September 26 28, 2013 Westin Tampa Harbour Island. Co-sponsored by
|
|
- Kevin Clarke
- 5 years ago
- Views:
Transcription
1 September 26 28, 2013 Westin Tampa Harbour Island Co-sponsored by
2 Depression and Women Across the Reproductive Lifecycle David R. Rubinow, MD University of North Carolina at Chapel Hill School of Medicine Chapel Hill, NC
3 Learning Objective 1 Identify factors that increase the risk of mood disturbance in women at key time points when hormonally-related triggers are present (e.g., menses, pregnancy, postpartum, perimenopause)
4 Learning Objective 2 Design and implement treatment plans to manage the mood symptoms in women at various life stages
5 Audience Response Has the Women s Health Initiative impacted the way you treat your perimenopausal and menopausal patients A. Yes, I discourage patients from taking estrogen B. It has made no difference C. Data is mixed, so I am cautious D. I ignore it and recommend estrogen when appropriate
6 Gonadal Steroids, Like All Steroid Hormones, are Derivatives of Cholesterol Hu J, et al. Nutr Metab (Lond). 2010;7:47. PMID:
7 Principles Reproductive hormones wire and rewire the brain Reproductive hormones regulate brain circuitry Changes in reproductive hormones alter brain states of clinical relevance Reproductive endocrine-related mood disorders account for a substantial amount of morbidity and mortality These disorders are NOT hormone deficiencies Reproductive steroids are both context-dependent and context-determining Rubinow DR et al. Hormones, Brain and Behavior, v4, , Rubinow, D.R., and Schmidt, P.J.: Gonadal steroids, brain, and behavior: role of context. Dial. Clin. Neurosci., 4: , Schmidt PJ, et al. N Engl J Med. 1998;338(4): PMID:
8 Reproductive Hormones Wire and Rewire the Brain
9 Reproductive Hormones Regulate Brain Circuitry
10 Steroids Regulate PFC Functional Correlations With Left Hippocampal Formation Activity Leuprolide Alone Progesterone Add-Back Estrogen Add-Back PFC = prefrontal cortex K Berman et al. Unpublished data. Rolls ET. Front Hum Neurosci. 2013;7:74. PMID: Ochsner KN, et al. Neuroimage. 2004;23(2): PMID:
11 OFC Activity in Response to Emotional Stimuli in the Context of Behavioural Inhibition Across the Menstrual Cycle OFC = orbitofrontal cortex Protopopescu X, et al. Proc Natl Acad Sci USA. 2005;102(44): PMID:
12 Periods of Reproductive Endocrine Change are Associated With Altered Mood States and Reproductive Endocrine-Related Mood Disorders Account for Substantial Morbidity and Mortality Puberty Menstrual Cycle Puerperium Perimenopause
13 Images Courtesy of PJ Schmidt; DHEA = dehydroepiandrosterone Grumbach MM. Horm Res. 2002;57 Suppl 2:2-14. PMID:
14 Gene Network Ojeda SR, et al. Mol Cell Endocrinol. 2010;324(1-2):3-11. PMID:
15 Gene network regulating puberty Ojeda SR, et al. Mol Cell Endocrinol. 2010;324(1-2):3-11. PMID:
16 Reproductive Endocrinerelated Mood Disorders Premenstrual dysphoria Perinatal depression Perimenopausal depression
17 Reproductive Endocrinerelated Mood Disorders Premenstrual dysphoria! Prevalence 5%! Cause of 14.5 million Disability Associated Live Events annually in US! Requires prospective confirmation of restriction of symptoms to the luteal phase Meltzer-Brody S, Stuebe, A. Best Pract Res Clin Obstet Gynecol. September [epub ahead of print]. doi: /j.bpobgyn
18 Efficacy of GnRH-A in the Symptoms of PMDD (Weekly Means + SEM) Most Anxiety Least Most Baseline ANOVA-R Phase X Week X Group: F = 2.8 p < 0.05 Phase X Group: F = 42.0, p < Leuprolide Anxiety Least 1 Baseline Placebo GnRH-A = gonadotropin-releasing hormone agonist; PMDD premenstrual dysphoric disorder. Schmidt PJ, et al. N Engl J Med. 1998;338(4): PMID:
19 Central Nervous System Effects of GnRH Agonist & Gonadal Steroid Replacement Leuprolide acetate (3.75 mg IM QM) Estradiol 0.1 mg/d Progesterone 200 mg BID Placebo Procedures OR Time (weeks) GnRH-A = gonadotropin-releasing hormone agonist; IM = intramuscular; QM = every month; BID = twice a day. Schmidt PJ, et al. N Engl J Med. 1998;338(4): PMID:
20 Steroid Precipitation of PMDD Symptoms Most 3 PMDD ANOVA-R Phase X Group: F 1,23 = 19.6 p <.001 Sadness 2 1 Sadness 3 2 Controls Least 1 Leuprolide Alone E 2 Replacement P 4 Replacement PMDD = premenstrual dysphoric disorder Schmidt PJ, et al. N Engl J Med. 1998;338(4): PMID:
21 Differential Brain Regional Activation by Ovarian Steroids in PMDD Subgenual Cingulate Leuprolide Estradiol Progesterone (-6, 20, -10) p =.0002 Relative regional Cerebral Blood Flow (-mm/100g/min) Controls (n = 32) Patients with PMDD (n = 16) PMDD = premenstrual dysphoric disorder Schmidt PJ, unpublished data.
