Menopausal women

Question 1

Safest hormone replacement

Answer 1

start young. Estradiol likely transdermal <50mcg

Question 2

should we treat premature ovarian failure

Answer 2

yes- decreased risk of coronary heart
disease, osteoporosis and neurodegenerative
disease

Question 3

Endometriosis and hormone replacement

Answer 3

If any residual disease progesterone is required

Question 4

BRCA s/p oophroectomy

Answer 4

Data exists that short-term HT does NOT increase

risk of breast cancer in this population

Question 5

Contraindications for HT

Answer 5

Absolute
 Unexplained vaginal bleeding,
 Active liver disease
 hx of DVT or PE
 known thrombophilia (although transdermal may
be an option)
 history of estrogen-dependent neoplasia
 history of CHD, stroke or TIA
 Relative
 High triglycerides (>400mg/dl)
 gallbladder disease
 elevated breast cancer risk (>5% by NCI
assessment)

Question 6

Alternative

Answer 6

TSEC (tissue-selective estrogen
complex):
Bazedoxifene/conjugated estrogens

Improves vasomotor symptoms
 Reduces vaginal atrophy
 Improves BMD
 Improves QOL, sleep parameters, and sexual
function

Bazedoxifene
 It is a breast antagonist with less fibrocystic
breast disease. Studies have been underpowered
to detect change in breast cancer
 Inhibits endometrial stimulation; 3 year studies
show effect is similar to placebo
 Prevents fractures
 Rate of cardiac disorders, cerebrovascular events
were no different than placebo in osteoporosis
studies
 Increases hot flashes
 Increased DVT risk

Question 7

non-hormone alternative

Answer 7

low dose paroxetine 7.5 mg 
Clonidine 0.1 mg/d
 Gabapentin 900 mg/d
 Pregabalin 75mg bid
 Venlafaxine XR 37.5-75
mg/d

Cognitive Behavioral Therapy
Hypnosis