Hormone Replacement Therapy

Question 1

Estrogen

Answer 1

Hormone Replacement Therapy
-Estradiol
-first-line therapy for vulvovaginal atrophy
•Oral tablets
•Transdermal: patch, gel, emulsion, spray
•Vaginal ring
•Vaginal cream (goal: local effect)
•Long acting depot injections (estradiol valerate and estradiol cypionate)
-Conjugated estrogens (mix of 6-10 estrogenic substances) (*Premarin) equine from horses.
-Others: esterified estrogens, estropipate
ADE
•If with Uterus: Increased risk of endometrial cancer.
•If without Uterus: Prescribe estrogen without progesterone.
Contraindications
-hx of endometrial cancer

Question 2

Progesterone

Answer 2

Hormone Replacement Therapy
-Progesterone is added to combat the adverse effects of estrogen, esp. endometrial cancer
•Medroxyprogesterone acetate 
•Norethindrone
•Norethindrone acetate
•Oral Capsule: Progesterone

Question 3

Megestrol

Answer 3

Hormone Replacement Therapy

• a synthetic progestin and has the same physiologic effects as natural progesterone
• antianorexic and anticachetic effects
• induction of secretory changes in the endometrium, increase in basal body temperature, pituitary inhibition, and production of withdrawal bleeding in the presence of estrogen.
• Main Indications (not hormone therapy) = Aids or Cancer related Cachexia (wasting of the body), Breast Cancer, Endometrial Cancer

Question 4

Bio-identical hormones

Answer 4

Hormone Replacement Therapy

• custom-made hormone therapy formulations
• Hormones are identical to the hormones used in the ovaries.
• recommended if the patient is allergic to normal HRT
• *Premarin = Pregnant Mare’s Urine, estrogen comes from the horse urine.

Question 5

Ospemifene

Answer 5

Hormone Replacement Therapy

• For moderate to severe dyspareunia (painful sexual intercourse)
• is an estrogen receptor. Agonist/antagonist; it has agonistic effects on the endometrium