22 Differential Brain Regional Activation by Ovarian Steroids in PMDD Leuprolide Estradiol Progesterone Subgenual Cingulate (-6, 20, -10), p =.0002 Relative regional Cerebral Flow (-mm/100g/min) Subgenual Cingulate Controls Patients Medial Orbitofrontal Cortex (-12, 42, 12), p = Relative regional Cerebral Flow (-mm/100g/min) Medial Orbitofrontal Cortex Controls Patients PMDD = premenstrual dysphoric disorder Schmidt PJ, unpublished data.
23 PMDD: Is it Triggered by the Level of Steroid or the Change in Level of Steroid?
24 Reproductive Endocrinerelated Mood Disorders Premenstrual Dysphoria Perinatal Depression Perimenopausal Depression
25 Perinatal Depression Prevalence 10% - 15% (MDE = 7.5%; mde = 6.5%) Suicide is the leading cause of maternal death MDE = major depressive episode; mde = minor depressive episode Meltzer-Brody S, Stuebe, A. Best Pract Res Clin Obstet Gynecol. September [epub ahead of print]. doi: /j.bpobgyn
26 Background: Perinatal Depression COMMON! 10%-15% prevalence! 4 million women give birth annually in U.S.; one-half million with perinatal depressive disorder! Most common, unrecognized complication of perinatal period! Compare to the prevalence rate of gestational diabetes at 2%-5% MORBID! Devastating consequences for patient and family! Low maternal weight gain, preterm birth! Impaired bonding between mother and infant! Increased risk of suicide and infanticide MISSED! No practice guidelines or routine screening! Symptoms often different from classic DSM-IV depression Meltzer-Brody S, et al. Arch Womens Ment Health Aug 1. [Epub ahead of print] PMID: Meltzer-Brody S, Stuebe, A. Best Pract Res Clin Obstet Gynecol. September [epub ahead of print]. doi: /j.bpobgyn
27 Distinguishing Characteristics of Perinatal Mood Symptoms Anxiety or agitation Depressed mood Sadness, weepiness Irritability Hypervigilance about the baby OR lack of interest in the newborn Impaired concentration or feeling overwhelmed Feelings of dependency or guilt Austin MP, et al. Acta Psychiatr Scand. 2005;112(2): PMID:
28 Other Facts and Dilemmas There is no free lunch Inadequacy of database During pregnancy, there are medications to avoid, but. Pregnancy affects medication levels! Increased volume of distribution, hepatic blood flow! Decreased plasma binding proteins! Effects of reproductive steroid on metabolic enzymes Koren G. J Popul Ther Clin Pharmacol. 2011;18(3):e PMID: Bodén R, et al. Arch Gen Psychiatry. 2012;69(7): PMID:
29 Profound Neuroendocrine Changes at Time of Birth Relative Hormone Concentration Russell JA, et al. Brain preparations for maternity adaptive changes in behavioral and neuroendocrine systems during pregnancy and lactation. An overview. In: Progress in Brain Research; 2001.
