Medcan Women

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Medcan Womens Health Forum

• Its The Menopause!
• Wilfred M Steinberg MD FRCSC
• University of Toronto
• St Michaels Hospital

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(No Transcript)
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Its a New World
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What Does it All Mean?
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What Does it All Mean?
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When Does It Start? Or End?
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Perimenopausenot a disease
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What Changes Occur in the Menopause ?
Alzheimers disease

• Menopausal symptoms
• Vasomotor symptoms
• Mood disturbances

Breast cancer
Cardiovascular disease
Bone loss and fractures
Colon cancer
Urogenital atrophy
Smith T, et al. J Soc Obstet Gynaecol Can 2001
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Progression of Symptoms
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Are you aware?
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Cognitive Changes
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Body Changes
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Range of Emotions
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Anyone you Know?
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Menopausal Changes?
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Some Weird Changes
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Unappreciated Symptoms
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Can I Still Get Pregnant?
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Fertility Rates Age
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Who are you going to trust?
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Does this resonate for you?
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Be an Intelligent Consumer
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Plants for menopausal Rx

•   Isoflavones
• Have estrogen-like effects, so be aware..
• Black Cohosh, Wild Yam
  Soy

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Herbs Traditional and Chinese
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Myth 1 Natural Hormones are Safer

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Myth 2 Compounded Bioidentical Hormones Work
Better than Brand Rx Hormones.
There is no scientific support for an advantage
of these compounds over common commercially
produced preparations.  Mary M. Gallenberg,
M.D Mayo Clinic
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Natural Hormones-FDA HW Approved
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What really works? 351 women
Placebo
Black cohosh
Multibotanical

Multibotanical soy
HT

Vasomotor Symptoms Per Day



Adjusted mean number of vasomotor symptoms per
day, by study group
Baseline
3 mo
6 mo
12 mo
Newton KM, et al. Ann Intern Med 2006145869-79.
Reproduced with permission.
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My Favourite Natural Treatment
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Non Hormonal Remedies

• Significantly reduced the number of hot flushes
  compared with placebo
• 66.6 reductions from baseline
• Hot flush severity and number of nighttime
  awakenings were significantly reduced
• American Journal of Obstetrics Gynecology,
  February 2009

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Myth 3 Since Compounded Bioidentical
Hormones Are Natural, They are Safer Than Other
Hormones.
They're produced in doses and forms that differ
from those in FDA-approved products BUT..with no
quality assurance standards

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KEEPS Kronos Early Estrogen Prevention Study 2012
Estrogen and progestogen therapy started soon
after menopause, not only relieve symptoms, but
appear safe.   

• No increase in blood pressure, no effects on
  atherosclerosis,
• No increase in breast cancer or uterine cancer,
• No effects on blood clots associated with stroke
  and myocardial infarction.

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Options Menopausal Symptoms

• Lifestyle changes.some benefit
• Regular exercise, diet, nonsmoking, moderate
  alcohol, BMI lt32
• Herbal remedies..minimal benefit
• Dong quai, ginseng, black cohosh, soy
  isoflavones, red clover, Goji j
• Medical therapiesmajor benefits
• Estrogen, progestin,
• gabapentin, clonidine
• SSRI / SNRIs

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Risks for Breast Cancer in Perspective
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7-year ET 5 years of CCEPT use 10 years of
CCEPT use 15 years of CCEPT use Late menopause
(10-year delay) Body mass index (BMI) (10 kg
increase) Alcohol consumption (2 drinks/day) Lack
of regular exercise Weight gain after menopause
(20 kg or more)
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Additional cancers per 1,000 women
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10

0
Baseline no HT use 45/1,000 women 5060 years

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Healthy is the New Sexy
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Healthy is the New Sexy
In postmenopausal women, the quality of the
relationship and the presence of sexual problems
in the partner are probably as important as are
hormonal change in the maintenance of sexual
interest and response.
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What Else May be Going On?

• urinary incontinence,
• depression,
• dementia,
• arthritis,
• stroke and
• breast cancer
• Family crisis

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Menopause or Depression?

• loss of or diminished sex drive
• lowered sexual desire and sexual activity
• loss of energy
• fatigue
• lethargy
• tiredness
• lack of concentration

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Vaginal Atrophy
superficial
intermediate
parabasal
Thick, healthy, well-estrogenizedlining of the
vagina
Thin, dry lining of vaginadue to
menopause(after estrogen loss)
The North American Menopause Society. Menopause.
200714357-369
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Most Important Sex Organ in Women
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Most Important Sex Organ in Women
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What happens 5 years after menopause?
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Testosterone For Post Menopausal Women?
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Androgel Off Label Use in Women

• AndroGel contains testosterone, a Schedule III
  controlled substance as defined by the Anabolic
  Steroids Control Act.
• AndroGel is supplied in non-aerosol, metered-dose
  pumps. .
• AndroGel is also supplied in unit-dose aluminum
  foil packets in cartons of 30

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(No Transcript)
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Hot Then(1959)
Still Hot Now (2014)