Update on Menopause: What s New?
|
|
- Janis Andrews
- 6 years ago
- Views:
Transcription
1 Karen Carlson, MD Current Clinical Issues in Primary Care
2 1 Update on Mepause: What s New? Karen Carlson, M.D. Massachusetts General Hospital Harvard Medical School Our agenda: Update on new data from WHI, SWAN, and other studies, and application to practice ce Approach to individualized management for mepausal symptoms The Women s Health Initiative: Translating Results to Practice The Study of Women s Health Across the Nation (SWAN) Multicenter, multiethnic longitudinal study of mepause transition 3300 women followed for 5 years Natural history of mepause: What can your patient expect? Perimepause Transitional stage lasts 4 years on average Mepause Average age is 51; 48 in smokers Early postmepause First 5 years after final period Estradiol Levels During Mepause Transition
3 2 Are symptoms due to mepause or to aging? 2005 Clear relationship to mepause: Vasomotor symptoms (hot flashes, night sweats) Vaginal dryness Sleep disturbance Unclear relationship to mepause: Mood disturbance Cognitive changes Somatic complaints (fatigue, joint pain) Urinary incontinence Decreased libido NIH Consensus Conference March 2005 Are symptoms due to mepause or to aging? 2009 Clear relationship to mepause: Vasomotor symptoms (hot flashes, night sweats) Vaginal dryness Sleep disturbance Mood disturbance 1 Joint pain 2 Unclear relationship to mepause: Cognitive changes Somatic complaints (fatigue) Urinary incontinence 1 Freeman EW. Arch Gen Psych 2006;63:375 2 Szoeke CE. Climacteric 2008;11:55. Which women have hot flashes? Hot flashes more common: Anxiety symptoms at baseline Smoking African-American or Hispanic women Higher body mass index Lower educational level Gold EB et al. Am J Public Health 2006;96:1226 Percent reporting symptoms What is the natural history of hot flashes? years + 1 year + 5 years + 8 years - 30% have hot flashes 5 years after final menstrual period - Median duration of symptoms 4 years Politi MC. J Gen Intern Med 2008;23:1507. Time from mepause Mepause and Mood Disorders Recent prospective studies suggest that depressive and other mood symptoms may increase in mepause transition 2- to 4-fold increase in depressive symptoms 1,2,3,4 Incidence depression 21-26% 1 Schmidt PJ. Am J Psych 2004;161: Freeman EW. Arch Gen Psych 2006;63:375 3 Cohen LS. Arch Gen Psych 2006;63:385 4 Bromberger JT J Affect Disord 2007 Mepause and Sexual Function SWAN: in early perimepause, multiple factors have impact on libido 1 Relationship factors, attitudes, vaginal dryness, cultural factors Penn Ovarian Aging Study: Two-fold increase in sexual dysfunction across transition; associations are multifactorial 2 Low DHEAs, absence of partner, anxiety, children under 18 at home 1 Avis NE. Mepause Gracia CR. Obstet Gynecol 2007
4 3 Changes in Body Composition at Mepause Changes in Body Composition at Mepause Both chrological aging and ovarian aging contribute to changes in body composition at midlife Increase in fat mass (av. 3.4 kg in 6 yrs) Increase in waist circumference (5.7 cm) Decrease in skeletal muscle mass (.2 kg) Sowers M. J Clin Endocril Metab Metabolic syndrome and mepause transition testosterone, SHBG) associated with increased likelihood for developing metabolic syndrome Relative androgen excess (t estrogen deficiency) present t clear if cause or association Changes in Bone Density during Mepause Transition Finkelstein JS. J Clin Endocril Metab 2008;93:861 Torrens J. Mepause 2009;16:257. Finkelstein JS. J Clin Endocril Metab 2008;93: year old nurse Mepause at 52 Recent BMD: femoral neck T score = Otherwise healthy Cholesterol 220, HDL 65, LDL 130 Severe hot flashes, insomnia, and vaginal dryness Treatment of mepausal symptoms: integrating evidence from WHI What are benefits and risks of estrogen in early postmepause? What preparation and dosage? How long should treatment be continued? How should treatment be stopped? What are the outcomes after treatment is stopped?
