Y2S3S3: Hormone Replacement Therapy – Women’s Health

What are the 3 main indications for hormone therapy?
1. Vasomotor Symptoms
2. Urogenital atrophy
3. Osteoporosis – not really used as initial therapy
Should hormone therapy be used to treat chronic conditions?
No, current data does not support the routine use of HT for prevention of chronic conditions
You are attempting to treat a patient with vasomotor symptoms related to menopause, what hormones can you use. What determines what hormones to use?
1. Use just estrogen if they are missing their uterus
2. Use both progesterone and estrogen if they still have an intact uterus.
What is the most effective treatment for Vasomotor symptoms?
Estrogen therapy
What is an effective treatment for vaginal dryness and atrophic changes that impede sexual function?
Estrogen
What treatment has been shown to increase sexual desire in women?
High-dose transdermal androgen therapy. (Not estrogen therapy)
What treatment has been shown to increase collagen content and skin thickness and reduce wrinkling in non-sun exposed areas?
Locally applied estrogen can increase collagen content and skin thickness.
That hormone (applied locally) may reduce UTI’s?
Estrogen
What hormone treatment improves atrophic vaginitis?
Estrogen with or without progesterone
What hormone therapy has been shown to increase the risk of breast cancer?
Combined HT (estrogen and progesterone) for women in menopause.

Estrogen alone does not increase risk (in women with hysterectomy/oophorectomy)

What is the causative agent in breast cancer for post menopausal therapy?
Progesterone
Does progesterone therapy increase the risk of breast cancer in premenopausal women?
No, does not apply to birth control.
What hormone replacement therapy increases the risk of thromboembolic disease?
Estrogen therapy (think of this as it uncovers an underlying clotting disorder)
If a postmenopausal patient has had a previous history of stroke or TIA, what therapy should be used to treat her hot flashes?
Not estrogen, you can use the non hormonal treatments.
Your patient is on anticoagulants and you decide to administer estrogen therapy. What should you consider?
You might need to adjust the coagulation therapy dosage.
What is a fatal risk of estrogen therapy associated with Triglyceride levels?
Pancreatitis & Cholecystitis
Why should estrogen therapy be avoided in someone with high triglyceride levels?
There is an increased risk of gallstones and biliary tract surgery.
Why should a woman with a uterus continue to use progesterone in their hormone replacement therapy?
Avoid increased risk for endometrial cancer: Progesterone will allow breakdown of the endometrial lining so growth is not unopposed.
How does postmenopausal hormone replacement therapy affect weight gain?
It doesn’t
How does postmenopausal hormone replacement therapy affect long-term glycemic control in women with type II DM?
It doesn’t
Does hormone replacement therapy aid in the prevention of osteoarthritis or rheumatoid arthritis?
No
What duration of hormone therapy treatment is required to determine effectiveness in alleviating vasomotor symptoms?
4 weeks
What duration of hormone therapy treatment is defined as short-term use?
2-4 years
According to WHI and HERS trials, why should conjugated estrogen and medroxyprogesterone acetate not given over 2 years?
There is an increased risk of breast cancer.
According to WHI and HERS trials, when is there an increased risk of thromboembolism associated with HT therapy?
In the first year of treatment
According to WHI and HERS trials, when is there an increased risk of stroke associated with HT therapy?
During the second year of hormone therapy.
What is the average length of vasomotor symptoms in the postmenopausal woman?
4 years
What is the only reason to withhold HT from persistently symptomatic women who desire HT?
They have significant risk factors
What herbal remedies can be used to relieve hot flashes?
None, they are all garbage. Drugs are the answer. DRUGS! DRUGS! DRUGS!
What is an alternative to hormone therapy for the treatment of hot flashes?
SSRI’s (not herbal remedies)
When should a postmenopausal woman on HT be reevaluated?
Every year
What natural remedies are contraindicated with estrogen dependent cancers (breast cancer) in women?
Soy and isoflavones – they interact with estrogen receptors.
What treatments show a very weak evidence of increasing sexual libido in postmenopausal women?
Oral estrogen and Estrogen + Testosterone
What HT can help with vaginal pain and dryness in a postmenopausal woman?
Low dose estrogen (pills, creams, rings)
What is the single, biggest modifier for weight gain?
Physical activity
What are the absolute contraindications for Estrogen and Progesterone treatment?
1. Known/Suspected pregnancy
2. Known/Suspected breast cancer (okay in patients being treated for metastatic disease)
3. Known/Suspected estrogen-dependent neoplasia
4. Undiagnosed abnormal genital bleeding (could be cancer)
5. Active thrombophlebitis or thromboembolic disease
What are the side effects of estrogen therapy? (5)
1. Breast Tenderness
2. Edema, bloating
3. Nausea
4. Headaches
5. Weight Gain
What are the side effects of progesterone therapy?
1. Breast Tenderness
2. Withdrawal bleeding
3. Fluid retention
4. Premenstrual-Like symptoms
5. Depression and irritability
6. Lethargy
7. Bloating
8. Headaches
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