Hormone therapy for menopausal symptoms

Published on June 30, 2020   36 min

Other Talks in the Series: The Female Reproductive System: from Basic Science to Fertility Treatments

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My name is Nanette Santoro. I am the E. Stewart Taylor Chair of Obstetrics and Gynecology at the University of Colorado School of Medicine, and I will be speaking about hormone therapy for menopausal symptoms.
The learning objectives for this presentation are really to look over the symptoms that are most likely to be relieved by hormone therapy, and to review the policy of shared decision-making, and how to engage in that process with patients regarding the risks, benefits, personal preferences and route of administration of hormone therapy, because there are so many choices.
This slide is a case study of a 47-year-old woman who has irregular menses and night sweats that she describes as drenching around the time of her menses, otherwise, she's healthy. What would you choose as the most appropriate treatment for her night sweats? The highlighted answer here would be a combination of estradiol and norethindrone transdermal patch, which is the best option from among these choices because drenching night sweats are unlikely to be relieved by cognitive behavioral therapy. While the clonidine patch might be effective, there's no contraindications to hormone therapy in this patient, and that will be more effective. Giving her intermittent transdermal estradiol the week before an anticipated menstrual period might work, except for the fact that this patient is having irregular menses. So her ability to be able to time that would be difficult and one would be concerned about unopposed estrogen in that setting, and levonorgestrel IUD would do little to treat her hot flashes directly, since it only contains progestogen.
In order to operate in a shared decision-making model, I'd like to use the concept of precision medicine, because I really feel that this is what we do when we prescribe hormone therapy for patients. The NIH definition of this is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.