5 4 % Reduction Effectiveness of treatment options for hot flashes Estrogen SSRI Clonidine CAM WHI: Attributable Risks with E, E+P Events per 10,000 women per year CHD Stroke PE BrCa Colon Ca Hip Fx E+P E Markers for increased CHD risk with hormone therapy: WHI results How do WHI results apply to early postmepause? The Timing Hypothesis Baseline LDL cholesterol interacts with hormone therapy to increase CHD risk 1 Women with LDL/HDL ratio <2.5 had increase in CHD risk with estrogen (with or without progestin) 2 1 Rossouw JE. Arch Intern Med 2008;168: Bray PF. Am J Cardiol 2008;101:1599 Effects of estrogen on coronary arteries appear to vary with: - reproductive life stage - time since mepause - stage of progression of subclinical atherosclerosis? Mikkola T et al. J Women s Health 2006;15:51 Proximity to mepause determines CHD risk: WHI results Years since mepause Relative risk < 10 years 0.76 (.5-1.2) increased risk > 20 years 1.28 ( ) increased risk Roussow JE. JAMA 2007 Estrogen Therapy and Coronary-Artery Calcification: WHI Results In women aged 50-59, calcified plaque burden in coronary arteries lower in women on estrogen (vs. placebo) Provides support for hypothesis that estrogen may have cardioprotective effects in younger women Manson JE. New Engl J Med 2007;356:25
6 5 Stroke in Early Postmepause: WHI Results Age 50-59: increase in stroke risk (E or E+P) < 10 years after mepause RR 1.77 ( ) If women >60 years or with prior CHD excluded, increase in stroke risk (E or E+P) Roussow JE. JAMA 2007 Diabetes and Hormone Therapy: WHI Results Reduced incidence of diabetes in women treated with HT (15 fewer cases per 10,000)? mediated by decrease in insulin resistance unrelated to body size Consistent in both E and E+P arms Margolis KL. Diabetalogia 2004;47:1175 SUMMARY: Hormone Therapy and Cardiovascular Disease Initiation of HT by women ages or within 10 years of mepause to treat symptoms does t seem to increase CHD risk Initiation in early postmepause may decrease CHD risk Estrogen plus progestin and breast cancer risk over time Hazard ratio 1 = No increase in risk Hazard Ratio Estrogen and Progestogen Use in Postmepausal Women. North American Mepause Society July 2008 Intervention Phase (yr) Chlebowski RT. N Engl J Med 2009;360: Treatment of mepausal symptoms: integrating evidence from WHI What are benefits and risks of estrogen in early postmepause? What preparation and dosage? How long should treatment be continued? How should treatment be stopped? What are the outcomes after treatment is stopped? Transdermal Estrogen Available in patch, gel, emulsion, spray Less adverse effects on: Triglycerides Cardiac biomarkers (e.g. CRP) Clotting Liver function Sex hormone binding globulin
7 6 Transdermal vs. Oral Estrogen: Effect on cardiovascular risk Transdermal estradiol: minimal effects on c-reactive protein and other inflammatory markers 1 In women with metabolic syndrome, coagulation and inflammatory markers unchanged with transdermal estradiol 2 Minimal effect on risk of veus thromboembolism 3 1 Shifren JL. J Clin Endocril Metabol 2008;93: Chu MC Am J Obstet Gynecol 2008;199: Canico M. BMJ 2008;336:1227 Bioidentical Hormones : FDA Advisory Risks of compounded bioidenticals unkwn No evidence of greater safety, efficacy Estriol is t FDA approved FDA Press Release, January 9, 2008 Treatment of Vulvovaginal Symptoms: Topical Therapy Conjugated estrogen or estradiol vaginal cream 1 gm pv 2x/w Estring delivers estradiol 7.5 ug/day undetectable effect on serum estradiol levels after 2 days Estradiol vaginal tablets (Vagifem) estradiol 25 ug 2x/w Some systemic absorption occurs 1 1 Labrie F. Mepause 2009;16:30. Systemic estrogen for treatment of vulvovaginal atrophy RCT of microdose estradiol 14 mcg/day patch (Mestar) vs 25 mcg estradiol /levorgestrel 60% response rate with both micro and low dose estradiol (vs 30% placebo) Mean E 2 level 8 pcg/ml with micro-dose patch Bachmann G. Mepause 2009;16:877. Effects of estrogen on specific GU symptoms Effective for dryness, dyspareunia Incontinence: WHI In women without incontinence, increased risk of developing it on E, E+P In women with incontinence, symptoms worsened on E and E+P 1 Incontinence: Nurses Health study Increased incidence incontinence with E, E+P 2 1 Hendrix SL et al. JAMA Townsend MC. Am J Obstet Gynecol 2009 SUMMARY: Hormone Therapy and Urinary Symptoms Urge incontinence: local ET may benefit some women Overactive bladder: clear evidence for role of ET Stress incontinence: systemic HT may worsen; effect of local ET controversial Recurrent UTI: local ET reduces risk Estrogen and Progestogen Use in Postmepausal Women. North American Mepause Society July 2008
8 7 Progestogens Established regimens cyclic or continuous Medroxyprogesterone (Provera) Micronized progesterone (Prometrium) more favorable effects on HDL cholesterol and clotting factors Not FDA approved Progestin IUS (Mirena) Progesterone 4% or 8% vaginal gel Progestogens Long-cycle progestogens Micronized progesterone (Prometrium) 100 mg qd or medroxyprogesterone acetates (Provera) 5-10 mg qd for 14 days every 3 months Limited data on endometrial protection When is a progestogen required? Use with systemic doses of estradiol 25 mcg/day or higher Need for cyclic P with long-term vaginal estrogens and systemic doses < 25 mcg/day E 2 uncertain Current consensus is progestin cycling with vaginal estrogens 2x/week or Estring Treatment of Mepausal Symptoms with HT Use lowest starting dose, for example: transdermal estradiol 25 mcg/d oral esterified estrogens.3 mg Increase dose if symptoms t controlled within 4 weeks For vulvovaginal symptoms only, topical or low-dose transdermal estrogen Treatment of mepausal symptoms: integrating evidence from WHI What are benefits and risks of estrogen in early postmepause? What preparation and dosage? How long should treatment be continued? How should treatment be stopped? What are the outcomes after treatment is stopped? Stopping HRT Options for tapering Slowly decrease daily dose Slowly decrease days/week of HT Back up to previous dose if hot flashes recur; then taper more slowly Continue progestins at least every 3 months Evidence to date suggests tapering t clearly better than stopping abruptly Grady D. New Engl J Med 2006;355:22.
