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?
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