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Menopause Therapy for Healthy Women And for Women with Diseases



Permanent cessation of menstruation due to low endogenous estrogen production


Lack of ovarian follicular development despite increased gonadotropin stimulation


Hypoestrogenism - an endocrine deficiency

Perimenopausal Healthy Women with Uterus

Optimal treatment is low dose OC

Switch to HRT when FSH T& E2


Urogenital Symptoms Associated with Menopause
Urinary Genital
Frequency Irritation
Urgency Burning
Nocturia Leukorrhea
Incontinence Dyspareunia

Decreased vaginal secretions

Shortening/lessening of vaginal distensibility

Effects of Short-Term ERT on the Urogenital Tracts
Restores glycogen disposition
Promotes return of normal pH and bacterial flora
Reduces recurrent urinary tract infections
Improves urethral function, including strengthening muscle contractility and tone
Reduces urinary incontinence
Improves vaginal blood flow

Skeletal Changes after Menopause

Cortical Bone - 80% (limbs)

Trabecular Bone - 20% (spine & distal radius)

Postmenopausal bone loss occurs for 15 yrs

Trabecular bone: 5%/yr

Cortical bone: 1-2%/yr


Trabecular bone 4, 50%

Cortical bone ,I, 30%

Demography of Osteoporosis in U.S. Women n ~ 20 million

Annual incidence Fx = 1.2 million

Vertebral Fx ~ 600,000/year

Hip Fx  200,000/yr

Mortality 10%

Nursing home - 150,000

Health care costs " $6 billion/year

Postmenopausal Bone Loss

Etiology    Rate bone resorption

ERT:    Rate bone resorption

Stabilizes bone mass

Bone formation unchanged

Stopping ERT results in Bone Loss

Need ERT >5 yrs to Fx

Should take ERT >15 yrs

Major CHD in Nurses Health Study

Follow up Study 60,000 PM Women

Risk of CHD in Current HRT Users According to Dose of Estrogen

Estrogen replacement Therapy/CHD

Angiographic Studies

Mechanisms of Cardioprotection by ERT

1. Altering lipid profile

2. Arterial blood flow

3. Antioxidant activity

4. N.O. endothelial synthesis

5. Acetylcholine reversal

6. ACE activity

Meta-Analysis of HRT and Risk of Colorectal Cancer

Use of Postmenopausal ERT Increases Life Span of Women

Retards development of atherosclerosis (~MI)

Reduces incidence of senile dementia (A.D.)

Lowers risk of hip fractures

Reduces Incidence of colorectal cancer

Increased survival rates after breast cancer dx (indirect)

What should Clinicians Tell Women About Exogenous Estrogen and Breast Cancer Today

Analysis of vast amount of epidemiologic data indicates exogenous estrogen in OCs does not Initiate breast cancer in women.

Exogenous estrogen can stimulate growth of occult breast cancer. This action Increases likelihood of early diagnosis and permanent cure.