30 What Is the Hormone Trigger in Perinatal Depression? PLACEBO E2+ PROG PLACEBO Leuprolide acetate BASELINE HYPO- GONADAL ADDBACK WITHDRAWAL E2 = estradiol; PROG = progesterone Bloch M, et al. Am J Psychiatry. 2000;157(6): PMID:
31 Weekly Cornell Depression Scale Scores (One Subject) Score Baseline Week 6 Week 8 Week 2 Week 4 Week 6 Week 8 Week 2 Week 4 Add back Early Late Follow-up Withdrawal Bloch M, et al. Am J Psychiatry. 2000;157(6): PMID:
32 PPD Study: Cornell Depression Score Cornell Depression Score BASELINE ADDBACK WITHDRAWL FOLLOW UP 0 PPD (Mean ±SEM) PPD = Postpartum depression Bloch M, et al. Am J Psychiatry. 2000;157(6): PMID: Normal
33 These Disorders Are NOT Hormone Deficiencies
34 Reproductive Endocrinerelated Mood Disorders Premenstrual Dysphoria Perinatal Depression Perimenopausal Depression
35 Perimenopausal Depression Prevalence 20% Is associated with a 50% increase in cardiovascular mortality Rubinow DR, Girdler SS. Depress Anxiety. 2011;28(6):E1-E15. PMID:
36 E2 Withdrawal Precipitates Depressive Symptoms in Asymptomatic Women With a Past Perimenopausal Depression E2 Open E2 DB Blind 15 p < 0.01 p < 0.01 Placebo p < CESD PMD + (n = 26) PMD - (n = 30) 5 0 E2 Continuous E2 Withdrawal E2 Withdrawal PMD + PMD - E2 = estradiol; PMD = perimenopausal depression; CESD = Center for Epidemiologic Studies Depression Scale; DB = double. Schmidt PJ, et al. unpublished data
37 Therapeutic Trial of Estradiol, SERM, and Phytoestrogen in Perimenopausal Depression (n = 38) 25 Estradiol p < Raloxifene p <.05 ANOVA-R: Tx*Time F 1,34 = 8.8 p < HDRS * Baseline Week 8 0 Baseline Week 8 25 Rimostil p = NS 25 Placebo p = NS HDRS Baseline Week 8 0 Baseline Week 8 *Week 8 E2 vs. Placebo: p <.05 SERM = selective estrogen-receptor modulator; HDRS = Hamilton Rating Scale for Depression; Tx*Time = treatment by time. Schmidt PJ. Unpublished data.
38 Baseline Characteristics of Participants in Randomized, Controlled Trials Trials and Hormone Regimens (E+P or E vs. Placebo) Characteristic (Hormone Therapy; Placebo) WHI E+P WHI E WHIMS E+P WHIMS E WHISCA E+P WHISCA E HERS E+P ESPRIT E EMS E+P WISDOM E +P ULTRA E Number 8506; ; ; ; ; ; ; ;504 70; ; ;185 Mean age, y 63.2; ; ; ; ; ; ; ; ; ; ;66.7 Nonwhite race, % Previous or current HT, % 16.1; ; ; ; ; ;10 3;3 4.3;9.7 1; ; ; ; ; ; ; ; ;1.7 12; ; ; Hysterectomy age <40 y, % ; Hysterectomy age y, % ; Bilateral oophorectom, % ; Never pregnant, % 10.1; ; Marjoribanks J, et al. Cochrane Database Syst Rev. 2012;7:CD PMID: Nelson HD, et al. Ann Intern Med. 2012;157(2): PMID: Schierbeck LL, et al. BMJ. 2012;345:e6409. PMID:
39 Results of Hormone Therapy Trials Cancer Outcome HR (95% CI) E+P vs. Placebo Differences in events per 10,000 women-years (95% CI) * HR (95% CI) E vs. Placebo Differences in events per 10,000 women-years (95% CI) * Invasive breast 1.25 ( ) 8 (3 14) more 0.77 ( ) 8 (1 14) less Colorectal 0.75 ( ) Not significant 1.11 ( ) Not significant Lung 1.23 ( ) Not significant 1.17 ( ) Not significant Endometrial 0.78 ( ) Not significant Not reported Not reported Ovarian 1.58 ( Not significant Not reported Not reported Cervical 1.44 ( ) Not significant Not reported Not reported Cardiovascular events Coronary heart disease (CHD death and total MI) 1.22 ( ) Not significant 0.95 ( ) Not