9 8 Risks and Benefits After Stopping Estrogen and Progestin 3 year follow up of WHI E+P trial Results: CV disease risks disappeared Hip fracture benefits dissipated Breast cancer risk did t seem to persist Heiss G. JAMA 2008;299: yr old secretary Mepause age 54, symptoms Hispanic Mother has osteoporosis ( fracture) Active lifestyle Good calcium and vitamin D intake BMD: femoral neck T score = Bone Density Testing at Mepause Consider BMD if major risk factor for osteoporosis or fracture: Personal history of fracture History of fragility fracture in 1 st degree relative Low body weight (weight <127 lbs) Current smoking Use of oral steroids for >3 months Khosla S. New Engl J Med 2007 Osteopenia: When to Treat? Osteopenia defined by BMD T score between 1.0 and 2.5 Fracture risk depends on other factors in addition to T score Falls are a stronger predictor of fracture than bone density Use clinical judgment, considering Estimated risk of fracture Cost-effectiveness and risks of treatment Patient preferences Osteopenia: When to Treat Treat according to absolute fracture risk, t simply T- score, considering: Previous fracture history Age Fall risk FRAX can be used to estimate future fracture risk FRAX
10 9 Using FRAX to Estimate Fracture Risk Age 55 Sex F Weight 59 kg Height 162 cm Previous fracture Parent fractured hip Current smoking Glucocorticoids Rheumatoid arthritis Secondary osteoporosis Alcohol > 3 units/day Femoral neck BMD.64 gm/cm 2 T score BMI year probability of fracture (%) Major osteoporotic 12 Hip fracture 1.2 Source: WHO FRAX Limitations of FRAX Applies only to patients who have t previously been treated Leaves out other important fracture risk factors (history of falls, muscle strength, balance) Does t consider spine BMD Has t been validated as a criterion for treatment Thresholds for Treatment to Prevent Osteoporosis Consider clinical significance for individual patient Consider cost-effectiveness Treatment is cost-effective when 10 year risk of hip fracture is 3% 1 Consider patient preference Tosteson ANA. Osteoporos Intl 2008;19:437 Osteopenia: When to treat? Unless prior fracture or major risk factor present, most osteopenic mepausal women will t benefit significantly ifi from treatment Need better tools for identifying osteopenic women at higher risk of fracture who would benefit from treatment SUMMARY: Hormone Therapy and Osteoporosis BMD is one of many factors that affects fracture risk Estrogen therapy has FDA approval for osteoporosis prevention Extended use is an option for women with low BMD when alternative rx t appropriate or tolerated Estrogen and Progestogen Use in Postmepausal Women. North American Mepause Society July 2008
11 10 58 year old professor Mepause age 53 Topical estrogen effective for vaginal dryness Bothered by decreased libido Healthy marriage No other medical issues Prevalence of low sexual desire at mepause SWAN study 42% of midlife women report infrequent or sexual desire 90% report being content t with sexual experiences Community-based sample (2207 women): reports of low sexual desire 27% of premepausal women 52% of naturally mepausal women 1 Basson R. NEJM West SL Arch Intern Med 2008;168:1441. Androgen Deficiency: What is the Evidence? Evidence lacking to support androgen deficiency syndrome in postmepausal women 1 No well-defined clinical syndrome Inadequate rmative data on testosterone or free testosterone levels in women across lifespan to define a disorder Wierman ME et al. J Clin Endocril Metab 2006;91: 3697 Androgen Therapy in surgically mepausal women Several RCTs show improved sexual desire and response with 300 ug testosterone patch biw No adverse lipid id or other androgenic effects Testosterone transdermal t FDA approved for women; Estratest (.2.5 mg) and Estratest HS (1.25 mg methyltestosterone) available Androgen therapy in naturally mepausal women: randomized trials INTIMATE NM1 study 1 RCT of 483 women for 24 weeks Testosterone 300 ug patch biw Results: Increased sexual desire and satisfaction No sig. increase in androgenic side effects (18% vs 12% placebo) 1 Shifren JL. Mepause 2006;13:770. Androgen therapy in naturally mepausal women: randomized trials RCT of 814 women for 52 weeks Testosterone 150, 300 mcg/d patch vs placebo Results: - Both doses associated with modest improvement in sexual function ug dose: number of satisfying sexual episodes increased by 2 per month Davis SR. New Engl J Med 2008;359:2005.
12 11 Androgen therapy in naturally mepausal women: randomized trials Free testosterone levels with 300 ug dose equivalent to those of women years of age Androgenic side effects (mostly hair growth) in 30% (vs 23% placebo) 4 women diagsed with breast cancer Davis SR. New Engl J Med 2008;359: year old accountant Missed two periods in past 6 months c/o hot flashes, insomnia, mood fluctuations Does t want to use estrogen Alternatives to hormone therapy for vasomotor symptoms Relaxation techniques Multiple studies of soy, black cohosh, other botanicals fail to show effectiveness 1 HALT study: RCT of black cohosh, soy, multibotanical, vs placebo for 12 months. No benefit from any compared with placebo 2 1 Nedrow A. Arch Int Med 2006;166: Newton KM. Ann Int Med 2006 Nonhormonal Therapy for Vasomotor Symptoms SSRIs and SNRIs Fluoxetine 20 mg qd Venlafaxine SR mg qd Desvenlafaxine 100 mg qd 1 Paroxetine CR mg qd 1 Speroff L. Obstet Gynecol 2008;111:67 2 Archer DL. Am J Obstet Gynecol 2009;200:238 Nonhormonal Therapy for Vasomotor Symptoms Gabapentin 1,2 300 mg tid 800 mg tid Clonidine mg bid po or 0.1 mg qd patch 1 Reddy SY. Obstet Gynecol 2006;108:41 2 Butt DA. Mepause 2008;15:310. Current Studies in Early Mepausal Women KEEPS (Kros Early Estrogen Prevention Study) Premarin.45 mg or Estradiol 50 ug patch (with cyclic micronized progesterone) Outcomes: carotid intimal thickness and coronary artery calcium ELITE (Early vs Late Intervention Trial with Estrogen) Oral estradiol; carotid IMT in perimepause vs 6 years post-mepause
Learning Objectives. Peri menopause. Menopause Overview. Recommendation grading categories
Learning Objectives Identify common symptoms of the menopause transition Understand the risks and benefits of hormone replacement therapy (HRT) Be able to choose an appropriate hormone replacement regimen
More informationOB/GYN Update: Menopausal Management What Does The Evidence Show? Rebecca Levy-Gantt D.O. PremierObGyn Napa Inc.
