HORMONE REPLACEMENT THERAPY Ann Steiner, MD University of Pennsylvania

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HORMONE REPLACEMENT THERAPYAnn Steiner,
MDUniversity of Pennsylvania

• WOMENS HEALTH UPDATE 2003

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HOW HAS WHI CHANGED HRT USE?

• Millions of American Women have stopped hormone
  therapy in the last 16 months.
• Others have not started who would have.
• 6 years ago 6 million U.S. women were on HRT or
  ERT.
• Now 2.5 million are on HRT or ERT.

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WHAT HAPPENED IN WHI?

• After an average of 5.2 years of study, risk for
  breast cancer in women in the Prempro group was
  shown to be higher than limits set, so this part
  of the WHI study was stopped
• Another arm of the study asking similar questions
  about replacement with estrogen only in women who
  have had hysterectomies is continuing

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WHAT ARE THE NUMBERS FROM WHI?
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WHI EFFECTS ON HEALTH RELATED QUALITY OF LIFE

• No significant improvement in QOL including
  general health, mental health, depressive
  symptoms, or
• sexual satisfaction
• with Prempro vs placebo

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MILLION WOMEN STUDY

• British study of 1,084,110 women
• Increased risk of breast cancer in 1-2 years of
  any estrogen use
• 30 increased risk for estrogen only users
• 100 increased risk for EP users
• No increased risk for vaginal estrogen users

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SUMMARY

• Treatment of vasomotor and vulvar/vaginal
  symptoms remains the primary indication for the
  use of estrogen in the menopause
• There is no indication for the use of progestins
  or progesterone in women who have no uterus
• There is no indication for using estrogen to
  protect against cardiovascular disease or
  dementia

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SUMMARY

• Take HRT for the shortest duration of time
  necessary to get through transitional symptoms
• It is likely best to take the lowest dose of
  estrogen necessary for relief of symptoms
• Means other than estrogen should be considered
  for treatment of low bone mineral density

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WHAT ABOUT VAGINAL DRYNESS?

• Non hormonal lubricant
• Vaginal estrogen

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AND FRACTURE RISK PREVENTION OFF HRT?

• Calcium-1200-1500mg, Vitamin D-700-800iu, weight
  bearing exercise
• Fracture risk assessment-DEXA
• Medication for bone loss and treatment of
  osteoporosis

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NATIONAL OSTEOPOROSIS FOUNDATIONS RISK FACTORS
FOR FRACTURES 2003

• Alcoholism
• Impaired eyesight
• Frequent falls
• Inadequate physical activity
• Use of corticosteroid therapy for3 mos
• Prolonged amenorrhea
• Lifetime calcium dietary insufficiency
• Early natural or surgical menopause (before age
  45)

• Personal history of fracture as an adult
• Family history of fragility fracture in a 1st
  degree relative
• Current cigarette smoking
• Body weight
• Advanced age
• Dementia
• Poor health/frailty

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WHAT ARE YOUR CHOICES NOW FOR ESTROGEN?

• Low dose estrogen progestin
• Almost same benefit on hot flashes, bone
  preservation, and vaginal dryness
  
• Hormone delivery systems

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ALTERNATIVE APPROACH FOR VASOMOTOR SYMPTOMS

• Lifestyle changes
• Black Cohosh
• Antidepressants
• Bellamine
• Clonidine
• Soy

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MENOPAUSE FRIENDLY WEB SITES

• http//www.menopause.org
• North American Menopause Society
• www.menopause.org/newsletter.html
• Menopause Flashes-newsletter-need to register
• http//www.whi.org/findings/default.asp
• Womens Health Initiative web site
• www.nof.org
• National Osteoporosis Foundation
• consumerlabs.com
• Alternative medicine website
• http//www.cancer.org
• American Cancer Society
• http//nccam.nih.gov
• National Center For Complimentary and Alternative
  Medicine