and progestogen are taken daily
  12. ALGORITHM REVIEW EACH TREATMENT FOR MENOPAUSAL SYMPTOMS: • At 3 months to assess efficacy and tolerability • Annually -if there are clinical indications for an earlier review (such as treatment ineffectiveness, side effects or adverse events). Menopausal HRT [coc
  13. Thank you

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