OB/GYN Update: Menopausal Management What Does The Evidence Show? Rebecca Levy-Gantt D.O. PremierObGyn Napa Inc. Napa, California IMPORTANT SAFETY INFORMATION ABOUT EVAMIST: WARNING: ENDOMETRIAL CANCER,
More informationWomen s Health: Managing Menopause. Jane S. Sillman, MD Assistant Professor of Medicine Harvard Medical School
Women s Health: Managing Menopause Jane S. Sillman, MD Assistant Professor of Medicine Harvard Medical School Disclosures I have no conflicts of interest. Learning Objectives 1. Apply strategies to help
More informationCase Presentation. Learning Objectives. Case Presentation. Case Presentation
Learning Objectives To apply up to date information about the natural history of menopause to improve the care of individual women To counsel women about the risks and benefits of systemic hormone therapy
More informationKathryn M. Rexrode, MD, MPH. Assistant Professor. Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School
Update: Hormones and Cardiovascular Disease in Women Kathryn M. Rexrode, MD, MPH Assistant Professor Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School Overview Review
More informationLessons from the WHI HT Trials: Evolving Data that Changed Clinical Practice
Lessons from the WHI HT Trials: Evolving Data that Changed Clinical Practice JoAnn E. Manson, MD, DrPH, FACP Chief, Division of Preventive Medicine Interim Executive Director, Connors Center Brigham and
More informationWHI Estrogen--Progestin vs. Placebo (Women with intact uterus)
HORMONE REPLACEMENT THERAPY In the historical period it was commonly held that estrogen had two principal benefits to postmenopausal women: 1) To alleviate the constitutional symptoms related to the climacteric
More informationHRT & Menopause Where Do We Stand Now?
HRT & Menopause Where Do We Stand Now? Mrs. SY Hussain Consultant Gynaecologist The Holly Private Hospital Spire Roding Hospital The Wellington Hospital Discussion Points Discuss Recommendations made by
More informationWhat's New in Menopause Management
Annual Review of Family Medicine December 10, 2015 San Francisco, CA What's New in Menopause Management Michael Policar, MD, MPH Clinical Professor of Ob, Gyn, and Repro Sciences UCSF School of Medicine
More information22/09/2014. Menopause Management. Menopause. Menopause symptoms
Menopause Management Dr Sonia Davison Jean Hailes for Women s Health Menopause Time of last menstrual period - average age 51 Premature Menopause: occurs before age 40 Perimenopause (menopause transition):
More informationMenopausal Management: What Has Changed?
Menopausal Management: What Has Changed? Julia V. Johnson, M.D. Professor and Chair, OB/GYN University of Massachusetts Medical School UMass Memorial Medical Center Conflicts of Interest None Learning
More informationAppendix: Reference Table of HT Brand Names
Appendix: Reference Table of HT Brand Names This is a full reference table in alphabetical order, of Brand Name drugs used in HT. It is the basis for prescription advice throughout this handbook. Drug
More informationMENOPAUSE. I have no disclosures 10/11/18 OBJECTIVES WHAT S NEW? WHAT S SAFE?
MENOPAUSE WHAT S NEW? WHAT S SAFE? I have no disclosures Sara Whetstone, MD, MHS OBJECTIVES To describe risks of HT by age and menopause onset To recommend specific HT regimen for women who undergo early
More informationManaging menopause in Primary Care and recent advances in HRT
Managing menopause in Primary Care and recent advances in HRT Raj Saha, MD, DMRT, FRCOG Consultant Gynaecologist Heart of England NHS Foundation Trust rajsaha1@yahoo.co.uk Content of today s talk Aims
More informationMenopause management NICE Implementation
Menopause management NICE Implementation Dr Paula Briggs Consultant in Sexual & Reproductive Health Southport and Ormskirk NHS Hospital Trust Why a NICE guideline (NG 23) Media reports about HRT have not
More informationHORMONE THERAPY A BALANCED VIEW?? Prof Greta Dreyer
HORMONE THERAPY A BALANCED VIEW?? Prof Greta Dreyer -- PART 1 -- Definitions HRT hormone replacement therapy HT genome therapy ERT estrogen replacement therapy ET estrogen EPT estrogen progesterone therapy
More informationHORMONE REPLACEMENT THERAPY-UPDATE KHALED SAKHEL, MD FACOG FACS FAIUM ASSOCIATE PROFESSOR EASTERN VIRGINIA MEDICAL SCHOOL
HORMONE REPLACEMENT THERAPY-UPDATE KHALED SAKHEL, MD FACOG FACS FAIUM ASSOCIATE PROFESSOR EASTERN VIRGINIA MEDICAL SCHOOL INTRODUCTION NORMAL WOMEN HAVE MENOPAUSE AT A MEAN AGE OF 51 YEARS, WITH 95 PERCENT
More information2017 Position Statement of Hormone Therapy of NAMS: overview SHELAGH LARSON, MS, RNC WHNP, NCMP ACCLAIM, JPS HEALTH NETWORK
2017 Position Statement of Hormone Therapy of NAMS: overview SHELAGH LARSON, MS, RNC WHNP, NCMP ACCLAIM, JPS HEALTH NETWORK WHI the only large, long-term RCT of HT in women aged 50 to 79 years, Drug trail
More informationManaging menopause in Primary Care and recent advances in HRT
Managing menopause in Primary Care and recent advances in HRT Raj Saha, MD, DMRT, FRCOG PG Cert. Advanced Gynaecology Endoscopy Consultant Gynaecologist Heart of England NHS Foundation Trust Spire Parkway
More informationMenopausal Symptoms. Hormone Therapy Products Available in Canada for the Treatment of. Physician Desk Reference - 3rd Edition
Hormone Therapy Products Available in Canada for the Treatment of Menopausal Symptoms Physician Desk Reference - 3rd Edition A clinical resource provided to you by: The Society of Obstetricians and Gynaecologists