significant Stroke 1.34 ( ) 9 (2 15) more 1.36 ( ) 11 (2 20) more Thromboembolic events Deep vein thrombosis 1.88 ( ) 12 (6 17) more 1.47 ( ) 7 (1 14) more Pulmonary embolism 1.98 ( ) 9 (4 14) more 1.37 ( ) Not significant Diabetes Self-reported new diagnosis requiring treatment with drugs 0.79 ( ) 15 (4 26) less 0.88 ( ) Not significant Marjoribanks J, et al. Cochrane Database Syst Rev. 2012;7:CD PMID: Nelson HD, et al. Ann Intern Med. 2012;157(2): PMID: Schierbeck LL, et al. BMJ. 2012;345:e6409. PMID:
40 Results of Hormone Therapy Trials E+P vs. Placebo E vs. Placebo Fractures Mortality Outcome HR (95% CI) Differences in events per 10,000 women-years (95% CI) * HR (95% CI) Differences in events per 10,000 women-years (95% CI) * Hip 0.67 ( ) 6 (1 10) less 0.61 ( ) 7 (1 12) less Vertebral 0.68 ( ) 6 (1 11) less 0.62 ( ) 6 (1 12) less Total fractures 0.76 ( ) 46 (29 63) less 0.70 ( ) 56 (37 75) less All-cause mortality 1.04 ( ) Not significant 1.02 ( ) Not significant Breast cancer mortality 1.96 ( ) Not significant 0.37 ( ) 2 (1 3) less Lung cancer mortality 1.71 ( ) 5 (1 8) more Not reported Not reported Gallbladder Gallbladder disease (cholecystitis and cholelithiasis) Cognitive function 1.61 ( ) 20 (11 29) more 1.79 ( ) 33 (20 45) more Probable dementia 2.05 ( ) 22 (5 39) more 1.49 ( ) Not significant Mild cognitive impairment 1.07 ( ) Not significant 1.34 ( ) Not significant Urinary incontinence Overall urinary incontinence (stress, urge, or mixed) 1.39 ( ) 872 ( ) more 1.53 ( ) 1271 ( ) more Marjoribanks J, et al. Cochrane Database Syst Rev. 2012;7:CD PMID: Nelson HD, et al. Ann Intern Med. 2012;157(2): PMID: Schierbeck LL, et al. BMJ. 2012;345:e6409. PMID:
41 Reproductive Steroids Are Both Context-Dependent and Context-Determining Susceptibility What do we mean by gene : environment interactions? Rubinow DR, et al. Dialogues Clin Neurosci. 2002;4(2): PMID:
42 Estradiol Effects in the Forced Swim Test: Strain Differences Wistar Hannover rat and Long Evans rat. Koss WA, et al. Physiol Behav. 2012;106(2):81-6. PMID:
43 Strain-dependent Effects of Estradiol in the Forced Swim Test 300 Vehicle Estradiol Withdrawal Immobility Seconds * * N = 12 N = 12 N = 12 N = 6 N = 7 N = 7 Wistar Long Evans Koss WA, et al. Physiol Behav. 2012;106(2):81-6. PMID:
44 Biology and Environment Meet at the Level of the Dance Partners SMRT, high-fat diet, and obesity/insulin resistance SMRT = silencing mediator of retinoid and thyroid hormone receptors Fang S, et al. Proc Natl Acad Sci USA. 2011;108(8): PMID:
45 High-Fat Diet Induced Severe Obesity in SMRTmRID1 Mice SMRT = silencing mediator of retinoid and thyroid hormone receptors; WT = wild type NC = normal control; HFD = high-fat diet. Fang S, et al. Proc Natl Acad Sci USA. 2011;108(8): PMID:
46 Effects of Genetic Differences are Unmasked by Environment SMRT mutation, high-fat diet, and obesity/insulin resistance GABA-A receptor mutation, pregnancy, and depression SMRT = silencing mediator of retinoid and thyroid hormone receptors Fang S, et al. Proc Natl Acad Sci USA. 2011;108(8): PMID:
47 Deficient NS Signaling: Postpartum Depression and Infanticide NS = neurosteroid ; WT = wild type Wistar; THIP = 4,5,6,7-tetrahydroisoxazolo-[5,4-c]pyridin-3-ol Maguire J, Mody I. Neuron. 2008;59(2): PMID:
48 Embrace the Uncertainty!
49 Abbreviations EMS = Estrogen Memory Study ESPRIT = Oestrogen in the Prevention of Reinfarction Trial HERS = Heart and Estrogen/Progestin Replacement Study HT = hormone therapy MI = myocardial infarction P = progestin PE = pulmonary embolism SBP = systolic blood pressure ULTRA = Ultra-Low-Dose Transdermal Estrogen Assessment WHI = Women s Health Initiative WHIMS = Women s Health Initiative Memory Study WHISCA = Women s Health Initiative Study of Cognitive Aging WISDOM = Women s Intl Study of Long Duration Oestrogen After Menopause CHD = coronary heart disease HR = hazards ratio CI = confidence intervals E + P; estrogen plus progestin E = estrogen only RCT = randomized controlled trial
50 Questions & Answers
51 Co-sponsored by
#CHAIR2015. Miami, Florida. September 24 26, JW Marriott Miami. Sponsored by
#CHAIR2015 September 24 26, 2015 JW Marriott Miami Miami, Florida Sponsored by If We Know So Much About Neurobiology, Why Do We Know So Little About Depression? David R. Rubinow, MD, PhD University of
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 informationSupplementary Online Content
Supplementary Online Content Gartlehner G, Patel SV, Feltner C, et al. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: Evidence Report and Systematic Review for
More informationHORMONE REPLACEMENT THERAPY
TRIALS OF HR RUTH (Barrett- Connor et al 29 ) JULY 2006 (Country) mean ± sd, range International trial 67.5 an Placebo component in 67.5 ± 6.7 women with Raloxifene or multiple 67.5 ± 6.6 risk factors
More information10/19/12. David R. Rubinow, MD Disclosures. Hormones, Heart Disease, and Health of the Perimenopausal Woman
10/19/12 Hormones, Heart Disease, and Health of the Perimenopausal Woman David R. Rubinow, MD University of North Carolina at Chapel Hill School of Medicine Chapel Hill, NC David R. Rubinow, MD Disclosures
More informationLearning 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 informationHRT and bone health. Management of osteoporosis and controversial issues. Delfin A. Tan, MD
Strong Bone Asia V. Osteoporosis in ASEAN (+), Danang, Vietnam, 3 August 2013 Management of osteoporosis and controversial issues HRT and bone health Delfin A. Tan, MD Section of Reproductive Endocrinology
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 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 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 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 informationHealth Risks and Benefits 3 Years After Stopping Randomized Treatment With Estrogen and Progestin. The WHI Investigators
Health Risks and Benefits 3 Years After Stopping Randomized Treatment With Estrogen and Progestin The WHI Investigators 1 Background: WHI Hormone Program Design YES N= 10,739 Conjugated equine estrogen
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 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 informationEvidence Synthesis Number 93
Evidence Synthesis Number 93 Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: Systematic Review to Update the 2002 and 2005 U.S. Preventive Services Task Force Recommendations
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 informationThe burden of mental disorders, such as depression and anxiety, fall disproportionately on women of childbearing and childrearing age.
The burden of mental disorders, such as depression and anxiety, fall disproportionately on women of childbearing and childrearing age. Psychiatric Clinics of North America, 2007 Rates of severe mental
More informationMenopausal hormone therapy includes various forms, Review
Review Annals of Internal Medicine Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendations Heidi
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 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 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 informationTreating Mood Disorders Associated with PMS and Perimenopause
Treating Mood Disorders Associated with PMS and Perimenopause Anna M. Cabeca, DO, FACOG, ABAARM HRT Symposium Savannah GA July 14-16, 2016 2016. All Rights Reserved. 1 Disclosure Anna M. Cabeca, DO, FACOG,
More informationWomen s Mental Health
Women s Mental Health Linda S. Mullen, MD Director, Women s Mental Health Assistant Professor of Clinical Psychiatry in OB/GYN Columbia University & NewYork Presbyterian Hospital Departments of Psychiatry
More informationTreatment of Mood Disorders in Midlife Women
Treatment of Mood Disorders in Women KAY ROUSSOS-ROSS, MD UNIVERSITY OF FLORIDA DEPARTMENTS OF OBGYN AND PSYCHIATRY Disclosures I HAVE NO DISCLOSURES Objectives UNDERSTAND INCIDENCE OF MOOD DISORDERS IN
More informationChemo-endocrine prevention of breast cancer
Chemo-endocrine prevention of breast cancer Andrea DeCensi, MD Division of Medical Oncology Ospedali Galliera, Genova; Division of Cancer Prevention and Genetics, European Institute of Oncology, Milano;
More informationPostpartum Depression. Deborah Kim, M.D. Assistant Professor Department of Psychiatry
Postpartum Depression Deborah Kim, M.D. Assistant Professor Department of Psychiatry drkim@upenn.edu Objectives Describe the difference between baby blues and postpartum depression (PPD) Describe the prevalence
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 informationCLINICIAN INTERVIEW CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN
CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN Nanette K. Wenger, MD, is a recognized authority on women and coronary heart disease. She chaired the US National Heart, Lung, and Blood Institute conference
More informationWEIGHING UP THE RISKS OF HRT. Department of Endocrinology Chris Hani Baragwanath Academic Hospital
WEIGHING UP THE RISKS OF HRT V. Nicolaou Department of Endocrinology Chris Hani Baragwanath Academic Hospital Background Issues surrounding post menopausal hormonal therapy (PMHT) are complex given: Increased
