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Printable Handouts
Navigable Slide Index
- Introduction
- Learning objectives
- Case study of a 47-year-old woman
- Precision medicine
- Isn’t this what we’ve been doing all along?
- Hormone therapy: balancing benefits and risks
- We need to apply the appropriate tools for the outcomes of interest
- FDA-approved hormone therapy: estrogens vs. progestins
- FDA-approved hormone therapy: SERMs vs. other
- The seven dwarves of menopause
- Benefits of hormone therapy
- The road to menopause
- The burden of VMS
- Natural history of hot flashes
- Duration of vasomotor symptoms: 2008
- New data indicates hot flashes last longer than previously believed
- Timing of onset, race/ethnicity and other factors influence VMS duration
- How many women seek treatment for symptoms?
- Hot flash math - US census data
- Fear of hormone therapy is…
- All hot flash outcomes improve with HT
- HT improves other menopause-associated symptoms
- Terrifying FDA labeling persists for vaginal estrogen products
- Vaginal estrogen use in the WHI OS
- Absolute risks and benefits of MHT
- The WHI RTs - 17 year follow-up
- But doctor, what about my…
- Case study of a 72-year-old woman
- Oral vs. transdermal estrogen and thromboembolic complications
- HT and risk of VTE with oral E2: case control studies
- Clinical guidelines
- The wonderful world of custom compounded bioidentical hormones!
- Absence of evidence is not evidence of absence!
- Case study of a 50-year-old woman
- Inconsistent regulation of BHRT and FDA-approved HT
- Illogical …yes, but it’s caught on!
- Summary
- The bottom line
- Thank you!
Topics Covered
- Common symptoms of menopause
- HT and menopause symptoms
- Hot flashes require long term treatment with HT
- Long term treatment risks
- Long term treatment study
- Non-oral forms of estrogen
- ‘bioidentical’ hormone therapy is not recommended
Links
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Talk Citation
Santoro, N. (2020, June 30). Hormone therapy for menopausal symptoms [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 11, 2024, from https://doi.org/10.69645/SBJT1815.Export Citation (RIS)
Publication History
Financial Disclosures
- Dr. Santoro is on the scientific advisory board and MenoGeniX, Inc. and Astellas/Ogeda, and has stock option ins MenoGeniX, Inc. She has received funding from the National Institute on Aging (NIA) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
Other Talks in the Series: The Female Reproductive System: from Basic Science to Fertility Treatments
Transcript
Please wait while the transcript is being prepared...
0:00
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.
0:14
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.
0:37
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.
1:39
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.