More informationManagement of Menopausal Symptoms
Management of Menopausal Symptoms Tammie Koehler DO, FACOG 1 Menopause Permanent cessation of menstruation that occurs after the loss of ovarian activity Determined to have occurred after 1 full year of
More informationOVERVIEW OF MENOPAUSE
OVERVIEW OF MENOPAUSE Nicole Budrys, MD, MPH Reproductive Endocrinology Michigan Center for Fertility and Women s Health Presented at SEMCME March 13,2019 Objectives Define menopause Etiology of menopause
More informationMENOPAUSE. Women in Midlife: Menopause & Osteoporosis. Outline for Menopause. STRAW Stages of the Menopausal Transition-NAMS, /29/2012
Women in Midlife: Menopause & Osteoporosis Lisa Ward, MD, MScPH, MS UCSF CME Conference March 23rd, 2012 MENOPAUSE Outline for Menopause Definitions Summary of the Evidence Current Guidelines Management
More information06-Mar-17. Premature menopause. Menopause. Premature menopause. Menstrual cycle oestradiol. Premature menopause. Prevalence ~1% Higher incidence:
Menopause Dr Sonia Davison MBBS FRACP PhD Endocrinologist and Clinical Fellow, Jean Hailes for Women s Health Women s Health Research Program, Monash University = the last natural menstrual period depletion
More informationPrior disclosures past 3 years Consultant for Pfizer University of Virginia received Grants/research support from TherapeuticsMD
Prior disclosures past 3 years Consultant for Pfizer University of Virginia received Grants/research support from TherapeuticsMD JoAnn V. Pinkerton, MD Professor of Obstetrics and Gynecology Director,
More informationBenton Franklin County Medical Society 31st Annual CME Seminar
Management of Current HT/ET and SERM Recommendations Benton Franklin County Medical Society 31st Annual CME Seminar February 21, 2015 Kennewick, Washington Spokane steoporosis Dr. Lynn Kohlmeier Lynn Kohlmeier,
More informationPost-menopausal hormone replacement therapy. Evan Klass, MD May 17, 2018
Post-menopausal hormone replacement therapy Evan Klass, MD May 17, 2018 Are we really still talking about this? Are we really still talking about this? 1960-1975- estrogen prescriptions doubled. Pharma
More informationDINE AND LEARN ENDOCRINOLOGY PEARLS. Dr. Priya Manjoo, MD, FRCPC Endocrinology, Victoria, BC
DINE AND LEARN ENDOCRINOLOGY PEARLS Dr. Priya Manjoo, MD, FRCPC Endocrinology, Victoria, BC OUTLINE HRT and CVD HRT and Breast Cancer Osteoporosis When to treat How long to treat for Bisphosphonates BMD
More informationMENOPAUSAL HORMONE THERAPY 2016
MENOPAUSAL HORMONE THERAPY 2016 Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA NICE provides the National Health Service advice on effective, good value healthcare.
More informationUPDATE: Women s Health Issues
UPDATE: Women s Health Issues Renee B. Alexis, MD, MBA, MPH, FACOG Associate Professor Department of OBGYN Kiran C. Patel College of Osteopathic Medicine Disclosure of Conflicts of Interest I have no financial
More informationNavigating the Change: Leading Patients Through Menopause
4:30pm - 5:30pm: Breakout 5 - Women s Health Option A: Navigating the Change: Leading Patients Through Menopause ACPE UAN 0107-0000-10-025-L01-P 0.1 CEU/1.0 Hr. Activity Type: Application-Based Program
More informationAusPharm CE Hormone therapy 23/09/10. Hormone therapy
Hormone therapy Learning objectives: Assess options to address quality of life and health concerns of menopausal women Outline indications for hormone therapy Counsel women on the risks and benefits of
More informationMenopause Matters. Equity Office Staff Seminar 14 November 2018
Menopause Matters Equity Office Staff Seminar 14 November 2018 1 What to expect at menopause How to manage symptoms Support at work Dr Janice Brown Medical lead, The University of Auckland NZ representative,
More informationMenopausal Symptoms The Who: Hot flashes are reported by as many as 75% of perimenopausal women in the U.S.
Menopausal Hormone Therapy: The Who, What, Where, When and Why Laurie Birkholz, MD, NCMP Knowledge of Clinical Trials Regarding Hormone Therapy and Likelihood of Prescribing Hormone Objective: The aim
More informationBy J. Jayasutha Lecturer Department of Pharmacy Practice SRM College of Pharmacy SRM University
By J. Jayasutha Lecturer Department of Pharmacy Practice SRM College of Pharmacy SRM University Cessation of menstruation as a result of the aging process of or surgical removal of the ovaries; change
More informationMenopause and HRT. John Smiddy and Alistair Ledsam
Menopause and HRT John Smiddy and Alistair Ledsam Menopause The cessation of menstruation Diagnosed retrospectively after 1 year of amenorrhoea Average age 51 in the UK Normal physiology - Menstruation
More informationMs. Y. Outline. Updates of SERMs and Estrogen
Ms. Y Updates of SERMs and Estrogen Steven R. Cummings, MD, FACP San Francisco Coordinating Center CPMC Research Institute and UCSF Support from Lilly, Pfizer, Berlex 55 y.o. woman with mild hypertension
More informationPearls for Menopause Management: I m ready: now what?
Pearls for Menopause Management: I m ready: now what? Friday November 13, 2015 Susan Goldstein MD CCFP FCFP NCMP Assistant Professor Department of Family and Community Medicine University of Toronto Menarche
More informationThese slides are the property of presenter. Do not duplicate without express written consent.
