Hormone Replacement Therapy

1. Hormone Replacement Therapy SEMC Women’s Expo KarlynArmbruster, MD September 27, 2014

2. Menopause • Menopause occurs when there are no menses for one year • The ovaries become dormant and stop making estrogen • 95% of women complete menopause between ages 45-55, with a mean age of 51 years

3. Menopause • A lucky few breeze through with minimal ill effects…. • But the majority of women experience some degree of menopausal symptoms • Hot flashes • Mood lability • Trouble sleeping • Vaginal atrophy

4. Vaginal Atrophy • The vaginal tissues are very sensitive to estrogen, and estrogen deficiency leads to thinning of the tissues. This is called vaginal atrophy or “atrophic vaginitis” • Symptoms of atrophic vaginitis • Dryness Pain with intercourse • Itching Urinary frequency • Burning Frequent urinary infections

5. What is hormone replacement? • Taking medications which contain estrogen (with or without progesterone) when the body no longer makes it • Hormone replacement is the best way to alleviate the undesirable effects of menopause

6. Then why doesn’t everyone take hormones? • A clinical trial showed that in some women, hormone therapy may increase risk of • Cardiovascular problems (heart attack and stroke) • Blood clots • Breast cancer • Uterine Cancer

7. Who might consider hormone therapy? • Women who have moderate-severe hot flashes • Women who suffer from symptoms of vaginal atrophy • Women who have NO personal history of • Breast, Ovarian, or Endometrial Cancer • Heart Attack • Stroke • Blood clots • Liver Disease

8. Who might consider hormone therapy? • Women who went through menopause prior to age 45 • Some women with osteoporosis • Women who do not smoke • Ideally, women who are younger than 60 • Women with a family history of breast cancer need to have a conversation with their doctors to weigh their own personal potential risks and benefits

9. In what forms is hormone replacement available? • Oral tablets • Patches • Vaginal creams* • Vaginal tablets* • Vaginal rings* • The vaginal preparations work better for vaginal atrophy and in low dose preparations, probably have less systemic side effects

10. How do I minimize my risks? • Hormone replacement therapy is not all good, but it is NOT all bad! • You should take the lowest effective dose, for the least amount of time necessary • Most women do well with 1-2 years of therapy • Ideally less than 5 years

11. What are the alternative therapies? • Some women cannot, or elect not to, take hormone replacement therapy • Keep cool! • Minimize caffeine and alcohol intake • Keep weight down • Don’t smoke • Acupuncture? • Some medications used for depression can help with mood swings and even hot flashes

12. What about over-the-counter medications? • “Phytoestrogens” • Soy, isoflavones, red clover, flaxseed • Compounds found in many plants, fruits, vegetables • Mimics estrogen effects in the body • Black Cohosh • Mimics estrogen effects, especially on the breast. Therefore it is not safe for those with breast cancer or high risk. • Evening Primrose Oil • Has not been proven to be effective

13. Over-the-counter medications • None have been proven to be more effective than placebo for alleviating menopausal hot flashes • They may increase breast cancer risk or encourage tumor growth • Bottom line – probably not worth the money.

14. In Summary • Hormone replacement therapy is not for everyone, but can be very safe and effective for many women! • Talk with your doctor!

15. THANK YOU! Questions?