Physiology of Menopause and the Women's Health Initiative
Transcript of Physiology of Menopause and the Women's Health Initiative
Physiology of Menopause and the Women’s Health Initiative
Michelle Berlin, M.D., M.P.H.Co-Director, OHSU Center for Women’s HealthVice Chair, OHSU Dept of OBGYN
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Key Objectives and Goals
1) Review the changes in hormones that happen at menopause
2) Discuss the major effects of these changes
3) Briefly review the Women's Health Initiative
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Overview
• What is menopause?(Hint: it’s not just that your periods stop)
• What do all the terms mean?• That major study released in 2002..
Menopause Basics• Definition: cessation of periods for 1
year– Average age: 51– Most common age range: 45-55
• What causes menopause?– Ovaries stop producing estrogen and
progesterone – Estrogen levels decrease as you reach
the menopause, which causes the ovaries to stop producing an egg each month (ovulation).
www.nhs.uk/Conditions/Menopause/Pages/Causes.aspx
https://medlineplus.gov/menopause.html
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Menopause Basics
• Perimenopause (“menopausal transition”)– when periods can become irregular– have some symptoms intermittently– not truly in menopause until no menses x 12
months
• Postmenopausal: after the menopause
www.nhs.uk/Conditions/Menopause/Pages/Causes.aspx
https://medlineplus.gov/menopause.html
What organs are affected?
Many if not all..
Terminology
• HRT: hormone replacement therapy– HT: hormone therapy– MHT: menopausal hormone therapy
• What hormones?– E: estrogen– P: progesterone– E+P: estrogen + progesterone
• also called PERT: progesterone & estrogen replacement therapy
Terminology (cont)
• Genitourinary Syndrome of Menopause (GSM)– Aka “atrophic vaginitis”
• Women’s Health Initiative (WHI)
Women’s Health Initiative (WHI)
• WHI = 6 studies• 160,000+ women
– 50-79 years of age– enrolled 1993-1998
• 40 clinical centers
Women’s Health Initiative (WHI)
• Estrogen + Progesterone
• Estrogen only
Had hysterectomy: Estrogen only
“intact uterus”:Estrogen + Progesterone
WHI: Estrogen + Progestin Study
• Designed to evaluate if using HRT– decreases the risk of heart disease– increases the risk of breast cancer
WHI: Estrogen + Progestin Study• 16,600+ women• post-menopausal
– 50-79 years of age– “intact uterus” (had not undergone
hysterectomy)• Assignment:
– half of group: estrogen + progestin– half of group: placebo (“sugar pill”)
Are the people studied appropriate?
• 16,600+ women• post-menopausal
– 50-79 years of age– “intact uterus” (had not undergone
hysterectomy)
WHI: Estrogen + Progestin Study Results
Heart disease 29%
Stroke 41%
Blood clot 13%
Breast cancer 26%
Colon cancer 37%
Hip fracture 33%
Study Results
Additional lives lost/saved
for each 10,000 women
Heart disease 29% 7
Stroke 41% 8
Blood clot 13% 18
Breast cancer 26% 8
Colon cancer 37% 6
Hip fracture 33% 5
Another way to look at the results..
Placebo HRT (Estrogen +
Progesterone)
Additional/Fewer
Cases
Heart disease 30 37 7 more Stroke 20 29 8- 9 more Blood clot 16 34 18 more Breast cancer 30 38 8 more Colon cancer 16 10 6 fewer Hip fracture 15 10 5 fewer
AMA July 8, 2002
Comparing 10,000 women in one year taking a placebo to 10,000
women taking HRT:
WHI: Estrogen Only Study
• Designed to evaluate if using Estrogen only– decreases the risk of heart disease– increases the risk of breast cancer
WHI: Estrogen Only Study
• 10,739 women• post-menopausal
– 50-79 years of age– had undergone hysterectomy
• Assignment:– half of group: estrogen only– half of group: placebo (“sugar pill”)
Are the people studied appropriate?
• 16,600+ women• post-menopausal
– 50-79 years of age– had undergone hysterectomy
Another way to look at the results..
Placebo Estrogen
only
Additional/Fewer Cases
Heart
disease - 54 49 5 fewer
Stroke 32 44 12 more Blood clot 15 21 6 more Breast
cancer - 33 27 7 fewer
Colon
cancer - 16 17 6 fewer
Hip fracture 17 11 6 fewer
JAMA April 14,2004
Comparing 10,000 women in one year taking a placebo to 10,000
women taking Estrogen only:
Timing Hypothesis
“The current study suggest that younger women who use (estrogen) may be at reduced risk of (heart disease) but this possible association may be due to chance.”
PERSONAL HEALTH
Rethinking the Use of Hormones to Ease Menopause Symptoms By JANE E. BRODY
AUGUST 29, 2016 6:45 AM August 29, 2016 6:45 am 150
Thank You