kimberly cheatham, md, facog director, ou-tulsa pa program october 26, 2012 hormone replacement...

KIMBERLY CHEATHAM, MD, FACOGDIRECTOR, OU-TULSA PA PROGRAM

OCTOBER 26 , 2012

Hormone Replacement Therapy: A Primer for the

Physician Assistant

Modified from Shapiro M, Goldstein SR, Pinkerton JV, Shifren JL. Customizing therapies to manage menopause-related symptoms. Medscape Women’s Health Education. 2012. Retrieved from http://www.medscape.org/viewprogram/32450?src=0_mp_cmenl_0

Objectives

At the conclusion of this presentation, the physician assistant will be able to:

Recognize the indications and contraindications for patient use of hormone therapy

Create a treatment strategy for patients who desire to use hormone therapy

Provide appropriate counseling to patients considering hormone therapy use

Take-Home MessageIndications

Women < 60 years old or < 10 years from menopause with moderate to severe vasomotor symptoms (hot flashes or night sweats)

Postmenopausal women with symptoms from vulvovaginal atrophy Vaginal dryness Dyspareunia Urge incontinence Recurrent UTI

Women experiencing premature menopause (< 40 y) or premature ovarian insufficiency

Stuenkel, C. A. et al. (2012). A decade after the WHI – the experts do agree.Fertility and Sterility, 98(2), 313-314.

Take-Home MessageTreatment Strategy

HT is the most effective treatment for menopause-related symptoms and their potential consequences (diminished sleep quality, irritability, QOL)

Progestogen therapy is required to prevent endometrial cancer when estrogen is used systemically in women with a uterus

Observational data shows that transdermal estrogen leads to fewer strokes and VTE/PE than oral therapy

Local low-dose estrogen therapy is effective and preferred for women whose symptoms are limited to vaginal dryness or discomfort with intercourse

Stuenkel, C. A. et al. (2012). A decade after the WHI – the experts do agree.Fertility and Sterility, 98(2), 313-314.

Take-Home MessageCounseling

Duration of treatment

Benefit-risk ratio

The lowest dose of HT should be used for the shortest amount of time to manage symptoms

Patient’s risk factors and effects of HT on CHD, stroke, VTE/PE, breast cancer, osteoporosis

DiscontinuanceStuenkel, C. A. et al. (2012). A decade after the WHI – the experts do agree.Fertility and Sterility, 98(2), 313-314.

Resources

Hormone products http://www.menopause.org/publications/clinical-practice-materials/hormone-therapy-charts

NAMS 2012 Hormone Therapy Position Statement http://www.menopause.org/docs/default-document-library/psht12.pdf?sfvrsn=2

NAMS 2007 Position Statement for Local Vaginal Estrogen Treatment of Vaginal Atrophy http://www.menopause.org/docs/2010/psvagestrogen07.pdf?sfvrsn=2

Bioidentical Hormone Therapy http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy

References

ACOG Committee Opinion. Compounded Bioidentical Hormones. Canonico M, et al. Maturitas. 2006; 54: 372-379. Chen WY, et al. Arch Intern Med. 2006; 8; 166: 1027-1032. Hsia J, et al. Arch Intern Med. 2006; 166: 357-365. LaCroix AZ, et al. JAMA. 2011; 305: 1305-1314. Lisabeth L, et al. Lancet Neurol. 2012; 11: 82-91. MacLennan AH, et al. Cochrane Database Syst Rev. 2004; CD002078. Minkin MJ. J Reprod Med. 2004; 49: 311-320. NAMS. Menopause. 2012; 19: 257-271. NAMS. Menopause Practice: A Clinician’s Guide, 4th edition; 2010. NIH. Annals Int Med 2005; 142: 1003-1013. Prescrire Int. 2006; 15: 137-138. Rada G, et al. Cochrane Database Syst Rev. 2010; CD004923. Rossouw JE, et al. JAMA. 2002; 288: 321-333. Salpeter SR, et al. J Gen Intern Med. 2006; 21: 363-366. Santen RJ. J Clin Endocrinol Metab. 2010; 95: s1-s66. Scarabin PY, et al. Lancet. 2003; 362: 428-432. Shapiro M, et al. Medscape Women’s Health Education. 2012. Retrieved from

http://www.medscape.org/viewprogram/32450?src=0_mp_cmenl_0 Stuenkel CA, et al. Fertility and Sterility. 2012; 98(2), 313-314.