Menopause & Cancer: Anticipatory Guidance Diana L. Bitner MD 2012 MICHIGAN BCCCP / WISEWOMAN / MCRCEDP ANNUAL MEETING 2 Why Are We Here? Knowledge is power! VS. 3 What is New about Aging? How we age is
More informationMenopause - a summary of management
Page 1 of 5 Menopause - a summary of management Original article by: May Su Resources Menopause treatment algorithm The Jean Hales Foundation for women's heath. Menopause, a treatment algorithm. (Australian
More informationManagement of Perimenopausal symptoms
Management of Perimenopausal symptoms Serge Rozenberg CHU St Pierre Université libre de Bruxelles Belgium serge_rozenberg@stpierre-bru.be serge.rozenberg@skynet.be Conflict of interest & Disclosure Conflicts
More informationPotential dangers of hormone replacement therapy in women at high risk
ESC meeting, Stockholm, August 30, 16.30-18.00, 2010 Potential dangers of hormone replacement therapy in women at high risk Karin Schenck-Gustafsson MD, PhD, FESC Professor, Chief consultant Department
More informationAn Evidence-based Review of Clinical Trial Data
An Evidence-based Review of Clinical Trial Data Karen K. Miller, MD Massachusetts General Hospital Harvard Medical School Boston, MA 1 Rationale for Investigating Androgen Administration in Women: Data
More informationHRT in Perimenopausal Women. Dr. Rubina Yasmin Asst. Prof. Medicine Dhaka Dental College
HRT in Perimenopausal Women Dr. Rubina Yasmin Asst. Prof. Medicine Dhaka Dental College 1 This is the Change But the CHANGE is not a disease 2 Introduction With a marked increase in longevity, women now
More informationEstrogen and progestogen therapy in postmenopausal women
Estrogen and progestogen therapy in postmenopausal women The Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Hormone
More informationBefore you prescribe
Initiating hormone replacement therapy (HRT) / menopausal hormone therapy (MHT) Dr Sonia Davison Jean Hailes Consultant Endocrinologist Before you prescribe Ensure there are no contraindications to HRT/MHT
More informationManagement of Menopausal Symptoms in Patients with Breast Cancer. Mike Dixon Edinburgh Breast Unit
Management of Menopausal Symptoms in Patients with Breast Cancer Mike Dixon Edinburgh Breast Unit Menopausal symptoms have a major impact on Quality of Life Variety of Symptoms associated with the Menopause
More informationA Practitioner s Toolkit for the Management of the Menopause
Medicine, Nursing and Health Sciences A Practitioner s Toolkit for the Management of the Menopause Developed by the Women s Health Research Program School of Public Health and Preventive Medicine Monash
More informationSERMS, Hormone Therapy and Calcitonin
SERMS, Hormone Therapy and Calcitonin Tiffany Kim, MD Clinical Fellow VA Advanced Women s Health UCSF Endocrinology and Metabolism I have nothing to disclose Thanks to Clifford Rosen and Steven Cummings
More informationThe Estrogen Question
The Estrogen Question Hormone Therapy still offers the best relief for menopausal symptoms. Is it right for you? When 49-year-old Lee Ann Dodson heard the news that the Women's Health Initiative (WHI)
More informationSex, hormones and the heart
Sex, hormones and the heart Dr Louise Newson BSc(Hons) MBChB(Hons) MRCP FRCGP www.menopausedoctor.co.uk #IandA2017 Declaration I have had financial relationships (lecturer, writer, member of advisory boards
More informationVirtual Mentor Ethics Journal of the American Medical Association November 2005, Volume 7, Number 11
Virtual Mentor Ethics Journal of the American Medical Association November 2005, Volume 7, Number 11 Clinical Pearl Post Women's Health Initiative Menopausal Women and Hormone Therapy by JoAnn V. Pinkerton,
More informationHormones friend or foe? Undertreatment and quality of life. No conflicts of interest to declare
Hormones friend or foe? Undertreatment and quality of life Anette Tønnes Pedersen MD, Ph.D. Consultant, Associate professor Dept. Of Gynecology / Fertility Clinic Rigshospitalet No conflicts of interest
More informationVenous thromboembolism 5 years of use *p-value <.05. Net bad events +2.0* +0.6
Management of Menopause: Should New Data Change Our Practice? Mary S. Beattie, MD, MAS Associate Professor of Medicine UCSF Women s Health, Primary Care Director of Clinical Research, UCSF Cancer Risk
More informationHORMONES AND YOUR HEALTH Charlie Tucker Pharm. D
HORMONES AND YOUR HEALTH Charlie Tucker Pharm. D All of the hormones in your body are designed to work together. This is God s plan. Therefore, if one is altered, or deficient, it will affect the actions
More informationHT: Where do we stand after WHI?
