physiology of menopause and the women's health initiative
TRANSCRIPT
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Physiology of Menopause and the Women’s Health Initiative
Michelle Berlin, M.D., M.P.H.Co-Director, OHSU Center for Women’s HealthVice Chair, OHSU Dept of OBGYN
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Key Objectives and Goals
1) Review the changes in hormones that happen at menopause
2) Discuss the major effects of these changes
3) Briefly review the Women's Health Initiative
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Overview
• What is menopause?(Hint: it’s not just that your periods stop)
• What do all the terms mean?• That major study released in 2002..
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Menopause Basics• Definition: cessation of periods for 1
year– Average age: 51– Most common age range: 45-55
• What causes menopause?– Ovaries stop producing estrogen and
progesterone – Estrogen levels decrease as you reach
the menopause, which causes the ovaries to stop producing an egg each month (ovulation).
www.nhs.uk/Conditions/Menopause/Pages/Causes.aspx
https://medlineplus.gov/menopause.html
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Menopause Basics
• Perimenopause (“menopausal transition”)– when periods can become irregular– have some symptoms intermittently– not truly in menopause until no menses x 12
months
• Postmenopausal: after the menopause
www.nhs.uk/Conditions/Menopause/Pages/Causes.aspx
https://medlineplus.gov/menopause.html
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What organs are affected?
Many if not all..
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Terminology
• HRT: hormone replacement therapy– HT: hormone therapy– MHT: menopausal hormone therapy
• What hormones?– E: estrogen– P: progesterone– E+P: estrogen + progesterone
• also called PERT: progesterone & estrogen replacement therapy
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Terminology (cont)
• Genitourinary Syndrome of Menopause (GSM)– Aka “atrophic vaginitis”
• Women’s Health Initiative (WHI)
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Women’s Health Initiative (WHI)
• WHI = 6 studies• 160,000+ women
– 50-79 years of age– enrolled 1993-1998
• 40 clinical centers
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Women’s Health Initiative (WHI)
• Estrogen + Progesterone
• Estrogen only
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Had hysterectomy: Estrogen only
“intact uterus”:Estrogen + Progesterone
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WHI: Estrogen + Progestin Study
• Designed to evaluate if using HRT– decreases the risk of heart disease– increases the risk of breast cancer
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WHI: Estrogen + Progestin Study• 16,600+ women• post-menopausal
– 50-79 years of age– “intact uterus” (had not undergone
hysterectomy)• Assignment:
– half of group: estrogen + progestin– half of group: placebo (“sugar pill”)
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Are the people studied appropriate?
• 16,600+ women• post-menopausal
– 50-79 years of age– “intact uterus” (had not undergone
hysterectomy)
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WHI: Estrogen + Progestin Study Results
Heart disease 29%
Stroke 41%
Blood clot 13%
Breast cancer 26%
Colon cancer 37%
Hip fracture 33%
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Study Results
Additional lives lost/saved
for each 10,000 women
Heart disease 29% 7
Stroke 41% 8
Blood clot 13% 18
Breast cancer 26% 8
Colon cancer 37% 6
Hip fracture 33% 5
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Another way to look at the results..
Placebo HRT (Estrogen +
Progesterone)
Additional/Fewer
Cases
Heart disease 30 37 7 more Stroke 20 29 8- 9 more Blood clot 16 34 18 more Breast cancer 30 38 8 more Colon cancer 16 10 6 fewer Hip fracture 15 10 5 fewer
AMA July 8, 2002
Comparing 10,000 women in one year taking a placebo to 10,000
women taking HRT:
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WHI: Estrogen Only Study
• Designed to evaluate if using Estrogen only– decreases the risk of heart disease– increases the risk of breast cancer
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WHI: Estrogen Only Study
• 10,739 women• post-menopausal
– 50-79 years of age– had undergone hysterectomy
• Assignment:– half of group: estrogen only– half of group: placebo (“sugar pill”)
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Are the people studied appropriate?
• 16,600+ women• post-menopausal
– 50-79 years of age– had undergone hysterectomy
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Another way to look at the results..
Placebo Estrogen
only
Additional/Fewer Cases
Heart
disease - 54 49 5 fewer
Stroke 32 44 12 more Blood clot 15 21 6 more Breast
cancer - 33 27 7 fewer
Colon
cancer - 16 17 6 fewer
Hip fracture 17 11 6 fewer
JAMA April 14,2004
Comparing 10,000 women in one year taking a placebo to 10,000
women taking Estrogen only:
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Timing Hypothesis
“The current study suggest that younger women who use (estrogen) may be at reduced risk of (heart disease) but this possible association may be due to chance.”
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PERSONAL HEALTH
Rethinking the Use of Hormones to Ease Menopause Symptoms By JANE E. BRODY
AUGUST 29, 2016 6:45 AM August 29, 2016 6:45 am 150
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Thank You