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Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT). What is Menopause?. Cessation of menstruation as a result of the aging process of or surgical removal of the ovaries; change from fertility to infertility. Physiological changes that take place within women between the ages of 30 to 60.

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Hormone Replacement Therapy (HRT)

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  1. Hormone Replacement Therapy (HRT)

  2. What is Menopause? • Cessation of menstruation as a result of the aging process of or surgical removal of the ovaries; change from fertility to infertility. • Physiological changes that take place within women between the ages of 30 to 60. • Hormone levels change in female body; practically the production of estrogen. • Perimenopause and menopause can last 10 plus years. • Menopause itself begins 12 months after a woman’s final period.

  3. Symptoms of Perimenopause/Menopause • Cycles become irregular • Erratic or heavy bleeding • Decrease in sexual response • Irritability/Mood Swings • Fatigue • Forgetfulness

  4. Symptoms of Perimenopause/Menopause • Headache • Hot flashes • Night sweats • Vaginal dryness • Dry skin • Bone loss • Urinary incontinence

  5. Hormone Replacement Therapy • Supplemental hormones: Estrogen, progesterone, and testosterone. • Estrogen and progesterone can be made from plants of from synthetic chemicals. • Delivery options: pills, patches, creams, inserted into vagina by means of creams, tablets or ring, placed under skin by implants or by injection; future: nasal spray.

  6. PROGESTOGENS 19 NORTESTOSTERONE DERIVATIVES • norethisterone • levonorgestrel • norgestrel 17 HYDROXY-PROGESTERONE DERIVATIVES • dydrogesterone • medroxy progesterone acetate

  7. Prescription of HRT: ROUTES Transdermal: patch or gel Oral Intra-uterine (Mirena) Subcutaneous(implant) Intra-vaginal (tablets, ring or cream) Intramuscular (depot)

  8. Preparations of HRT • Oestrogen Only HRT (tablet, patch, gel, implant) • Sequential Combined HRT - oestrogen and progestogens (tablets or patch) • Continuous Combined HRT - oestrogen and progestogens (tablets or patch)

  9. Oestrogen Only HRT • Only to be used in women who have had a total hysterectomy • If the hysterectomy was subtotal, then may need to use progestogens as well (some endometrium may be left behind) • If the hysterectomy was for endometriosis, then progestogens continuously along with oestrogen should be used at least initially

  10. Sequential Combined HRT • Sequential oestrogen and progestogen • The addition of the progestogen protects the endometrium and leads to a regular bleed • Single named product available as patch or tablet but individualisation possible eg gel and IUS Oestrogen for 28 days Progestogen for 14 days

  11. Continuous Combined HRT • Continuous Combined HRT (CCT) • This should not be started until 1 year after the LMP or aged 54. Should also be used after 2 years of cyclical therapy if under the age of 54. • No monthly bleed Oestrogen combined with progestogen for 28 days

  12. Tibolone or Livial • This is an alternative CC HRT • It is a gonadomimetic containing oestrogen, progestogens and androgens • Licensed for vasomotor symptoms and osteoporosis • The risk:benefit ratio similar to HRT in women under 60, but over 60 increased risk of stroke • Slightly increased risk for endometrial cancer • Less risk of breast cancer compared with CCT but increased over E2 only HRT • May help libido due to androgen content

  13. Benefits of HRT • Maintains thickness and vascularity of vaginal and urethral tissue for comfort and lubrication during sexual interaction. • Reduces hot flashes and sleep disturbances from night sweats. • Protects against osteoporosis and resultant fractures, particularly of the hip. • Reduces risk of colon cancer

  14. Media Reports of HRT • Media reports: Hazard Ratio- compares the difference between numbers of people in each treatment condition who experienced the health problem or benefit. Example: “The Scientists found a 29% increase in strokes, and a 26% increase in breast cancer.” • Absolute Risk- Compares the actual number of people who experience the problem or benefit. Example: Women’s Health Initiative actual report was 8% increase in strokes, and 8% increase for breast cancer.

  15. Risks of HRT • Breast cancer • In 2003 there was 14,000 less cases of breast cancer possibly due to the decrease in women taking HRT • If a woman is diagnosed with breast cancer while taking HRT, she is advised to stop immediately. • Endometrial cancer • Cardiovascular disease • Stroke • Blood clots

  16. Side Effects of HRT • Weight gain • Bloating • Breast tenderness • Irregular bleeding • Some do not take HRT for fear of cancer • Some physicians recommend a discontinuation of HRT

  17. Alternative Therapies • One study indicated 68 percent of women have tried alternative therapies and 62 percent were satisfied with the results. • Diet and Exercise are the most common.

  18. Alternative Therapies (Diet) • Soy isoflavones in soy products • Relieves a number of symptoms, including hot flashes, night sweats, fatigue and vaginal dryness • Soy has also been shown to assist the body in absorbing and retaining calcium, suppress bone loss, lower LDL cholesterol and decrease blood clotting • Recommended daily amount is 25 grams of soy protein and 30-50 mg of isoflavones as a starting amount and could gradually increase to two to three times that amount • Seen to reduce symptoms in 4 out of 10 women

  19. Alternative Therapies (Diet) • Black Cohosh • Has been seen to reduce hot flashes • Potential for liver damage and shouldn’t take more than 6 months • Calcium, magnesium and vitamins D & E • Magnesium promotes bone density • RDA is 600 mg, although most Americans only consume 300 mg

  20. Alternative Therapies • Exercise • A study in Sweden showed that out of 1,323 women, 15 percent sedentary women demonstrated hot flash symptoms compared to only five percent of the physically active subjects • Weight bearing exercises and strength training strengthens bones and muscles, enhances self-esteem and creates a positive outlook, promotes sleep and increases levels of neurotransmitters in the brain • Serotonin (calming effect), endorphins (pain killers), and dopamine (alertness and concentration).

  21. Alternative Therapies • Smoking cessation • Reduces risk for pretty much everything! • Avoiding spicy foods for those who get heartburn • Can reduce severity and frequency of hot flashes • Limiting or eliminating caffeine • Promotes sleep • Relaxation methods • Helps with mood swings/irritability

  22. Alternative Therapies • Acupuncture • Reflexology • Controlling weight and avoiding weight gain • Preparing for hot weather by wearing layers of clothing and bringing a small fan

  23. Conclusion • Controversial subject • Limited extensive scientific research • Limitations on the studies conducted • HRT or not? • History of breast cancer • Presence of other risk factors

  24. Thank you

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