Hormone Replacement Therapy

04/19/23OB-GYN Specialists, PC and Covenant Medical Center

Hormonal Therapy Beliefs before July 2002

Relieves hot flashes, improves mood, improves sexuality, improves sleep

Prevents osteoporosis Prevents heart disease and stroke Improves urinary problems ? Slight increase in breast cancer

04/19/23OB-GYN Specialists, PC and Covenant Medical Center

Women’s Health Initiative Study BIG STUDY!

Multiple centers, 27347 patients, wide cross section of women, planned for 8.5 years of study

GOOD STUDY! Double blind-neither the patient nor the

researcher knows what medication the patient is taking

Placebo controlled-patient doesn’t know if she is taking ANY medication

04/19/23OB-GYN Specialists, PC and Covenant Medical Center

Stroke

Coronary artery diseaseBreast cancer

Risk Benefit

Plan to study until 2005

04/19/23OB-GYN Specialists, PC and Covenant Medical Center

26% increase Breast cancer

29% increase Coronary artery disease

41% increase Stroke

Risk Benefit

04/19/23OB-GYN Specialists, PC and Covenant Medical Center

Hormone Use Post WHI Only use in women with moderate

to severe symptoms of hot flashes, night sweats, sleep disturbances

Limit the total duration If possible use local estrogen

therapy for vaginal symptoms Use the lowest dose possible

Risks

• Increase risk of breast cancer (8 per 10,000 users)

• Increased risk of DVT (8 per 10,000 users)

• Increased risk of stroke (8 per 10,000 users)

• Increased risk of cholecytitis/pancreatis• Increased risk of MI in patients with

coronary artery disease or if long term menopausal

No Risk or Benefit

• Weight gain• Osteoarthritis• Ovarian/endometrial• Cognitive function/dementia• Development of coronary artery

disease in recently menopausal women

Discontinuing HRT

• Tapering off verses discontinuing abruptly

• What to do with the lady that can’t or won’t quit?

Bio Identical Hormone Replacement

What is it?

• Not very specific• Compounded mix of various hormones

– Estrone, estradiol, estriol– DHEA– Testosterone– “Natural” progestone

• Mixed may be determined by hormone testing

• Various routes of absorption

Why do this?

• Pro (as per advocates)– More effective– Safer

• Con– Costs more– Not always covered by insurance– Lacks scientific basis

Concerns

• Compounding lacks the quality control of traditional products

• As of 2005, no random clinical trials of compounded products in terms of efficacy and risks