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 informationPostmenopausal hormone therapy - cardiac disease risks and benefits
Postmenopausal hormone therapy - cardiac disease risks and benefits Tomi S. Mikkola, MD Helsinki University Central Hospital Department of Obstetrics and Gynecology Helsinki, Finland Disclosures Speaker/consulting
More informationHormone therapy. Dr. med. Frank Luzuy
Hormone therapy Dr. med. Frank Luzuy Reasons for Initiating/Continuing HT* Menopause-Related Symptoms Osteoporosis, Bone Loss, Fracture Prevention Doctor Prescribed It, Told Me to Take It Cardiovascular
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 informationLong-term safety of unopposed estrogen used by women surviving myocardial infarction: 14-year follow-up of the ESPRIT randomised controlled trial
DOI: 10.1111/1471-0528.12598 www.bjog.org Epidemiology Long-term safety of unopposed estrogen used by women surviving myocardial infarction: 14-year follow-up of the ESPRIT randomised controlled trial
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 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 informationPMS / PMDD. Prof John Studd Imperial College London London PMS and Menopause Centre. www. studd.co.uk
PMS / PMDD Prof John Studd Imperial College London London PMS and Menopause Centre www. studd.co.uk PMS or PMDD????? 2 3 St Luke s hospital for the insane 1846 F > M x 2 most common in women of the servant
More informationHormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women US Preventive Services Task Force Recommendation Statement
Clinical Review & Education JAMA US Preventive Services Task Force RECOMMENDATION STATEMENT Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women US Preventive Services
More informationDifference between vagifem and yuvafem
Difference between vagifem and yuvafem Generally, when estrogen is prescribed for a postmenopausal woman with a uterus, a progestin should also be considered to reduce the risk of endometrial cancer. Estrogen-alone
More informationEndocrine Steroids 2. Signal transduction 3. Prostaglandins
Endocrine - 2 1. Steroids 2. Signal transduction 3. Prostaglandins Estrogen Menopause (pause in the menes) ["change of life" at about 50] - lack of estrogen. (Some hysterectomy or ovarian cancer surgeries
More informationThe New England Journal of Medicine
The New England Journal of Medicine Copyright, 1998, by the Massachusetts Medical Society VOLUME 338 J ANUARY 22, 1998 NUMBER 4 DIFFERENTIAL BEHAVIORAL EFFECTS OF GONADAL STEROIDS IN WOMEN WITH AND IN
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 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 informationBSO, HRT, and ERT. No relevant financial disclosures
BSO, HRT, and ERT Jubilee Brown, MD Professor & Associate Director, Gynecologic Oncology Levine Cancer Institute at the Carolinas HealthCare System Charlotte, North Carolina No relevant financial disclosures
More informationMaternal Depression: Prevalence, Implications, Diagnosis, and Current Treatment Options
Maternal Depression: Prevalence, Implications, Diagnosis, and Current Treatment Options Sarah E. (Betsy) Bledsoe-Mansori PhD, MPhil, MSW Assistant Professor Cathy Nguyen UNC School of Social Work Presented
More informationHarnessing the Power of Social Media: Investigating the Genetics of Post-Partum Depression using the Apple ResearchKit
Harnessing the Power of Social Media: Investigating the Genetics of Post-Partum Depression using the Apple ResearchKit Samantha Meltzer-Brody, M.D. M.P.H. Associate Professor and Associate Chair Director,
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 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 informationEndometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY
Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY Natural Cycle FET Protocol for endometrial preparation N FET, including modified N FET HRT FET:
More informationSomething has changed? The literature from 2008 to present?
Something has changed? The literature from 2008 to present? Elina Hemminki National Institute for Health and Welfare, Helsinki, Finland Rome Oct 7, 2011: Post-menopausal hormone therapy and women's information
More informationMenopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: An Evidence Review for the U.S. Preventive Services Task Force
Evidence Synthesis Number 155 Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: An Evidence Review for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare
More informationScientific Report Series: Understanding the Biology of Sex Differences:
Scientific Report Series: Understanding the Biology of Sex Differences: Report on the Society for Women s Health Research-National Institute of Mental Health Roundtable on Mood Disorders and Hormonal Transitions
More informationHaemostasis, thrombosis risk and hormone replacement therapy
Haemostasis, thrombosis risk and hormone replacement therapy Serge Motte Brussels 13.05.17 - MY TALK TODAY The coagulation cascade and its regulation Effects of hormone replacement therapy on haemostasis
More informationThe Practice Committee of the American Society for Reproductive Medicine,
FERTILITY AND STERILITY VOL. 81, NO. 1, JANUARY 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. PRACTICE COMMITTEE Estrogen
More informationSummary of the risk management plan (RMP) for Duavive (conjugated oestrogens / bazedoxifene)
EMA/679870/2014 Summary of the risk management plan (RMP) for Duavive (conjugated oestrogens / bazedoxifene) This is a summary of the risk management plan (RMP) for Duavive, which details the measures
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 informationEstrogens and progestogens
Estrogens and progestogens Estradiol and Progesterone hormones produced by the gonads are necessary for: conception embryonic maturation development of primary and secondary sexual characteristics at puberty.
