What is the primary circulating estrogen before menopause?
What is the primary circulating estrogen after menopause?
What is the metabolism of oral hormone administration?
What is the estrone:estradiol ratio of oral hormone administration?
What is the dosing of oral hormone therapy?
Higher doses than systemic therapy
What is the effect on hepatic proteins and enzymes of oral hormone administration?
Increased synthesis of hepatic proteins and enzymes
What is the metabolism of systemic hormone administration?
Bypasses the GI tract and avoids 1st pass metabolism
What is the estradiol: estrone ratio of systemic hormone administration?
What hormones are most appropriate for urogenital symptoms?
-Vaginal estrogen formulations
-Estrogens well absorbed from vagina
How do transdermal estradiol patches work?
Deliver estradiol to venous circulation at a continuous rate
Where are estradiol patches placed?
Need to rotate sites
What are transdermal gels, emulsions and sprays approved for?
What are potential issues with transdermal gels, emulsions and sprays?
-potential issues with washing or bathing
-transferring onto others through skin contact
-Require QD dosing
What must be given to women with a uterus?
-Prevent endometrial hyperplasia
What is the most effective treatment for hot flashes?
-Decrease hot flashes by mean of 18/week
What is the effect of progestins on hot flashes?
What urogenital symptoms can hormone therapy treat?
How does estrogen therapy prevent osteoperosis?
-Inhibit osteoclastic resorption
-Increase calcium absorption
-Supports survival of osteoblasts
What does treatment with estrogen and progestin definitively help?
What does estrogen definitively help?
What does hormone therapy increase the risk of?
Strokes, blood clots
What are approved indications of hormone therapy in the post-WHI era?
Moderate to severe vasomotor symptoms
-moderate to severe symptoms of vulvar and vaginal atrophy
-Prevention of esteoperosis
What are absolute contraindications to estrogen?
-Estrogen dependent neoplasia
-Abnormal genital bleeding
What are the most common AEs of hormone therapy?
What is the outcome of AEs of hormone therapy?
Typically decrease or disappear over time
How are bioidentical hormones made?
Something to do with salivary hormone concentrations
Reality: No correlation between salivary hormone levels and tissue levels or symptoms
What is the main hormone of bioidentical hormone therapy?
-not approved in any form in the US
What are Soy Isoflavones?
Nonsteroidal compounds with estrogenic activity
What are soy isoflavones said to help?
(epidemoiologic studies in Asians)
What are reported AEs of Black Cohosh?