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Health and Hormone Therapy – Women

Therapies

Menopause   |   Coronary Artery Disease   |   Osteoporosis   |   Bio Identical Hormones

 

Patient Protocol

 

Evidence-Based Treatment Options

Our Purpose

Our purpose is to provide personalized menopause counseling.

Our Goals

Our goals are to develop a partnership that provides a comprehensive review of a woman’s past medical and family history, the results of a recent physical examination and her current use of medications and supplements. And, to provide personalized treatment options and enhance a woman’s confidence in the decision making process of hormone replacement.

Counseling and Decision Making

If a therapy is chosen, the patient and physician should agree on goals, whether they are short-term (menopause symptom relief), long-term (primary or secondary relief of diseases associated with aging), or both. Routine follow-up is essential to achieving therapeutic goals as some women may experience side effects or not achieve their desired benefits.

 

Menopause

MENOPAUSE – The Facts

  • The average age of a woman at menopause is 51 (>90% by age 55)
  • Most women begin “perimenopause” around the age of 47
  • Perimenopause usually lasts 4-5 years (sometimes as short as 2 years)
  • Perimenopausal changes include changes in the amount or duration of menstrual flow and the length of a cycle
  • There is a risk of unintended pregnancy during perimenopause
  • Symptoms most commonly associated with hormonal status (estrogen and progesterone deficiency-related menopause symptoms) are:
    – Hot flashes, day sweats, and/or night sweats
    – Vaginal dryness/painful intercourse

MENOPAUSE – The Benefits of Hormone Therapy

  • Improved sleep quality (i.e., increased duration of REM sleep)
  • Reduction of the time it takes to fall asleep in menopausal women
  • Epidemiological studies consistently find that women using ERT/HRT have a 40-50% lower risk of dying of coronary heart disease than women who do not take ERT/HRT.
  • Prevention of osteoporosis

MENOPAUSE – Treatment Options – Hot Flashes

  • Non-pharmacologic
    – Dress in layers
    – Identify and avoid triggers (e.g., hot rooms)
    – Exercise (aerobically)
  • Pharmacologic
    – ERT/HRT
    – Clonidine
    – Low dose oral contraceptives (20 mcg estrogen)
    – Herbal preparations/dietary supplements

 

Coronary Artery Disease

CORONARY ARTERY DISEASE – Treatment Options

  • Assessment of and counseling on risk factors
  • Smoking cessation
  • Healthful diet (fat, cholesterol, salt, high fiber)
  • Weight loss if overweight and exercise
  • Stress management
  • Control of blood pressure if elevated
  • Control of diabetes if present
  • Total cholesterol, LDL, HDL, and triglycerides
  • ERT/HRT
  • Antioxidants (e.g., vitamins C and E)
  • Adequate folic acid

 

Osteoporosis

OSTEOPOROSIS – Treatment Options

  • Assessment of and counseling on risk factors
  • Dietary calcium 1,500 mg daily
  • Vitamin D 5,000 units daily
  • Exercise
  • Fall prevention
  • Smoking cessation
  • Limit alcohol
  • Bone mineral density (BMD) testing for:
    – postmenopausal women with fractures
    – postmenopausal women under 65 w/ > 1 risk factor

OSTEOPOROSIS – Consider Treatment for the Following

  • All postmenopausal women who present with vertebral or hip fractures, or have a BMD T-score < -2 (or < -1.5 if they have additional risk factors)
  • ERT/HRT – Effective for the prevention and treatment of postmenopausal osteoporosis for the duration during which it is used
  • It prevents bone loss in women in the early and late postmenopause
  • Epidemiologic studies of ERT/HRT indicate a 50-80% decrease in vertebral fractures and a 25% decrease in nonvertebral fractures with five years or more of use

OSTEOPOROSIS – Treatment

  • Alendronate
  • Risedronate
  • Raloxifene
  • Calcitonin
    – Soy/phytoestrogens
    – Calcium and Vitamin D (these should be considered supplemental as they are not sufficient by themselves)

 

Bio Identical Hormones

  • The studies reviewed suggest bioidentical progesterone does not have a negative effect on blood lipids or vasculature as do many synthetic progestins, and may carry less risk with respect to breast cancer incidence. Studies of both bioidentical estrogens and progesterone suggest a reduced risk of blood clots compared to non-bioidentical preparations. Bioidentical hormone preparations have demonstrated effectiveness in addressing menopausal symptoms. – Altern Med Rev. 2006 Sep;11(3):208-23
  • Patients report greater satisfaction with HRTs that contain progesterone compared with those that contain a synthetic progestin. Bioidentical hormones have some distinctly different, potentially opposite, physiological effects compared with their synthetic counterparts, which have different chemical structures. Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins. Estriol has some unique physiological effects, which differentiate it from estradiol, estrone, and CEE. Synthetic progestins have a variety of negative cardiovascular effects.
  • Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly. – Postgrad Med. 2009 Jul;121(4):172
  • Early evidence suggests that ERT/HRT may prove beneficial for the prevention and/or treatment of the following conditions, but more research is needed:
    – Alzheimer’s Disease
    – Colon Cancer
    – Macular Degeneration

 

Patient Protocol

HORMONAL DEFICIENCIES can negatively affect the way a women feels, thinks and sleeps. Hormone replacement involves the use of bio-identical creams, patches, capsules or lozenges to help raise reproductive hormone levels to a physiological suitable range in an effort to lessen symptoms.

  1. The initial visit will involve a review of the medical history, family history, medication history and physical exam. You will also be asked to complete a hormone symptom questionnaire. This will be used to follow changes in symptoms.
  2. Morning lab work will be obtained to determine hormone levels. Fasting blood work is recommended to also assess cholesterol and blood sugar levels.
  3. A one-week follow-up is scheduled. At the follow-up visit, labs tests are reviewed and hormones are prescribed as medically necessary.
  4. After beginning hormone replacement, a 6-8 week re-check of morning hormone levels are required. No appointment is needed for this blood test. Schedule a one-week follow-up appointment at that time to review your symptoms and hormone levels.
  5. If you symptoms are improved and your blood tests support physiologic levels, a 6 month refill of hormone therapy is prescribed.
  6. At the 6 month follow-up visit, it is recommended that you have your morning hormone blood levels drawn in our office one-week prior to your visit.
  7. If you symptoms remain controlled and your hormone levels remain therapeutic, a 6-12 month follow-up is scheduled. If symptoms are not well controlled and hormone levels are not therapeutic, dosing changes will be made.
  8. It is imperative that each patient understands that once hormonal balance is a achieved an annual physical exam and lab work are required. Please understand that there are no exceptions as regular monitoring and documentation is essential.
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