HT: Where do we stand after WHI? Hormone therapy and cardiovascular disease risk Experimental and clinical evidence indicate that hormone therapy (HT) reduces the risk of cardiovascular disease (CVD) Women
More informationDisclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None
Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease Micol S. Rothman, MD Associate Professor of Medicine Endocrinology, Diabetes and Metabolism Clinical Director Metabolic Bone
More informationpresents with Ken Sekine, MD
presents Pioneering Technologies For Pellet Hormone Therapy Lifestyle Based Medicine A Primer for Clinicians with Ken Sekine, MD Dr. Sekine is a board certified OB-GYN who has been in private practice
More informationMenopause: diagnosis and management NICE guideline NG23. Published November 2015
Menopause: diagnosis and management NICE guideline NG23 Published November 2015 1 Full title: Menopause : diagnosis and management Available at: http://www.nice.org.uk/guidance/ng23 Guideline published
More informationMenopause. Medicines To Help You
Medicines To Help You Menopause Use this guide to help you talk to your doctor, pharmacist, or nurse about your hormone medicines. The guide lists all of the FDA-approved products now available to treat
More informationOVERVIEW WOMEN S HEALTH: YEAR IN REVIEW
OVERVIEW WOMEN S HEALTH: YEAR IN REVIEW Judith Walsh, MD, MPH Professor of Medicine UCSF Update in Women s Health for SGIM Drs. Mary Beattie and Pam Charney Review of literature from March, 2008 through
More informationNorth American Menopause Society (NAMS)
North American Menopause Society (NAMS) 2012 Hormone Therapy Position Statement Cynthia B. Evans, MD Assistant Professor-Clinical Department of Obstetrics and Gynecology The Ohio State University College
More informationApplying Best Evidence to Menopause Management MENOPAUSE IS NOT A DISEASE. Overview. Feminine Forever. Page 1
Applying Best Evidence to Menopause Management Judith Walsh, MD, MPH Division of General Internal Medicine Women s Health Center of Excellence UCSF Overview Natural history of menopause Hormone therapy:
More informationInternational Journal of Research and Review E-ISSN: ; P-ISSN:
International Journal of Research and Review www.gkpublication.in E-ISSN: 2349-9788; P-ISSN: 2454-2237 Original Research Article Risk Assessment of Osteoporosis in Postmenopausal Women Dr Savita Tamaria
More informationFinancial Conflicts of Interest
Hormone Treatment of Menopausal Women: What Are the Data Telling Us (and Not Telling Us)? S. Mitchell Harman, M.D., Ph.D. Chief, Endocrine Division Phoenix VA Health Care System Clinical Professor, Medicine
More information11/15/2017. Update on HRT. Highgate Private Hospital (Barnet Hospital) Women s Health. Menopause
Update on HRT Miss Moneli Golara Consultant Obstetrician and Gynaecologist MBBS, FRCOG Highgate Private Hospital (Barnet Hospital) E: lauren@medicaladministration.co.uk Women s Health Life expectancy of
More informationMenopause Symptoms and Management: After Breast Cancer
Menopause Symptoms and Management: After Breast Cancer An Educational Webinar for Patients and their Caregivers Wen Shen, MD, MPH Division of Gynecologic Specialties July 27, 2018 1 Disclosure I have a
More informationVol-5 No-1 Jan-Mar 2012
"Women's Health" is also available at www.squarepharma.com.bd Editorial Board Dr. Omar Akramur Rab MBBS, FCGP, FIAGP Mohammad Hanif M. Pharm, MBA A.H.M. Rashidul Bari M. Pharm, MBA Executive Editor Chowdhury
More informationCurrent Topics in Hormone Replacement Therapy
Current Topics in Hormone Replacement Therapy Corey R. Babb, D.O., FACOOG, IF, NCMP Clinical Assistant Professor of Obstetrics and Gynecology Director of the Oklahoma State University Center for Women
More informationMenopause and Post Gynecological Reproductive Care
Menopause and Post Gynecological Reproductive Care Nguyet-Cam Vu Lam, MD, FAAFP Associate Program Director St. Luke s Family Medicine Residency 1 Disclosure Dr. Nguyet-Cam Vu Lam has no conflict of interest,
More informationMenopause & HRT. Matt McKenna Elliot Davis
Menopause & HRT Matt McKenna Elliot Davis Menopause Before age 40: Premature Menopause After 12 months clinical diagnosis made Depletion of Ovarian Follicles Oestrogen Progesterone LH FSH Spontaneous Amemorrhoea
More informationGuidelines for Menopause Management
Guidelines for Menopause Management Judith M.E. Walsh, MD, MPH Professor of Medicine UCSF Women s Health Center of Excellence Conflicts of Interest: None Overview Natural history of menopause Hormone therapy:
More informationFinancial Disclosures
Common Cases and Conundrums in Menopause care Dr. Kerstin Gustafson, MD, FRCSC Financial Disclosures Dr. Kerstin Gustafson, MD, FRCSC, NCMP Speaker fees: Amgen Bayer Merck Novartis Novo-Nordisk Warner-Chilcott
More informationDisclosures. Objec7ves 9/9/15. What Exactly are bio- iden7cal hormones and what should I tell my pa7ents? Christy Blanco, DNP, RN, WHNP- BC.
What Exactly are bio- iden7cal hormones and what should I tell my pa7ents? Christy Blanco, DNP, RN, WHNP- BC Disclosures None Objec7ves Discuss terminology of bio- iden7cal, synthe7c and natural hormones.
More informationMenopause & HRT. Rosie & Alex. Image:
Menopause & HRT Rosie & Alex Image: http://www.keepcalm-o-matic.co.uk/ Menopause The permanent cessation of menstruation for 12 months When does it happen? Average age 51 Image: Nature Medicine - 12, 612-613
More informationHormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals
Hormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals Literature Review (January 2009) Hormone Therapy for Women Women's Health
More informationPrimary Care of the Breast Cancer Survivor. Case Presentation. Case Presentation (cont) Case Presentation (cont) Breast Cancer
Primary Care of the Breast Cancer Survivor Janet P. Pregler, MD Professor of Clinical Medicine Director, Iris Cantor UCLA Women s Health Center Case Presentation B.C. is a 58 year-old African American
More informationOutline. Estrogens and SERMS The forgotten few! How Does Estrogen Work in Bone? Its Complex!!! 6/14/2013
Outline Estrogens and SERMS The forgotten few! Clifford J Rosen MD rosenc@mmc.org Physiology of Estrogen and estrogen receptors Actions of estrogen on bone BMD, fracture, other off target effects Cohort
More information1
