Menopause and Hormone Therapy

2000 double-blind clinical trial on HRT and ERT

(done by WHI)- by 1990s women began asking if all women were on hormones and why all women required the same dose. ~ July 2002- HRT (Prempro) part of the study canceled because of increased incidence of heart disease and breast cancer 26% increase in breast cancer 41% increase in stroke 200% increase in blood clots in legs and lungs NO increase in "quality of life" or memory related issues 2000: ads talked about HRT and ERT as being a lifestyle change with no side effects mentioned 2004: ads talked about NOT being a life-long change with lower dose of hormones (marketing as a new and improved form HRT and ERT after WHI results released) Women taking HRT had: 37% less colorectal cancer 34% less hip fractures (increased bone density) March 2004- ERT part of study canceled because increased risk of stroke outweighed any benefits Changes after WHI results released (besides ad changes): # women taking HRT dropped dramatically Medical attitudes towards HRT changed Symptoms of menopause returned even stronger after women in study stopped taking HRT (after study terminated)

Antidepressants

- SSRIs: Selective serotonin reputake inhibitors such as paxil and prozac which reduce anxiety and mood swings, also used off label for hot flashes - Sarafem: FDA approved to treat PPMD but also used off-label for menopause - Neurotonin (Gabapentin): FDA approved as anti-seizure medication; renal malefaction; nerve damage caused by shingles. Off-label: antidepressant, hot flashes, restless leg syndrome, bipolar disorder, fibromyalgia, brand name lyrica (Study found less effective than placebo altho it was advertised as first non-hormonal medication for menopause)

Other Changes during perimenopause

- considerably shorter cycles - considerably longer periods - Major changes occur in ovaries Potential effects: - lack of energy - hot flashes & palpitations - Depression, anxiety, irritability, mood swings - memory problems, lack of concentration - vaginal dryness, urgency of urination - Bone loss

Hormonal changes of menopause

- lower estrogen (estrone dominates) - lower progesterone - High levels of FSH and LH - no cycles, no menstruation for one year - Same potential effects as perimenopause but more exacerbated or severe

Hormonal changes during perimenopause

1. Lower levels of estrogen - estrone (weaker form of estrogen produced in body fat and ovaries) becomes more dominant 2. Lower levels of progesterone 3. High levels of FSH and LH - follicles stop responding to LH; shorter & more irregular follicular phase; fewer ovulations

Menopause

Amenorrhea (loss of period) for one year (Avg. Age = 45 to 53 years old) - Cessation of estradiol and progesterone production by the ovaries and no menstrual bleeding for 12 consecutive months

Bioidentical Hormone RT

BHRTs are chemically identical in molecular structure to those produced in the female body - Soy and Yams - Manufacturers claim that "natural" is safer than synthetic - "Natrual may simply be an euphemism for "unregulated" - FDA states that BHRT is expected to present the same risks and benefits on non-bioidentical HRT - Mostly used to anti-aging, physicians claim: "help women suffering from imbalances such as low estrogen and progesterone"

Surgical menopause

Can occur at any stage in a woman's life; causes onset of menopause symptoms -Ovariectomy: removal of ovaries causing menopause onset -Complete hysterectomy: uterus and ovaries removed (hysterectomy where only uterus is removed does not onset menopause because the ovaries are still functioning and present)

Hormone Therapy (HT)

ERT: estrogen only for women who had a hysterectomy HRT: estrogen + progestin for women w/intact uterus Conjugate Equine Estrogens (CEE) - mixture Examples: - Premarin (derived from urine of pregnant horses) = most common and longest prescribed type of HRT from 1950s to 1990s - Prempro (with synthetic progestin) - Patches, creams, IUDs, vaginal rings, gels, skin sprays, pills, injections, subcutaneous implants

Medicalization of Menopause

Menopause is neither a disease, nor a disorder and does not automatically require any kind of medical intervention - BUT symptoms should also not be dismissed - Menopause does need careful medical attention since many signs of important diseases can be masked by menopausal symptoms - Medical intervention may be necessary when the physical, mental, and emotional effects are severe

Natural menopause

Natural process occurring on average in US between ages 45 and 53; occurs as a regular process of aging

SERMS

Selective Estrogen Receptor Modulators. Synthetically produced or derived from botanical source (phytostems) Acts selectively as: - Agonists: increase the effect of estrogen ( in bones and blood vessels to help prevent osteoporosis and heart disease) - Antagonist: decreases effects of estrogen (in breast and endometrium to help prevent breast and endometrial cancer) Types: - Raloxifone: (osteoporosis, breast cancer) ---agonist on bone; antagonist at breast & uterus - Tamoxifen (breast cancer): --- Agonist (promotes estrogen) to bone and uterus ---Antagonist (inhibits estrogen) at breast

Postmenopause

Time after 12 consecutive months without a period

Perimenopause

Years leading up to last period