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Hormone Replacement Therapy

Hormone Replacement Therapy. Hormonal Therapy. Beliefs before July 2002 Relieves hot flashes, improves mood, improves sexuality, improves sleep Prevents osteoporosis Prevents heart disease and stroke Improves urinary problems ? Slight increase in breast cancer.

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Hormone Replacement Therapy

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  1. Hormone Replacement Therapy

  2. Hormonal Therapy • Beliefs before July 2002 • Relieves hot flashes, improves mood, improves sexuality, improves sleep • Prevents osteoporosis • Prevents heart disease and stroke • Improves urinary problems • ? Slight increase in breast cancer OB-GYN Specialists, PC and Covenant Medical Center

  3. Women’s Health Initiative Study • BIG STUDY! • Multiple centers, 27347 patients, wide cross section of women, planned for 8.5 years of study • GOOD STUDY! • Double blind-neither the patient nor the researcher knows what medication the patient is taking • Placebo controlled-patient doesn’t know if she is taking ANY medication OB-GYN Specialists, PC and Covenant Medical Center

  4. Benefit Risk Stroke Coronary artery disease Breast cancer Plan to study until 2005 OB-GYN Specialists, PC and Covenant Medical Center

  5. Benefit Risk 29%increase Coronary artery disease 41%increase Stroke 26%increase Breast cancer OB-GYN Specialists, PC and Covenant Medical Center

  6. Hormone Use Post WHI • Only use in women with moderate to severe symptoms of hot flashes, night sweats, sleep disturbances • Limit the total duration • If possible use local estrogen therapy for vaginal symptoms • Use the lowest dose possible OB-GYN Specialists, PC and Covenant Medical Center

  7. Risks • Increase risk of breast cancer (8 per 10,000 users) • Increased risk of DVT (8 per 10,000 users) • Increased risk of stroke (8 per 10,000 users) • Increased risk of cholecytitis/pancreatis • Increased risk of MI in patients with coronary artery disease or if long term menopausal

  8. No Risk or Benefit • Weight gain • Osteoarthritis • Ovarian/endometrial • Cognitive function/dementia • Development of coronary artery disease in recently menopausal women

  9. Discontinuing HRT • Tapering off verses discontinuing abruptly • What to do with the lady that can’t or won’t quit?

  10. Bio Identical Hormone Replacement

  11. What is it? • Not very specific • Compounded mix of various hormones • Estrone, estradiol, estriol • DHEA • Testosterone • “Natural” progestone • Mixed may be determined by hormone testing • Various routes of absorption

  12. Why do this? • Pro (as per advocates) • More effective • Safer • Con • Costs more • Not always covered by insurance • Lacks scientific basis

  13. Concerns • Compounding lacks the quality control of traditional products • As of 2005, no random clinical trials of compounded products in terms of efficacy and risks

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