www.osteoporosis.ca 1 2 Overview of the Presentation Osteoporosis: An Overview Bone Basics Diagnosis of Osteoporosis Drug Therapies Risk Reduction Living with Osteoporosis 3 What is Osteoporosis? Osteoporosis:
More informationNon hormonal medical treatment of vasomotor symptoms
Non hormonal medical treatment of vasomotor symptoms Caroline Antoine Menopause Clinic Department of Gynaecology and Obstetrics CHU Saint-Pierre Belgian Menopause Society Symposium November 14, 2015 No
More informationMenopause. Pamela S Miles MD Dept. of OB/GYN
Menopause Pamela S Miles MD Dept. of OB/GYN Defining Menopause Defined as the point in time after 12 consecutive months of amenorrhea with no obvious pathologic cause (avg. 52) Peri-menopause/menopause
More informationEndocrine Update Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh
Endocrine Update 2016 Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh Disclosure of Financial Relationships Mary Korytkowski MD Honoraria British Medical Journal Diabetes Research
More informationWhat s New in Menopause Management. Objectives
What s New in Menopause Management Leslee L. Subak, MD Professor of Obstetrics, Gynecology & Reproductive Science University of California, San Francisco Objectives Define the menopause transition Review
More informationReal life issues & answers: The hormonal patient Defining best practice, 5 key issues & case study
Real life issues & answers: The hormonal patient Defining best practice, 5 key issues & case study Dr Louise Newson BSc(Hons) MBChB(Hons) MRCP FRCGP www.menopausedoctor.co.uk Case Number 1 - Claire Age
More informationOrals,Transdermals, and Other Estrogens in the Perimenopause
Orals,Transdermals, and Other Estrogens in the Perimenopause Cases Denise Black, MD, FRCSC Assistant Professor, Obstetrics, Gynecology and Reproductive Sciences University of Manitoba 6/4/18 197 Faculty/Presenter
More informationGary Elkins, PhD., ABPP
Gary Elkins, PhD., ABPP *What are Hot Flashes? *Hormone Replacement Therapy *Alternate Treatment Options *Clinical Hypnosis? *Methods *Preliminary Results *Conclusions & Future Directions *Over 66% of
More informationApples & Oranges Synthetic vs. Bio-Identical Studied Under the Nation s Greats in Hormone Therapy! Salt Lake City Dr. Neal Rouzier Orlando Dr. Sangeeta Pati Naples Dr. Daved Rosensweet And finally Dallas
More informationUsing the FRAX Tool. Osteoporosis Definition
How long will your bones remain standing? Using the FRAX Tool Gary Salzman M.D. Director Banner Good Samaritan/ Hayden VAMC Internal Medicine Geriatric Fellowship Program Phoenix, Arizona Using the FRAX
More informationApplying Best Evidence to Menopause Management
Applying Best Evidence to Menopause Management Judith Walsh, MD, MPH Division of General Internal Medicine Women s Health Center of Excellence UCSF Overview Natural history of menopause Hormone therapy:
More informationPERIMENOPAUSE. Objectives. Disclosure. The Perimenopause Perimenopause Menopause. Definitions of Menopausal Transition: STRAW.
PERIMENOPAUSE Patricia J. Sulak, MD Founder, Living WELL Aware LLC Author, Should I Fire My Doctor? Author, Living WELL Aware: Eleven Essential Elements to Health and Happiness Endowed Professor Texas
More informationApplying Best Evidence to Menopause Management MENOPAUSE IS NOT A DISEASE. Overview. Feminine Forever. Page 1
Applying Best Evidence to Menopause Management Judith Walsh, MD, MPH Division of General Internal Medicine Women s Health Center of Excellence UCSF Overview Natural history of menopause Hormone therapy:
More informationEmerging Challenges in Primary Care: Managing Menopause: Update on The Role and Rationale of Hormonal Therapy. Faculty.
Emerging Challenges in Primary Care: 2018 Managing Menopause: Update on The Role and Rationale of Hormonal Therapy Faculty Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner Certified Menopause
More informationHRT. Responding to questions about. The Women s Health Initiative (WHI) is a large, CME Workshop. associated with combined
CME Workshop Responding to questions about HRT By Margaret Burnett, MD, BA(Hon), MA, CCFP, FRCPC The Women s Health Initiative (WHI) is a large, prospective, placebo-controlled trial sponsored by the National
More informationMenopausal hormone therapy currently has no evidence-based role for
IN PERSPECTIVE HT and CVD Prevention: From Myth to Reality Nanette K. Wenger, M.D. What the studies show, in a nutshell The impact on coronary prevention Alternative solutions Professor of Medicine (Cardiology),
More informationHormone therapy for menopausal vasomotor symptoms
Hormone therapy for menopausal vasomotor symptoms Given our available (better) options for treating hot flashes, can we reduce our use of medroxyprogesterone acetate? OBG Manag. 2014;26(7):10,13 15. Robert
More informationJames H. Liu, M.D. Arthur H. Bill Professor Chair of Reproductive Biology Dept of Obstetrics and Gynecology
Disclosure Estrogen Therapy After Postmenopausal Hysterectomy: Issues, Challenges, Risks/Benefits James H. Liu, M.D. Arthur H. Bill Professor Chair of Reproductive Biology Dept of Obstetrics and Gynecology
More informationWOMEN S HEALTH: A REVIEW OF THIS YEAR S MOST IMPORTANT PAPERS OVERVIEW BUT NOT. TOPICS 8/14/2009. Judith Walsh, MD, MPH Professor of Medicine UCSF
WOMEN S HEALTH: A REVIEW OF THIS YEAR S MOST IMPORTANT PAPERS Judith Walsh, MD, MPH Professor of Medicine UCSF OVERVIEW Update in Women s Health for SGIM Drs. Mary Beattie and Pam Charney Review of literature
More informationGERIATRICS: definitions
Caring For The Modern Menopausal Woman in 2016: An Update on Women s Health In the Geriatric Population David J Boes, DO, FACOOG MSU-COM May 2016 What defines the geriatric population???? GERIATRICS: definitions
More informationWHI, Nurses and SWANs: Do Big Clinical Trials Inform Personalized Care? KIRTLY PARKER JONES MD
WHI, Nurses and SWANs: Do Big Clinical Trials Inform Personalized Care? KIRTLY PARKER JONES MD Conflicts? No financial conflicts of interest (Dr. Jones is a post menopausal female reproductive endocrinologist
More informationIssues in Cancer Survivorship. Larissa A. Korde, MD, MPH June 26, 2010
Issues in Cancer Survivorship Larissa A. Korde, MD, MPH June 26, 2010 Estimated US Cancer Cases in Women: 2006-2008 CA Cancer J Clin 2006; 56:106-130; CA Cancer J Clin 2008;58:71 96. Relative Survival*
More information