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© 2013 North American Menopause Society. Menopause. 2013;20(9): Key points from the 2013 Position Statement of The North American Menopause Society
Therapeutic goals Alleviate symptoms of VVA Preserve sexual function © 2013 North American Menopause Society. Menopause. 2013;20(9):
Nonprescription therapies Vaginal lubricants and moisturizers — Should be considered first-line therapies — Over-the-counter products can significantly decrease or eliminate symptoms for many women Herbal products have not demonstrated any beneficial effect in clinical trials North American Menopause Society. Menopause. 2013;20(9): © 2013
Prescription therapies Low-dose vaginal estrogen therapy (ET) Ospemifene (indicated for dyspareunia) North American Menopause Society. Menopause. 2013;20(9): © 2013
North American Menopause Society. Menopause. 2013;20(9): US FDA-approved vaginal ET products — Estradiol vaginal cream (Estrace) a — Conjugated estrogen vaginal cream (Premarin) a — Estradiol vaginal ring (Estring) — Estradiol acetate vaginal ring (Femring) b — Estradiol hemihydrate vaginal tablet (Vagifem) All are effective at recommended doses Choice depends on clinical experience and patient preference © 2013 Vaginal ET: Types a Multiple doses available; use low dose for VVA. b This product delivers systemic levels of estradiol.
Vaginal ET: Effectiveness Typically provides greater benefit than nonhormonal interventions Preferred mode of delivery when vaginal symptoms are the only complaint Shown in clinical trials to be more effective than systemic oral ET May also reduce risk of urinary urgency and recurrent urinary tract infections North American Menopause Society. Menopause. 2013;20(9): © 2013
Presumed lower risk than commonly used doses of systemic ET Serum estrogen levels reported with use are within postmenopausal range North American Menopause Society. Menopause. 2013;20(9): © 2013 Vaginal ET: Safety
North American Menopause Society. Menopause. 2013;20(9): Vulvovaginal candidiasis, uterine bleeding, mastalgia, and nausea have been reported; may be dose-related Data for women at high risk for venous thromboembolism are lacking Endometrial carcinoma is a concern with use of ET in women who have a uterus © 2013 Vaginal ET: Adverse effects
Improvement in symptoms typically occurs within a few weeks of starting treatment Vaginal ET may be continued as long as distressful symptoms remain North American Menopause Society. Menopause. 2013;20(9): © 2013 Vaginal ET: Length of therapy
North American Menopause Society. Menopause. 2013;20(9): Insufficient data to recommend annual endometrial surveillance in asymptomatic women Closer surveillance may be required if a woman is — Using a higher dose of vaginal ET — At high risk for endometrial cancer — Having symptoms such as spotting, breakthrough bleeding © 2013 Vaginal ET and endometrial carcinoma
Symptoms of VVA are common among women with breast cancer, especially those on endocrine treatments or aromatase inhibitors For women with a nonhormone-dependent cancer, VVA management is similar to that for women without cancer For women with a hormone-dependent cancer, VVA management depends on each woman’s preference in consultation with her oncologist North American Menopause Society. Menopause. 2013;20(9): © 2013 Vaginal ET and breast cancer
Ospemifene North American Menopause Society. Menopause. 2013;20(9): © 2013 Nonhormonal selective estrogen- receptor modulator (SERM) Only SERM approved in the United States to treat moderate to severe dyspareunia
Ospemifene: Effectiveness North American Menopause Society. Menopause. 2013;20(9): © 2013 Two 12-week studies showed improvements with daily use (60 mg) in — Vaginal maturation index — Vaginal pH — Most bothersome symptom (vaginal dryness) 52-week extension study showed sustained improvements with no cases of venous thromboembolism, endometrial hyperplasia, or carcinoma
Ospemifene: Adverse effects North American Menopause Society. Menopause. 2013;20(9): © 2013 Vasomotor symptoms most common Prescribing information contains precautions similar to those for estrogens and other SERMs Data in women with breast cancer or at high risk of developing breast cancer are lacking
What’s new in Menopausal Medicine Erica Johnstone, MD Feb. 9, 2015.
Postmenopausal vaginal atrophy Presentation by the International Menopause Society for World Menopause Day October 18th, 2010.
Food and Drug Administration Regulatory Implications of The WHI Study Eric Colman, MD Center for Drug Evaluation and Research Division of Metabolic and.
Atrophic Vaginitis Mohamed Kandeel M.B.B.Ch., M.Sc.(Ob/Gyn), M.D.(Ob/Gyn) Professor of Obstetrics and Gynecology Menofyia University Egypt.
Medication Options H ealthPLACE/HOPE Program COPYRIGHT © 2002 Highmark Inc. All Rights Reserved. These materials may not be copied or otherwise reproduced.
Osphena® (ospemifene) Stefanie L Drahuschak University of Pittsburgh PharmD Candidate 2014.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 61 Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications.
The statement was published in the journals of The North American Menopause Society (Menopause), the American Society for Reproductive Medicine (Fertility.
