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Menopause in Women With IBD

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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  1. Menopause in Women With IBD

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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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