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What is the primary circulating estrogen before menopause?

Estradiol

What is the primary circulating estrogen after menopause?

Estrone

What is the metabolism of oral hormone administration?

1st pass

What is the estrone:estradiol ratio of oral hormone administration?

Higher

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?

More physiologic

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?

-Abdomen
-Buttocks
-Upper arm
Need to rotate sites

What are transdermal gels, emulsions and sprays approved for?

Vasomotor symptoms

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?

Progestin
-Prevent endometrial hyperplasia

What is the most effective treatment for hot flashes?

Hormone therapy
-Decrease hot flashes by mean of 18/week

What is the effect of progestins on hot flashes?

No effect

What urogenital symptoms can hormone therapy treat?

-Urogenital atrophy
-Overactive bladder

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?

Colon Cancer
Fractures

What does estrogen definitively help?

Fractures

What does hormone therapy increase the risk of?

Strokes, blood clots
Dementia

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?

-Breast cancer
-Estrogen dependent neoplasia
-Thromboembolic disease
-Abnormal genital bleeding

What are the most common AEs of hormone therapy?

Breast tenderness
Headache
Irregular bleeding

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?

Estriol (E3)
-not approved in any form in the US

What are Soy Isoflavones?

Nonsteroidal compounds with estrogenic activity

What are soy isoflavones said to help?

Breast cancer
Hot flashes
(epidemoiologic studies in Asians)

What are reported AEs of Black Cohosh?

GI Upset
Headache
Dizziness
Hepatotoxicity

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