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Hormone Therapy Drugs for Menopause: Overview and Treatment Principles

This chapter provides an overview of hormone therapy drugs for menopause, including estrogens, progestogens, and androgens. It also discusses treatment principles, guidelines, and evidence-based recommendations.

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Hormone Therapy Drugs for Menopause: Overview and Treatment Principles

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  1. Chapter 54 Menopause Hormone Therapy

  2. Drug Overview • Estrogens • Conjugated estrogens • Conjugated estrogens (equine) • Conjugated estrogens (synthetic) • Conjugated estrogens B (synthetic) • Synthesized estrogens • estrogens, esterified • ethinyl estradiol • estropipate (estrone)

  3. Drug Overview • Estrogens (cont’d) • Bioidentical • estradiol • estrone • estriol • Progestogens • Synthesized • Bioidentical 

  4. Drug Overview • Combination Agents • Conjugated estrogen/medroxyprogesterone • estradiol/norethindrone acetate • Androgens • Synthesized • Bioidentical

  5. Drug Overview • Indications • Hormone therapy (HT), estrogens, progestogen • Androgens • Unlabeled Uses

  6. Mechanism of Action • Drug Effects in Menopause • Vasomotor effects • Vaginal atrophy • Cardiovascular • Breast cancer • Bone density • Brain • Endometrial cancer • GI • Overall effects

  7. Treatment Principles • Standardized Guidelines • North American Menopause Society (NAMS) • National Association of Nurse Practitioners in Women’s Health (NPWH) • American Society of Reproductive Medicine (ASRM) • American College of Gynecologists and Obstetricians (ACOG) • U.S. Food and Drug Administration (FDA)

  8. Treatment Principles • Evidence-Based Recommendations • Menopausal symptoms • Colorectal cancer • Osteoporosis • Prevention of endometrial hyperplasia and cancer

  9. Treatment Principles • Cardinal Points of Treatment • Pregnancy • Lifestyle modification • Individualization of treatment • Dosing and length of treatment

  10. Treatment Principles • Nonpharmacologic Treatment • Lifestyle modifications • Complementary and alternative therapies • Pharmacologic Treatment • Oral contraceptives during perimenopause • Short-term HT use • Long-term HT use

  11. Treatment Principles • Pharmacologic Treatment (cont’d) • HT regimens • Dosage • Adjust dosage as necessary • Adding androgens to hormone replacement therapy

  12. Treatment Principles • How to Monitor • Patient Variables • Geriatrics • Pediatrics • Pregnancy and lactation • Race/gender

  13. Treatment Principles • Patient Education

  14. Estrogens • Conjugated equine estrogen (Premarin) • Contraindications • Pharmacokinetics • Adverse effects • Drug interactions • Dosage and effects

  15. Progestogens • medroxyprogesterone acetate (Provera, Cycrin, Amen) • Contraindications • Drug interactions

  16. Androgens • methyltestosterone (Combination: Estratest, Estratest H.S.) • Contraindications • Warnings • Precautions • Drug interactions

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