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MENOPAUSE &
HORMONE
REPLACEMENT
THERAPY
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“Like an electrical
current, menstruation
and the ebb and flow of
energy is an alternating
current.”
- Farida Shaw -
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INTRODUCTION
OLDER POPULATION BY AGE, 19002050
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PERSPECTIVES
ON MENOPAUSE
ECONOMIC & GLOBAL DIMENSIONS
Total Annual Costs of Menopause:
Urogenital tract health issues = $125 million
Menopause/physiological disturbances = $480
million
Skeletal issues and osteoporosis = $540 million
Cardiovascular and cerebral disease = $1.1 million
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Total Annual Costs of Hormone
Replacement Therapy, in Millions
Europe
Latin America &
Canada
US
900
300
2500
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Prevalence of Hormone
Replacement Therapy Around
the World, 1999
In France = 47% of eligible women took HRT
In United States = 25% of eligible women took
HRT
In Germany = 25% of eligible women took HRT
In Italy = 3% of eligible women took HRT
In Japan = 2% of eligible women took HRT
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MENOPAUSE
NATURAL MENOPAUSE
Perimenopause –  estrogen levels and sporadic ovulation
Ovaries begin to fail to respond to the luteinizing and folliclestimulating hormones
Ovaries producing  levels of estrogen and progesterone in
response
Menstruation ceases
SURGICALLY INDUCED MENOPAUSE
Hysterectomy – removal of both ovaries and fallopian
tubes
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4 TYPES OF HYSTERECTOMY
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HYSTERCTOMY RATES, BY
GEOGRAPHIC REGION, U.S., 1994-1999
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HEALTH EFFECTS
OF MENOPAUSE
ASSOCIATED EFFECTS
Hot flashes
Vaginal discharge
Urinary incontinence
 vaginal lubrication
Thinning hair
Vaginal infections
 incidence depression Urinary tract infections
Insomnia
 libido
Vaginal atrophy
Painful intercourse
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LONG-TERM EFFECTS
 HDL levels
 LDL levels
Postmenopausal Cardiovascular Disease
Osteoporosis
Affects 25 million American women
Osteopenia
Curvature of Spine
Alzheimer’s Disease
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PREVALENCE OF LOW FEMUR BONE
DENSITY IN U.S. WOMEN OVER 50,
1988-1994, BY RACE
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MENOPAUSAL
MANAGEMENT
HORMONE REPLACEMENT THERAPY
3 Types :
1. Estrogen alone
2. Estrogen + Progesterone
3. Estrogen + Progesterone + Testosterone
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3 Types of Preparation:
Oral Preparation
Natural Estrogen
Synthetic
Progestin
Combination Therapy
Selective Estrogen Receptor Modulators
Vaginal Cream
Vaginal Ring
Transdermal Patch
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HRT RISK FACTORS
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OTHER MENOPAUSE MANAGEMENT
METHODS
Regular Exercise
Weight-bearing exercise (osteoporosis)
Aerobic exercise (CVD)
Proper diet
 fruits/vegies,  whole grains,  saturated
fats,  cholesterol,  calcium, vitamin C,D,E
Herbal Medicine
Black cohosh, Vitex, Dong quai
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Regular Exercise Can Help
Can improve: insomnia, depression, other mood
changes, weight gain, headache
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INFORMED
DECISION MAKING
Conditions That May Preclude
the Use of HRT
Personal history of breast cancer
History of blood clots in legs, lungs, or eyes
Undiagnosed or abnormal vaginal bleeding
Preexisting cardiovascular conditions, such as blood
clots, stroke, or uncontrolled hypertension
History of liver, gallbladder, or pancreatic disease;
impaired liver function