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

  • 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

  • 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

  • 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

  • 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

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

  • 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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