1 / 37

Hormone Replacement Therapy: A Primer for the Physician Assistant

Hormone Replacement Therapy: A Primer for the Physician Assistant. Kimberly Cheatham, MD, FACOG Director, OU-Tulsa PA Program October 26, 2012. Modified from Shapiro M, Goldstein SR, Pinkerton JV, Shifren JL. Customizing therapies to manage

lynde
Download Presentation

Hormone Replacement Therapy: A Primer for the Physician Assistant

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hormone Replacement Therapy: A Primer for the Physician Assistant Kimberly Cheatham, MD, FACOG Director, OU-Tulsa PA Program October 26, 2012 Modified from Shapiro M, Goldstein SR, Pinkerton JV, Shifren JL. Customizing therapies to manage menopause-related symptoms. Medscape Women’s Health Education. 2012. Retrieved from http://www.medscape.org/viewprogram/32450?src=0_mp_cmenl_0

  2. Objectives At the conclusion of this presentation, the physician assistant will be able to: • Recognize the indications and contraindications for patient use of hormone therapy • Create a treatment strategy for patients who desire to use hormone therapy • Provide appropriate counseling to patients considering hormone therapy use

  3. Take-Home MessageIndications • Women < 60 years old or < 10 years from menopause with moderate to severe vasomotor symptoms (hot flashes or night sweats) • Postmenopausal women with symptoms from vulvovaginal atrophy • Vaginal dryness • Dyspareunia • Urge incontinence • Recurrent UTI • Women experiencing premature menopause (< 40 y) or premature ovarian insufficiency Stuenkel, C. A. et al. (2012). A decade after the WHI – the experts do agree. Fertility and Sterility, 98(2), 313-314.

  4. Take-Home MessageTreatment Strategy HT is the most effective treatment for menopause-related symptoms and their potential consequences (diminished sleep quality, irritability, QOL) Progestogen therapy is required to prevent endometrial cancer when estrogen is used systemically in women with a uterus Observational data shows that transdermal estrogen leads to fewer strokes and VTE/PE than oral therapy Local low-dose estrogen therapy is effective and preferred for women whose symptoms are limited to vaginal dryness or discomfort with intercourse Stuenkel, C. A. et al. (2012). A decade after the WHI – the experts do agree. Fertility and Sterility, 98(2), 313-314.

  5. Take-Home MessageCounseling Duration of treatment Benefit-risk ratio The lowest dose of HT should be used for the shortest amount of time to manage symptoms Patient’s risk factors and effects of HT on CHD, stroke, VTE/PE, breast cancer, osteoporosis Discontinuance Stuenkel, C. A. et al. (2012). A decade after the WHI – the experts do agree. Fertility and Sterility, 98(2), 313-314.

  6. Resources Hormone products http://www.menopause.org/publications/clinical-practice-materials/hormone-therapy-charts NAMS 2012 Hormone Therapy Position Statement http://www.menopause.org/docs/default-document-library/psht12.pdf?sfvrsn=2 NAMS 2007 Position Statement for Local Vaginal Estrogen Treatment of Vaginal Atrophy http://www.menopause.org/docs/2010/psvagestrogen07.pdf?sfvrsn=2 BioidenticalHormone Therapy http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy

  7. References ACOG Committee Opinion. Compounded Bioidentical Hormones. Canonico M, et al. Maturitas. 2006; 54: 372-379. Chen WY, et al. Arch Intern Med. 2006; 8; 166: 1027-1032. Hsia J, et al. Arch Intern Med. 2006; 166: 357-365. LaCroix AZ, et al. JAMA. 2011; 305: 1305-1314. Lisabeth L, et al. Lancet Neurol. 2012; 11: 82-91. MacLennan AH, et al. Cochrane Database Syst Rev. 2004; CD002078. MinkinMJ. J Reprod Med. 2004; 49: 311-320. NAMS. Menopause. 2012; 19: 257-271. NAMS. Menopause Practice: A Clinician’s Guide, 4th edition; 2010. NIH. Annals Int Med 2005; 142: 1003-1013. PrescrireInt. 2006; 15: 137-138. Rada G, et al. Cochrane Database Syst Rev. 2010; CD004923. Rossouw JE, et al. JAMA. 2002; 288: 321-333. Salpeter SR, et al. J Gen Intern Med. 2006; 21: 363-366. Santen RJ. J ClinEndocrinolMetab. 2010; 95: s1-s66. Scarabin PY, et al. Lancet. 2003; 362: 428-432. Shapiro M, et al. Medscape Women’s Health Education. 2012. Retrieved from http://www.medscape.org/viewprogram/32450?src=0_mp_cmenl_0 Stuenkel CA, et al. Fertility and Sterility. 2012; 98(2), 313-314.

More Related