Download Free Medical Treating Women Transitioning to Menopause HT or Not PowerPoint Presentation

Treating Women Transitioning to Menopause HT or Not PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Obstetrics & Gynecology, which is titled "Treating Women Transitioning to Menopause: HT or not", to know about perimenopause and menopause, the clinical presentation of menopause and impact on quality of life, and the treatment options for menopausal symptoms.

Tags : Obstetrics, Gynecology, Menopause, perimenopause, menopause, menopausal symptoms

Published on : Jul 18, 2021 | Views : 2185 | Downloads : 6

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Treating Women Transitioning to Menopause: HT or not Gloria Richard-Davis, MD, FACOG Professor and Division Director, Fertility and Reproductive Services Department of Obstetrics & Gynecology
Slide 2-

Treating Women Transitioning to Menopause and Beyond Gloria Richard-Davis, MD, FACOG Professor and Division Director, Fertility and Reproductive Services Department of Obstetrics & Gynecology
Slide 3-

Disclosure Pfizer Advisory Board and Consultant
Slide 4-

Objectives Define perimenopause and menopause Discuss clinical presentation of menopause and impact on quality of life Be able to manage treatment options for menopausal symptoms Identify resources to help patients and providers manage menopause
Slide 5-

What is menopause?
Slide 6-

When is menopause? Naturally (spontaneously) average age 51 Prematurely from medical intervention (eg, bilateral oophorectomy, chemotherapy) at any time from impaired ovarian function Premature ovarian failure or insufficiency (POI)
Slide 7-

Menopause Terminology: STRAW* Staging System *STRAW = Stages of Reproductive Aging Workshop. Soules MR et al. Fertil Steril. 2001;76:875-878. *STRAW+10 Sioban Menopause 2013
Slide 8-

Terminology: Postmenopause
Slide 9-

52% of US population Up to 90% of health care decisions 59% of all prescription drugs purchased 2 out of every 3 health care dollars spent (approximately $500 billion annually) Women account for: In the future, health care providers will spend up to 75% of their time treating women aged 65 years and older. Impact of Women on Health Care CareData Reports, Inc. 1999.
Slide 10-

Age at Menopause Has Remained Constant While Life Expectancy Has Increased Campbell S, ed. The Management of the Menopause and Postmenopausal Years. Baltimore, Md: University Park Press; 1976.
Slide 11-

1North American Menopause Society. 2US Bureau of the Census. Menopause Demographics Approximately 4900 US women enter menopause each day.1 Number of US Women 2 *Estimate.
Slide 12-

Ethnicity in the United States US Census Bureau. Population Projections. Available at: http://www.census.gov/population/www/projections/popproj.html.
Slide 13-

May Issue 2011 Features  Providing culturally competent care for menopausal women   Gloria Richard-Davis, MD, FACOG
Slide 14-

Life expectancy in years for U.S. Women by race/ethnicity, 2007 *Persons of Hispanic origin may be of any race. Source: Day, Jennifer Cheeseman. Population projections of the United States by age, sex, race, and Hispanic origin: 1995 to 2050, U.S. Bureau of the Census, Current Population Reports, P25-1130, U.S. Government Printing Office, Washington, DC, 1996. http://www.cdc.gov/nchs/data/hus/hus10.pdf#022 Health U.S. 2010
Slide 15-

4 Themes Cambio de vida (change of life) Being silent about menopause Trying to be optimistic Getting support Menopause Experience in Hispanic Women Eun-Ok 2009, Health care Women Internat
Slide 16-

Menopause Management- Getting Clinical Care Back on Track HT declined 80% post WHI 35% menopausal women are using compounding hormones ACOG, Endocrine Society, NAMS support use of HT in symptomatic recently menopausal women JoAnn E. Manson, M.D., Dr.P.H., and Andrew M. Kaunitz, M.D. N ENGL J MED 374;9 NEJM.ORG March 3, 2016
Slide 17-

