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Treating Women Transitioning to Menopause HT or Not PowerPoint Presentation

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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 : 1904 | Downloads : 6

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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
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Treating Women Transitioning to Menopause and Beyond Gloria Richard-Davis, MD, FACOG Professor and Division Director, Fertility and Reproductive Services Department of Obstetrics & Gynecology
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Disclosure Pfizer Advisory Board and Consultant
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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
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What is menopause?
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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)
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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
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Terminology: Postmenopause
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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.
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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.
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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.
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Ethnicity in the United States US Census Bureau. Population Projections. Available at: http://www.census.gov/population/www/projections/popproj.html.
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May Issue 2011 Features  Providing culturally competent care for menopausal women   Gloria Richard-Davis, MD, FACOG
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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
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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
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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
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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
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Serum hormone levels at menopause
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Estrogen receptor activity
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Estrogen Loss and Manifestations of Health Risks Over Time
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Vasomotor symptoms
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Hot flash physiology illustration
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Vaginal symptoms
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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)
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Sexual health
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MANAGEMENT OPTIONS FOR MENOPAUSAL SYMPTOMS
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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
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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
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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
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Hormone therapy terminology
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Hormone therapy—what we know today
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North American Menopause Society (NAMS) Updates KEEPS Trial NAMS 2012 Position paper on HT/ET Solidarity statement by NAMS, ASRM, and The Endocrine Society
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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
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KEEPS Trial Overall beneficial effect when newly diagnosed menopausal patients are treated for VMS or vaginal atrophy.
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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)
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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
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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
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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.
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Regimens for Hormone Replacement Therapy
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Counseling
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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
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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
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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
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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
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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.
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Questions??? Reminders: North American Menopause Society (NAMS) Nationally Certified Menopause Provider (NCMP)