Menopause in women with ibd
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Menopause in Women With IBD. Menopause. Natural menopause results from gradual decline in number of estradiol-producing ovarian follicles Surgical menopause may occur at any age as a result of oophorectomy Estradiol decreases; estrone becomes primary circulating hormone

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Menopause in Women With IBD

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Menopause in women with ibd

Menopause in Women With IBD


Menopause

Menopause

  • Natural menopause results from gradual decline in number of estradiol-producing ovarian follicles

  • Surgical menopause may occur at any age as a result of oophorectomy

  • Estradiol decreases; estrone becomes primary circulating hormone

  • Testosterone declines at varying rate

  • No data on effect of menopause on IBD

Carr BR, Bradshaw KD. In: Braunwald E, et al, eds. Harrison’s Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2002.


Menopausal symptoms

Menopausal Symptoms

  • Bone loss—may be accelerated in CD and by corticosteroid use

  • Vasomotor symptoms—“hot flashes” (50%–85%)

  • Increases in total and LDL cholesterol

  • Urogenital symptoms (45%)

    • Dyspareunia

    • Dysuria

    • Incontinence

    • Urinary tract infections

U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. 1996. Available at: http/www.ahcpr.gov/clinic/cpsix.htm. Accessed January 28, 2003.


Postmenopausal hrt

Postmenopausal HRT

  • Replaces estrogen in postmenopausal women

  • Goal: manage symptoms caused by loss of estrogen

  • Unopposed estrogen: only for women who have had hysterectomies

  • Combined estrogen/progestin: recently found to increase risks for breast cancer, heart attacks, stroke


Hrt protective against disease activity after menopause

HRT Protective Against Disease Activity After Menopause

  • Cohort of post-menopausal women

  • Disease activity pre and post menopause

  • Those taking HRT less likely to have a disease flare in 2 years post menopause

  • Dose response for length of use

  • Form of menopause did not matter

Kane SV Am J Gastro 2008; 103(5):1193-96.


Potential benefits vs risks of hrt

Potential Benefits

Decrease in vasomotor symptoms

Slower changes in body morphology

Fewer osteoporotic fractures

Improvement in lipid balance

Reduce IBD flare

Potential Risks

Increase in invasive breast cancer

Side effects: bloating, irritability, weight gain, depression, vaginal bleeding

Increased risk of thromboembolic events (blood clots, stroke)

Increase in CVD

Potential Benefits vs Risks of HRT

Clements D, et al. Gut. 1993;34:1543-1546. Stampfer MJ, et al. N Engl J Med. 1991;325:756-762. Women's Health Initiative. JAMA. 2002;288:321-333.


Hrt guidelines for ibd patients

HRT Guidelines for IBD Patients

  • As with all therapeutic choices, therapy for menopausal symptoms should be individualized

  • For women with severe osteopenia or osteoporosis, HRT benefits may outweigh risks if alternatives are not feasible

  • For women at increased risk for breast cancer, HRT risks may outweigh benefits

  • CVD risk vs benefit is controversial, but risk may outweigh benefit


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