Professional Documents
Culture Documents
Bioidentical Hormones
Identical to the ovarian hormones produced during
reproductive years
Some are FDA Approved
Some are “Compounded” by Pharmacists
Some are sold on the Internet without a prescription
MENOPAUSAL THERAPIES
Herbals
Eastern Medicine, Alchemy, Witchcraft
Can be helpful and safe
Alternative Modalities
Massage, Acupuncture, Relaxation exercises,
Chiropractic, Nutritional Medicine, Stellate
Ganglion Injection
HT TERMINOLOGY
ET – Estrogen Therapy
EPT – Combined Estrogen-Progestogen Therapy
HT – Hormone Therapy (Encompassing both ET and
EPT
Progestogen – Encompassing both progesterone and
progestin
Systemic Therapy – HT administration that results in
absorption in the blood high enough to provide
clinically significant effects
Local Therapy – Vaginal ET that does not result in
systemic absorption
WHAT ABOUT FDA
APPROVAL?
What does it take to get approval?
How does a Patent influence
approval?
What does it mean to use a drug
“Off Label”?
What is informed consent?
ADDITIONAL TERMINOLOGY
Spontaneous/Natural Menopause
Induced Menopause-surgical/chemorx
Sports Ban
1.5
1 RR
0.5
0
MI CVA DVT FX Colon Breast
What Else Can We Use?
Hot Flashes
Bone Density
Cardiovascular Disease
Colon Cancer
Incontinence
Breast Cancer
Libido
Mood Changes
Memory Deficits
Individualize, New Drugs
SSRI’s, Catapres, Bellergal -FLASHES
Fosamax, Actonel, Boniva, Forteo-BONE
Detrol, Ditropan, Hyoscyamine-INCONT.
Topical Estrogen-BLADDER,VAGINA
Testosterone, DHEA -LIBIDO
Progesterone-MOOD, BLEEDING,SLEEP
Tamoxifen, Evista-BREAST DISEASE
Injections of Neck Nerves-FLASHES
Lifestyle Influences
(Diet, Exercise, Nutriceuticals
Meditation, Stress Management)
Soy, Black Cohosh-FLASHES
Cruciferous (Indole-3-Carbinol)-BREAST
Calcium/Vitamin D-BONE
Folic Acid-MEMORY
B Vitamins-MOOD
Antioxidants-CANCER
Soluble Fiber-COLON
Melatonin-SLEEP
What Do the Experts Now Say?
Benefits
Desires
Continuing Research
Protective Levels
Flushes
Vulvovagina
Uterus
Bone
Breast
Colon
Duration of Treatment
SHORT TERM PROTECTION
To manage immediate flushes, palpitations,
sleep disorders, usually <5 yr. needed
INTERMEDIATE PROTECTION
To manage intermediate vulvovaginal
dryness, dyspareunia, libido, incontinence
LONG TERM PROTECTION
For cardiovascular?, skeletal, colon, CNS
Changed with WHI Study
Goal
Choices which
will allow us to
live the longest
time without
disability or loss
of function
Case Presentation
48 y.o. MWF. LMP 18 months ago.