1. Hormone Replacement Therapy

2. 6/11/2014 OB-GYN Specialists, PC and Covenant Medical Center Hormonal Therapy Beliefs before July 2002 Relieves hot flashes, improves mood, improves sexuality, improves sleep Prevents osteoporosis Prevents heart disease and stroke Improves urinary problems ? Slight increase in breast cancer

3. 6/11/2014 OB-GYN Specialists, PC and Covenant Medical Center Womens Health Initiative Study BIG STUDY! Multiple centers, 27347 patients, wide cross section of women, planned for 8.5 years of study GOOD STUDY! Double blind-neither the patient nor the researcher knows what medication the patient is taking Placebo controlled-patient doesnt know if she is taking ANY medication

4. 6/11/2014 OB-GYN Specialists, PC and Covenant Medical Center Stroke Coronary artery disease Breast cancer Risk Benefit Plan to study until 2005

5. 6/11/2014 OB-GYN Specialists, PC and Covenant Medical Center 26 % increase Breast cancer 29 % increase Coronary artery disease 41 % increase Stroke Risk Benefit

6. 6/11/2014 OB-GYN Specialists, PC and Covenant Medical Center Hormone Use Post WHI Only use in women with moderate to severe symptoms of hot flashes, night sweats, sleep disturbances Limit the total duration If possible use local estrogen therapy for vaginal symptoms Use the lowest dose possible

7. Risks Increase risk of breast cancer (8 per 10,000 users) Increased risk of DVT (8 per 10,000 users) Increased risk of stroke (8 per 10,000 users) Increased risk of cholecytitis/pancreatis Increased risk of MI in patients with coronary artery disease or if long term menopausal

8. No Risk or Benefit Weight gain Osteoarthritis Ovarian/endometrial Cognitive function/dementia Development of coronary artery disease in recently menopausal women

13. Discontinuing HRT Tapering off verses discontinuing abruptly What to do with the lady that cant or wont quit?

14. Bio Identical Hormone Replacement

15. What is it? Not very specific Compounded mix of various hormones –Estrone, estradiol, estriol –DHEA –Testosterone –Natural progestone Mixed may be determined by hormone testing Various routes of absorption

16. Why do this? Pro (as per advocates) –More effective –Safer Con –Costs more –Not always covered by insurance –Lacks scientific basis

17. Concerns Compounding lacks the quality control of traditional products As of 2005, no random clinical trials of compounded products in terms of efficacy and risks