Hormone Replacement Therapy SEMC Women’s Expo Karlyn Armbruster, MD September 27, 2014

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

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

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

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

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

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

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

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

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

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

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

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.

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

THANK YOU! Questions?