MENOPAUSE & HORMONE REPLACEMENT THERAPY

8 MENOPAUSE & HORMONE REPLACEMENT THERAPY

8 “Like an electrical current, menstruation and the ebb and flow of energy is an alternating current.” - Farida Shaw -

8 INTRODUCTION OLDER POPULATION BY AGE, 1900-2050

8 PERSPECTIVES ON MENOPAUSE ECONOMIC & GLOBAL DIMENSIONS Total Annual Costs of Menopause: • Urogenital tract health issues = $125 million • Menopause/physiological disturbances = $480 million • Skeletal issues and osteoporosis = $540 million • Cardiovascular and cerebral disease = $1.1 million

8 Total Annual Costs of Hormone Replacement Therapy, in Millions

8 Prevalence of Hormone Replacement Therapy Around the World, 1999 • In France = 47% of eligible women took HRT • In United States = 25% of eligible women took HRT • In Germany = 25% of eligible women took HRT • In Italy = 3% of eligible women took HRT • In Japan = 2% of eligible women took HRT

8 MENOPAUSE NATURAL MENOPAUSE • Perimenopause –  estrogen levels and sporadic ovulation • Ovaries begin to fail to respond to the luteinizing and follicle-stimulating hormones • Ovaries producing  levels of estrogen and progesterone in response • Menstruation ceases SURGICALLY INDUCED MENOPAUSE • Hysterectomy – removal of both ovaries and fallopian tubes

8 4 TYPES OF HYSTERECTOMY

8 HYSTERCTOMY RATES, BY GEOGRAPHIC REGION, U.S., 1994-1999

8 HEALTH EFFECTS OF MENOPAUSE ASSOCIATED EFFECTS • Hot flashes • Urinary incontinence • Thinning hair •  incidence depression • Insomnia • Vaginal atrophy • Vaginal discharge •  vaginal lubrication • Vaginal infections • Urinary tract infections •  libido • Painful intercourse

8 LONG-TERM EFFECTS •  HDL levels •  LDL levels • Postmenopausal Cardiovascular Disease • Osteoporosis • Affects 25 million American women • Osteopenia • Curvature of Spine • Alzheimer’s Disease

8 PREVALENCE OF LOW FEMUR BONE DENSITY IN U.S. WOMEN OVER 50, 1988-1994, BY RACE

8 MENOPAUSAL MANAGEMENT HORMONE REPLACEMENT THERAPY 3 Types : • Estrogen alone • Estrogen + Progesterone • Estrogen + Progesterone + Testosterone

8 3 Types of Preparation: • Oral Preparation • Natural Estrogen • Synthetic • Progestin • Combination Therapy • Selective Estrogen Receptor Modulators • Vaginal Cream • Vaginal Ring • Transdermal Patch

8 HRT RISK FACTORS

8 OTHER MENOPAUSE MANAGEMENT METHODS • Regular Exercise • Weight-bearing exercise (osteoporosis) • Aerobic exercise (CVD) • Proper diet •  fruits/vegies,  whole grains,  saturated fats,  cholesterol,  calcium, vitamin C,D,E • Herbal Medicine • Black cohosh, Vitex, Dong quai

8 Regular Exercise Can Help • Can improve: insomnia, depression, other mood changes, weight gain, headache

8 INFORMED DECISION MAKING Conditions That May Precludethe Use of HRT Personal history of breast cancer History of blood clots in legs, lungs, or eyes Undiagnosed or abnormal vaginal bleeding Preexisting cardiovascular conditions, such as blood clots, stroke, or uncontrolled hypertension History of liver, gallbladder, or pancreatic disease; impaired liver function

MENOPAUSE & HORMONE REPLACEMENT THERAPY