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Medcan Women’s Health Forum

Medcan Women’s Health Forum. It’s The Menopause! Wilfred M Steinberg MD FRCSC University of Toronto St Michael’s Hospital. It’s a New World. What Does it All Mean?. What Does it All Mean?. When Does It Start? Or End?. Perimenopause…not a disease. What Changes Occur in the Menopause ?.

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Medcan Women’s Health Forum

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  1. Medcan Women’s Health Forum It’s The Menopause! Wilfred M Steinberg MD FRCSC University of Toronto St Michael’s Hospital

  2. It’s a New World

  3. What Does it All Mean?

  4. What Does it All Mean?

  5. When Does It Start? Or End?

  6. Perimenopause…not a disease

  7. What Changes Occur in the Menopause ? Alzheimer’s disease • Menopausal symptoms • Vasomotor symptoms • Mood disturbances Breast cancer Cardiovascular disease Bone loss and fractures Colon cancer Urogenital atrophy Smith T, et al. J Soc Obstet Gynaecol Can 2001

  8. Progression of Symptoms

  9. Are you aware?

  10. Cognitive Changes

  11. Body Changes

  12. Range of Emotions

  13. Anyone you Know?

  14. Menopausal Changes?

  15. Some Weird Changes

  16. Unappreciated Symptoms

  17. Can I Still Get Pregnant?

  18. Fertility Rates & Age

  19. Who are you going to trust?

  20. Does this resonate for you?

  21. Be an Intelligent Consumer

  22. Plants for menopausal Rx Isoflavones Have estrogen-like effects, so …be aware.. Black Cohosh, Wild Yam Soy

  23. Herbs: Traditional and Chinese

  24. Myth #1: “Natural Hormones are Safer :

  25. Myth #2: Compounded Bioidentical Hormones Work Better than Brand Rx Hormones. There is no scientific support for an advantage of these compounds over common commercially produced preparations. Mary M. Gallenberg, M.D Mayo Clinic

  26. Natural Hormones-FDA H&W Approved

  27. 8 7 6 5 4 3 2 1 0 What really works? 351 women Placebo Black cohosh Multibotanical * Multibotanical + soy HT * Vasomotor Symptoms Per Day * * * Adjusted mean number of vasomotor symptoms per day, by study group Baseline 3 mo 6 mo 12 mo Newton KM, et al. Ann Intern Med 2006;145:869-79. Reproduced with permission.

  28. My Favourite Natural Treatment

  29. Non Hormonal Remedies • Significantly reduced the number of hot flushes compared with placebo • 66.6% reductions from baseline • Hot flush severity and number of nighttime awakenings were significantly reduced American Journal of Obstetrics & Gynecology, February 2009

  30. Myth #3: Since Compounded Bioidentical Hormones Are Natural, They are Safer Than Other Hormones.” They're produced in doses and forms that differ from those in FDA-approved products BUT..with no quality assurance standards

  31. KEEPS:Kronos Early Estrogen Prevention Study 2012 Estrogen and progestogen therapy started soon after menopause, not only relieve symptoms, but appear safe.  • No increase in blood pressure, no effects on atherosclerosis, • No increase in breast cancer or uterine cancer, • No effects on blood clots associated with stroke and myocardial infarction.

  32. Options :Menopausal Symptoms Lifestyle changes:.some benefit Regular exercise, diet, nonsmoking, moderate alcohol, BMI <32 Herbal remedies:..minimal benefit Dong quai, ginseng, black cohosh, soy isoflavones, red clover, Goji j Medical therapies:major benefits Estrogen, progestin, gabapentin, clonidine SSRI / SNRIs

  33. Risks for Breast Cancer in Perspective 50 7-year ET* 5 years of CCEPT use 10 years of CCEPT use 15 years of CCEPT use Late menopause (10-year delay) Body mass index (BMI) (10 kg increase) Alcohol consumption (2 drinks/day) Lack of regular exercise Weight gain after menopause (20 kg or more) 40 30 Additional cancers per 1,000 women 20 10 * 0 Baseline no HT use 45/1,000 women 50–60 years† *

  34. Healthy is the New Sexy

  35. Healthy is the New Sexy In postmenopausal women, the quality of the relationship and the presence of sexual problems in the partner are probably as important as are hormonal change in the maintenance of sexual interest and response.

  36. What Else May be Going On? • urinary incontinence, • depression, • dementia, • arthritis, • stroke and • breast cancer • Family crisis

  37. Menopause or Depression? • loss of or diminished sex drive • lowered sexual desire and sexual activity • loss of energy • fatigue • lethargy • tiredness • lack of concentration

  38. Vaginal Atrophy superficial intermediate parabasal Thick, healthy, well-estrogenizedlining of the vagina Thin, dry lining of vaginadue to menopause(after estrogen loss) The North American Menopause Society. Menopause. 2007;14:357-369

  39. Most Important Sex Organ in Women

  40. Most Important Sex Organ in Women

  41. What happens 5 years after menopause?

  42. Testosterone For Post Menopausal Women?

  43. Androgel Off Label Use in Women • AndroGel contains testosterone, a Schedule III controlled substance as defined by the Anabolic Steroids Control Act. • AndroGel is supplied in non-aerosol, metered-dose pumps. . • AndroGel is also supplied in unit-dose aluminum foil packets in cartons of 30

  44. Hot Then(1959) Still Hot Now (2014)

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