Menopause Management- Getting Clinical Care Back on Track 2009 100 IM residents surveyed 75% considered menopause care important 50% reported low confidence in managing symptoms 33% had no clinical experience managing menopause women in previous 6 months Primary Care and ObGyn residency are often inadequate in menopause management JoAnn E. Manson, M.D., Dr.P.H., and Andrew M. Kaunitz, M.D. N ENGL J MED 374;9 NEJM.ORG March 3, 2016
Slide 18-

Serum hormone levels at menopause
Slide 19-

ppt slide no 19 content not found
Slide 20-

Estrogen receptor activity
Slide 21-

Estrogen Loss and Manifestations of Health Risks Over Time
Slide 22-

Vasomotor symptoms
Slide 23-

Hot flash physiology illustration
Slide 24-

Vaginal symptoms
Slide 25-

Vaginal atrophy illustration Vaginal atrophy as illustrated by contrast of vaginal epithelium in a well-estrogenized premenopausal state (left panel) with a low-estrogen postmenopausal state (right panel)
Slide 26-

Sexual health
Slide 27-

MANAGEMENT OPTIONS FOR MENOPAUSAL SYMPTOMS
Slide 28-

ET with or without progestogen is most effective treatment of menopause-related vasomotor symptoms Almost all systemic HT products are FDA approved for vasomotor symptom relief NAMS Menopause 2012;19:257-71 HT & vasomotor symptoms
Slide 29-

ET is most effective treatment of moderate to severe symptoms of vulvar and vaginal atrophy Many systemic HT and local vaginal ET products are available for treating one or both of these symptoms NAMS Menopause 2012;19:257-71 HT & vaginal symptoms
Slide 30-

FIG. 4. US vaginal MHT use by age group, January 2001 through December 2009, IMS Health, National Disease and Therapeutic Index. MHT, menopausal hormone therapy. Menopause, Vol. 18, No. 4, 2011 NAMS Vaginal Estrogen Use
Slide 31-

Hormone therapy terminology
Slide 32-

Hormone therapy—what we know today
Slide 33-

North American Menopause Society (NAMS) Updates KEEPS Trial NAMS 2012 Position paper on HT/ET Solidarity statement by NAMS, ASRM, and The Endocrine Society
Slide 34-

Kronos Early Estrogen Prevention Study (KEEPS) 727 newly menopausal woman CCE 0.45 mg; TE 0.5 mg (prometrium 200mg x 12d both); placebo Both arms Outcome measures-hot flushes, BMD, CVD biomarkers, coronary artery calcium, cognitive function Outcomes CE-LDL,  HDL, TG; TE- neutral; IR Cognitive function- NO adverse effect both hot flushes, mood & sexual function  bone loss
Slide 35-

KEEPS Trial Overall beneficial effect when newly diagnosed menopausal patients are treated for VMS or vaginal atrophy.
Slide 36-

A Decade After The Women’s Health Initiative— The Experts Do Agree The statement was published in the journals of The North American Menopause Society (Menopause), the American Society for Reproductive Medicine (Fertility and Sterility), and The Endocrine Society (Journal of Clinical Endocrinology and Metabolism)
Slide 37-

By whom? This solidarity statement was prepared by The North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society 12 other leading organizations in women’s health endorsed the statement
Slide 38-

Endorsing organizations Academy of Women’s Health American Academy of Physician Assistants American Academy of Family Physicians American Association of Clinical Endocrinologists American Medical Women’s Association Asociación Mexicana para el Estudio del Climaterio Association of Reproductive Health Professionals National Association of Nurse Practitioners in Women’s Health National Osteoporosis Foundation Society for the Study of Reproduction Society of Obstetricians & Gynaecologists of Canada SIGMA Canadian Menopause Society
Slide 39-

Menopause, Vol. 18, No. 4, 2011 The North American Menopause Society FIG. 1. US reported MHT use by formulation, January 2000 through December 2009, IMS Health, National Disease and Therapeutic Index. MHT, menopausal hormone therapy; WHI, Women’s Health Initiative; E; estrogen; P, progestogen; ET, estrogen therapy; EPT, estrogen + progestogen therapy.
Slide 40-

