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  • Image not available. The decision to use menopausal hormone therapy must be individualized and based on several parameters, including symptoms, osteoporosis risk, cardiovascular disease risk, breast cancer risk, and thromboembolism risk.
  • Image not available. The lowest effective dose of hormone therapy for the shortest duration needed for effective symptom control should be prescribed, weighing the potential benefits and risks for the individual woman.
  • Image not available. Hormone therapy is the most effective treatment option for alleviating vasomotor and vaginal symptoms of menopause.
  • Image not available. Osteoporosis prevention remains an indicated use of estrogen products; however, nonestrogen products, specifically bisphosphonates, are as effective as hormone therapy for preventing osteoporosis.
  • Image not available. Hormone therapy improves depressive symptoms in symptomatic menopausal women, most likely by relieving flushing and improving sleep. However, it may worsen quality of life in women without hot flushes.
  • Image not available. Cardiovascular disease, including coronary artery disease, stroke, and peripheral vascular disease, is the leading cause of death among women. Postmenopausal hormone therapy should not be used for reducing the risk of cardiovascular disease.
  • Image not available. Because of the increased risk of endometrial hyperplasia and endometrial cancer with estrogen monotherapy (unopposed estrogen), hormone therapy in women who have not undergone hysterectomy should include a progestogen in addition to the estrogen.
  • Image not available. Use of hormone therapy at doses lower than those prescribed historically is effective in the management of menopausal symptoms.
  • Image not available. Results from randomized trials of hormone therapy in postmenopausal women cannot be extrapolated to premenopausal women with ovarian dysfunction. Women with primary ovarian insufficiency need exogenous sex steroids to compensate for decreased production by their ovaries.

Upon completion of the chapter, the reader will be able to:

  • 1. Describe the physiology of normal menopause.
  • 2. Identify the contraindications for hormone therapy.
  • 3. Assess the risks and benefits of short-term and long-term hormone therapy in women.
  • 4. Analyze the risks and benefits of individual hormonal regimens for the management of menopausal symptoms.
  • 5. List the factors that would guide selection of a specific hormone therapy regimen for an individual perimenopausal or postmenopausal woman.
  • 6. Describe alternative nonhormonal options for the management of menopausal symptoms.
  • 7. Based on patient-specific data, select an appropriate hormonal or nonhormonal treatment regimen for a postmenopausal woman with vasomotor symptoms.
  • 8. Recommend an appropriate duration of hormone therapy for the treatment of vasomotor symptoms.
  • 9. Select an appropriate hormone therapy regimen for the treatment of menopausal urogenital atrophy.
  • 10. List the benefits and risks of hormone therapy for osteoporosis prevention.
  • 11. Formulate a patient-specific monitoring plan for a perimenopausal or postmenopausal woman on a given hormonal regimen.
  • 12. Explain the pathophysiologic mechanisms underlying primary ovarian insufficiency.
  • 13. Describe the typical clinical features of women with primary and secondary amenorrhea.
  • 14. Recommend an appropriate hormone therapy regimen for girls with primary amenorrhea.
  • 15. Design an appropriate treatment plan for a woman with primary ovarian insufficiency.
  • 16. Propose an appropriate monitoring plan for a woman with primary ovarian insufficiency receiving long-term physiologic hormone replacement therapy.

Menopause is the permanent cessation of menses following the ...

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