1. Hormone Replacement Therapy
SEMC Women’s Expo
Karlyn Armbruster, 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?