HR for Clinical Outcomes with CEE-MPA and CEE only Prentice, R Seminar Reprod Med 2014
Slide 41-

Menopause Management — Getting Clinical Care Back on Track JoAnn E. Manson, M.D., Dr.P.H., and Andrew M. Kaunitz, M.D. N ENGL J MED 374;9 NEJM.ORG March 3, 2016 WHI 50-59 YO
Slide 42-

Menopause Management — Getting Clinical Care Back on Track JoAnn E. Manson, M.D., Dr.P.H., and Andrew M. Kaunitz, M.D. N ENGL J MED 374;9 NEJM.ORG March 3, 2016
Slide 43-

HT Decision Use Mod-severe VMS not relieved by lifestyle changes NO contraindications Newly menopause Not Use VMS not bothersome Symptoms only vaginal- use ET Contraindication to E2 Late menopause Contraindications: Breast or endometrial cancer, DVT/PE, CHD, stroke/TIA, and other contraindications to HT ,
Slide 44-

Treatment for Menopausal Symptoms Hormone Therapy (HT) Oral Patch Pellets or cream Gel Spray Prescription vaginal estrogen creams Vaginal estrogen ring or tablet Osphena (ospemifene) Nonprescription vaginal lubricants Alternative treatments black cohosh, soy
Slide 45-

ET Drug Delivery Oral delivery Requires larger total doses than patch ET* Undergoes first-pass hepatic metabolism and is rapidly metabolized by the liver1 Taken once daily Transdermal patch delivery Requires smaller total doses than oral ET* Absorbed through the skin directly into the bloodstream, avoiding first-pass hepatic metabolism1 Applied once or twice weekly *Therapeutic levels are achieved with smaller transdermal doses compared to oral therapy. This does not imply differences in safety or efficacy. 1. Vivelle-Dot Prescribing Information. Novartis Pharmaceuticals Corp; 2004.
Slide 46-

Regimens for Hormone Replacement Therapy
Slide 47-

ppt slide no 47 content not found
Slide 48-

ppt slide no 48 content not found
Slide 49-

ppt slide no 49 content not found
Slide 50-

Counseling
Slide 51-

Components of counseling Listen Respect and validate Build trust Support Nichols MP In: The Lost Art of Listening 2nd ed. New York: Guildford Press, 2009
Slide 52-

Alternatives to hormone therapy Lifestyle changes Try relaxation techniques (eg, yoga, meditation) Eat a healthy diet Get regular exercise Avoid hot flash triggers (eg, caffeine, alcohol, spicy food) Keep cool Dress in layers (eg, light or wicking clothing) Sleep in cool room (eg, fan, thermoregulating pillow) Consume cold drinks Reduce sexual discomfort and increase sensitivity with moisturizers, lubricants, and vibrators
Slide 53-

Alternatives to hormone therapy Non-hormonal prescription drugs (off-label use): Antidepressant SSRIs: fluoxetine, paroxetine, escitalopram SNRIs: venlafaxine and desvenlafaxine Hypnotic Eszopiclone Anticonvulsant Gabapentin Antihypertensive Clonidine Neuropathic pain drug Pregabalin
Slide 54-

Alternatives to hormone therapy (cont’d) Complementary & Alternative Medicine Soy isoflavones Traditional Chinese medicine Herbs Black cohosh Cranberry St. John’s wort Valerian Vitex Over-the-counter hormones (dietary supplements) Topical progesterone Melatonin
Slide 55-

Counseling in Perimenopausal African-American Women A study of 33 African-American and 35 Caucasian perimenopausal women who had similar serum hormone levels and symptoms Pham KT et at. J Gen Intern Med. 1997;12:230.
Slide 56-

Questions??? Reminders: North American Menopause Society (NAMS) Nationally Certified Menopause Provider (NCMP)