A Comparison of Fulvestrant 500 mg with Anastrozole as First-line Treatment for Advanced Breast Cancer: Follow-up Analysis from the FIRST Study Robertson.
HORMONE REPLACEMENT THERAPY (HRT) Evidence-based Guidelines Dr Mahdy El- Mazzahy Damietta general Hospital 7 th International Annual Congress “Alexandria”
Siraya K. ฮอร์โมนสำคัญ อย่างไรในวัยทอง. Clinical Practice Guideline.
Treatment. Bisphosphonates Promotes bone formation and decreases bone resorption Mechanism of Action First line treatment for osteoporosis in both men.
IS HRT SAFE? Rosol Hamid Consultant O&G. NO What is safe? Driving Swimming Crossing the street Cycling Riding a motor bike Parachute jumping Flying.
Menopause and HRT. AIMS Menopause : How to diagnosis Symptoms Treatments Premature menopause HRT : indications/contraindications.
Menopause Case Study. VETERANS HEALTH ADMINISTRATION Case Study Marion, a 52-year-old female veteran, presents to your office for evaluation of hot flashes.
Premarin 1.25mg Injection In India Conjugated Estrogens Cost premarin without prescriptions side effects long term premarin use premarin and hormone replacement.
Best first ? The ATAC completed treatment analysis Professor Jack Cuzick Wolfson Institute of Preventive Medicine, London, UK.
By: Erin Hutzell. Background: Breast Cancer Second leading cause of death due to cancer among women in in 3 women diagnosed with cancer is diagnosed.
Ibrance ® - Palbociclib Manufacturer: Pfizer FDA Approval Date: February 3, 2015.
POST-MENOPAUSAL SYMPTOMS AND TREATMENT James Simpson Tuesday, April 26 th 2016.
Breast Cancer Mechanisms 1. 2 Her
1 ESTROGENS AND ANDROGENS. 2 Estrogens Natural: Estradiol, estrone & estriol Conjugated: premarin (estrone and equillin) Steroidal synthetic: Mestranol.
GYN ONCOLOGY OBesity Project. “Obesity is linked as a cause of 20% of cancer deaths in women.”
Patient Management Issues in Menopause A CME Slide Library From the Council on Hormone Education.
Bioidentical Hormones W hat Women Need to Know Presented by Daria C Yanez, MD Campus Chief at Riddle Hospital In collaboration with Beverly Vaughn, MD.
Hormone Replacement Therapy 5/11/07 5/11/07Tanu. History of HRT Approximately 100years of research and 80 years of clinical practice Ovarian extracts.
1 Hormone Replacement Therapy (HRT). 2 Recent MHRA/CHM advice Drug Safety Update 2007; 1(2):2-4 The decision to prescribe HRT should be based on a thorough.
SC300 Unit five Prof. Maureen Foley AIM: FoleyMaur.
Hormone Therapy for Menopause: Current Data Jan Shepherd, MD, FACOG.
Herbal way to relieve menopausal symptoms Natural remedies for menopause We often hear women talking about middle-aged menopausal and menopausal symptoms.
To treat or not to treat? Highly individualized. Debilitating symptoms. Mild symptoms.
Midlife Women’s Health Margery Gass, MD, NCMP Executive Director The North American Menopause Society Consultant, Cleveland Clinic Center for Specialized.
Menopausal Hormone Replacement Professor Gordana Prelevic, MD, DSc, FRCP Consultant Endocrinologist Royal Free Hampstead NHS Trust Whittington Health.
Activity of Fulvestrant 500 mg Versus Anastrozole 1 mg As First- Line Treatment for Advanced Breast Cancer: Results From the FIRST Study Robertson JFR.
Menopause occurs when there are no menses for one year The ovaries become dormant and stop making estrogen 95% of women complete menopause between.
Menopause in Women With IBD. Menopause Natural menopause results from gradual decline in number of estradiol-producing ovarian follicles Natural menopause.
HORMONE REPLACEMENT, AN OVERVIEW DR SARAH WHITFIELD.
© Copyright Annals of Internal Medicine, 2016 Ann Int Med. 164 (6): ITC6-1. In the Clinic Breast Cancer Screening and Prevention.
Anastrozole (‘Arimidex’): a new standard of care? Professor Gershon Y. Locker Northwestern University Feinberg School of Medicine, Evanston, IL, USA.
MANAGING THE MENOPAUSE SUMMARY HRT appropriate for moderate to severe symptoms HRT appropriate for moderate to severe symptoms HRT should not be.
The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong.
Date of download: 6/27/2016 From: Systematic Review: Comparative Effectiveness of Medications to Reduce Risk for Primary Breast Cancer Ann Intern Med.
Menopause Case Studies Interprofessional version
Developing clinical stage small molecule therapeutics to treat hormonal and reproductive system disorders.
Asymptomatic Endometrial Thickening in Postmenopausal Patient Dr.Yousefi Professor OF Mashhad University of Medical Sciences Gynecologist Oncologist Society.
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