More informationEvidence Synthesis Number 155
Evidence Synthesis Number 155 Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: An Evidence Review for the U.S. Preventive Services Task Force Prepared for: Agency
More informationJAMA US Preventive Services Task Force EVIDENCE REPORT
Clinical Review & Education JAMA US Preventive Services Task Force EVIDENCE REPORT Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women Evidence Report and Systematic
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 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 informationEffects of Transdermal Estradiol in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial
Effects of Transdermal Estradiol in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial Jennifer L. Gordon 1,2, David R. Rubinow 1, Tory A. Eisenlohr-Moul 1,
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 Hormone Therapy & Haemostasis
Menopausal Hormone Therapy & Haemostasis The Haematologist Perspective Dr. Batia Roth-Yelinek Coagulation unit Hadassah MC Menopausal Hormone Therapy & Hemostasis Hemostatic mechanism Mechanism of estrogen
More informationTHE SAFETY CHECK LIST BEFORE STARTING HT
THE SAFETY CHECK LIST BEFORE STARTING HT This safety checklist was designed by the Endocrine Society in 2015 to minimize the chance of giving hormone therapy to women who may be negatively affected by
More informationThe preferred treatment for osteoporosis
Alternate Options to Hormone Replacement Therapy for Osteoporosis James R. Shoemaker, DO Andrea B. Klemes, DO This presentation, developed from a symposium lecture at the 40th Annual Convention of the
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 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 informationWhen the Bough Breaks
Avoiding Crisis and the Loss of Life by Recognizing and Treating Angela Burling RN MSN Chris Raines MSN RN APRN-BC When the Bough Breaks Angela s Story Raines and Burling 1 A rare but devastatingcondition,
More informationPrevalence of Premenstrual Syndrome in Autism: a Prospective Observer-rated Study
The Journal of International Medical Research 2008; 36: 268 272 Prevalence of Premenstrual Syndrome in Autism: a Prospective Observer-rated Study H OBAYDI 1 AND BK PURI 2 1 Hertfordshire Partnership Foundation
More informationPostmenopausal hormone therapy and cancer risk
International Congress Series 1279 (2005) 133 140 www.ics-elsevier.com Postmenopausal hormone therapy and cancer risk P. Kenemans*, R.A. Verstraeten, R.H.M. Verheijen Department of Obstetrics and Gynaecology,
More information5/24/ Maria H. Elswick, MD. Maternal Wellness Program Physician Lead
Maria H. Elswick, MD Maternal Wellness Program - Physician Lead Department of Obstetrics & Gynecology Kaiser Permanente San Diego Maria H. Elswick, MD Maternal Wellness Program Physician Lead Department
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 informationHormonal contraception and PMS. Inger Sundström Poromaa Department of Women s and Children s Health Uppsala University
Hormonal contraception and PMS Inger Sundström Poromaa Department of Women s and Children s Health Uppsala University Definitions Premenstrual syndrome (PMS) ICD 10: Two symptoms, at least one psychological,
More informationTransgender Medicine beyond the guidelines.
Transgender Medicine beyond the guidelines. Rachel Hopkins, MD Assistant Professor of Medicine SUNY Upstate Medical University Division of Endocrinology and Metabolism Overview Definitions and history
More informationBreast Cancer Risk Assessment and Prevention
Breast Cancer Risk Assessment and Prevention Katherine B. Lee, MD, FACP October 4, 2017 STATISTICS More than 252,000 cases of breast cancer will be diagnosed this year alone. About 40,000 women will die
More information5. Summary of Data Reported and Evaluation
326 5. Summary of Data Reported and Evaluation 5.1 Exposure data Combined estrogen progestogen menopausal therapy involves the co-administration of an estrogen and a progestogen to peri- or postmenopausal
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 informationDVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
More informationTHE WOMEN S HEALTH INITIAtive
ORIGINAL CONTRIBUTION JAMA-EXPRESS Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women Principal Results From the Women s Health Initiative Randomized Controlled Trial Writing
More informationDo Ovarian Hormones Affect Somatosensation, Pain, and Mood?
