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Hormone Replacement Therapy

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Hormone Replacement Therapy. Martha Petersen MPH, CHES, PA-C ... Premature Ovarian Failure. Spontaneous cessation of menses 40 yo. POF = elevated FSH x 2 ... – PowerPoint PPT presentation

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Title: Hormone Replacement Therapy


1
Hormone Replacement Therapy
Martha Petersen MPH, CHES, PA-C Womens Health
Module Summer2001 PA Program Lock Haven University
2
Cycle
  • Pituitary FSH
  • Ovulation LH
  • Ovaries
  • Estrogen
  • Progesterone
  • Androgens
  • ?????????

3
Premature Ovarian Failure
  • Spontaneous cessation of menses
  • POF elevated FSH x 2
  • R/O autoimmune disorder
  • Karyotypic abnormalities

4
PeriMenopause
  • Change in menses
  • Vasomotor symptoms

5
Menopause
  • Amenorrhea
  • Vasomotor symptoms (cultural?)
  • Definitive Dx FSH
  • 40 mIU (x2) Amenorrhea (6months)

6
FSH Levels
7
Menopause
  • Average age 50 52
  • 40-60 normal
  • Genetic Influence
  • Early Menarche Late Menopause
  • Hysterectomy Earlier Menopause
  • Smoking Earlier Menopause
  • Chemotherapy /or Radiation

8
HRT Indications
  • Symptoms of Hormonal Deficiency
  • Prevention of Specific Medical Conditions

9
HRT Benefits
  • Symptomatic
  • Vasomotor
  • Mood
  • Vaginal Atrophy
  • Insomnia

10
HRT Benefits
  • Preventative
  • Osteoporosis
  • Coronary Heart Dz
  • Alzheimers
  • Genitourinary Health
  • Colon Cancer
  • Atrophic Vaginitis
  • General Sense of Well Being
  • Sexual Functioning

11
HRT RISK
  • Breast Ca
  • Deep Vein Thrombosis (DVT)
  • Pulmonary Emboli (PE)
  • Endometrial Ca
  • Gallbladder Dz
  • Systemic Lupus Erythematosus

12
ESTROGENS
13
Progestins
Not FDA Approved
14
Androgens
  • Part of the hormones lost w/ cessation of
    ovarian function
  • Contributes to bone density, libido and sense of
    general well being
  • Methyltestosterone 1.25 5.0 mg

15
Alternative Rx for Vasomotor Sx
16
Delivery Method
  • Oral
  • Transdermal
  • Transvaginally
  • IM

17
HRT Contraindications
  • Absolute
  • Temporary
  • Relative

18
HRT for Whom?
  • Individualize to Patient
  • Symptoms?
  • Personal History?
  • Family History?

19
HRT Regimen
  • Provides Benefits
  • Minimize SE
  • Cyclic vs Continuous

20
HRT - Cyclic
  • Estrogen qd
  • .3 mg minimum dose for Osteo
  • Progestin 2.5 5.mg
  • Minimum of 12 days /cycle of estrogen
  • May have w/drawal bleeding

21
HRT Continuous
  • Estrogen qd
  • .3 for Osteo
  • .625 most common
  • .9 or 1.25 if needed
  • Progesterone qd
  • 2.5 mg
  • 5 mg if needed

22
HRT Rx
  • http//www.earlymenopause.com/hrt.htm
  • http//www.imaginis.com/breasthealth/hrt.asp

23
HRT Secrets to Success
  • Individualize to Patient
  • Educate
  • Re Evaluate
  • Reassure

24
References
  • Johnson S. Menopause and Hormone Replacement
    Therapy (2000)
  • Sheehey G. Silent Passages ( 1998)
  • Sullivan J, Fowlkes L. Changing the Natural
    History of Coronary Artery Disease (1999)
  • http//www.earlymenopause.com/links.htm
  • http//www.imaginis.com/breasthealth/hrt.asp
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