Gender Aspects in Cognitive Neuroscience Do Ovarian Hormones Affect Somatosensation, Pain, and Mood? Laboratory of Cognitive Neuroscience and Women s Health Department of Pyschology and School of Public
More informationA Tale of Three Hormones: hcg, Progesterone and AMH
A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Human Ovarian Steroidogenesis and Gonadotrophin Stimulation Johan
More informationClass Objectives. Depressive Disorders 10/7/2013. Chapter 7. Depressive Disorders. Next Class:
Chapter 7 Class Objectives Depressive Disorders - Major Depressive Disorder - Persistent Depressive Disorder - Disruptive Mood Dysregulation Disorder - Premenstrual Dysphoric Disorder (PMDD) Next Class:
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 informationTherapeutic Cohort Results
Patient: SAMPLE PATIENT DOB: Sex: MRN: Menopause Plus - Salivary Profile Therapeutic Cohort Results Hormone Average Result QUINTILE DISTRIBUTION 1st 2nd 3rd 4th 5th Therapeutic Range* Estradiol (E2) 8.7
More informationReproductive outcome in women with body weight disturbances
Reproductive outcome in women with body weight disturbances Zeev Shoham M.D. Dep. Of OB/GYN Kaplan Hospital, Rehovot, Israel Weight Status BMI (kg/m 2 ) Underweight
More informationPrenatal and Post Partum Depression is Not Just a Mood. This is Serious Stuff.
Prenatal and Post Partum Depression is Not Just a Mood. This is Serious Stuff. Deborah McMahan, MD Health Commissioner Prenatal and Infant Care Network November 28, 2016 Agenda Prevalence of mental illness
More informationNeural model of emotional regulation structures - Circuits involving prefrontal cortex and subcortical limbic structures - MDE associated with
Topics Brain and signalling changes in depression Ketamine activity in refractory depression Mechanism of Action New Data Dose finding Route of Administration Activity in Other Disorders Neural model 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 informationPostpartum depression is the most common medical complication of childbirth, estimated to affect approximately 400,000 women annually in the U.S.
Sage Therapeutics Announces FDA Approval of ZULRESSO (brexanolone) Injection, the First and Only Treatment Specifically Indicated for Postpartum Depression March 19, 2019 Approval based on results from
More informationScreening for. perinatal depression. ACOG CO No. 757, Nov 2018 Kristen Giefer, PGY-2
Screening for perinatal depression ACOG CO No. 757, Nov 2018 Kristen Giefer, PGY-2 Introduction Prevalence of perinatal depression is a significant cost to individuals, children, families and the community
More informationHormone replacement therapy in postmenopausal women
The American Journal of Surgery 188 (2004) 136 149 Review Hormone replacement therapy in postmenopausal women Edgar D. Staren, M.D., Ph.D., M.B.A.*, Shuab Omer, M.D. Department of Surgery, Medical College
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 informationSMOKING CESSATION WORKSHOP. Dr Mark Palayew December
SMOKING CESSATION WORKSHOP Dr Mark Palayew December 5 2016 Conflicts of Interest None Case 1 Mr. T is a 55 year old smoker 2 packs/day He has been smoking continuously since age 16 When he wakes up at
More informationThe Female Brain: Balancing Social Expectations with Your Own Health 10/30/12. Louann Brizendine, MD
BIOGRAPHY: The Female Brain: Balancing Social Expectations with Your Own Health 10/30/12 Louann Brizendine, MD DR LOUANN BRIZENDINE is a neuropsychiatrist who completed her degree in Neurobiology at UC
More informationMaternal Mental Health: Risk Factors, Ramifications, and Roles. Anna Glezer MD UCSF Assistant Clinical Professor Founder, Mind Body Pregnancy
Maternal Mental Health: Risk Factors, Ramifications, and Roles Anna Glezer MD UCSF Assistant Clinical Professor Founder, Mind Body Pregnancy Disclosures None Objectives for Today Review major maternal
More informationPhysiology of Menopause
6/4/18 21 Physiology of Menopause Timothy Rowe University of British Columbia 6/4/18 22 I have received consulting fees and honoraria for speaking from Pfizer Canada Inc. I have no other competing or potentially
More informationTherapeutic Cohort Results
Patient: PAGE LOVE DOB: January 11, 1983 Sex: F MRN: 1232704193 Order Number: J9020008 Completed: July 08, 2016 Received: July 02, 2016 Collected: July 01, 2016 Aum Healing Center Sarika Arora MD 332 Newbury
More information