Download Hormone Replacement Therapy

University of Southern California
School of Pharmacy
American Pharmacy Student Alliance
Lambda Kappa Sigma
Effective August 2007
Women’s Health Project:
HORMONE REPLACEMENT THERAPY
Protocols & Procedures
POLICY STATEMENT
Since the publication of the Women’s Health Initiative (WHI) study of hormone
replacement therapy, the use of hormone therapy by menopausal women has declined.
Many women and healthcare providers are concerned that hormone replacement therapies
are dangerous to a woman’s health and uncertain about the benefits or when to use
hormone therapy. Prior to the publication of the WHI, about 8 million women who had
undergone hysterectomies were on estrogen therapy, and another 6 million were on a
combination of estrogen and progesterone1. As a result of the study, millions quit
immediately and saw their symptoms rebound. Others stayed on the hormone
replacement therapy but live in fear of the consequences. While hormone replacement
therapy has its risks, it is still the most effective therapy for treating menopausal
symptoms such as hot flashes, night sweats, and sleep disruptions.
The purpose of the project is to provide patient education on menopause and hormone
replacement therapy to pre-menopausal and post-menopausal women. Students will
clarify common misconceptions, explain what the results of the WHI study means, and
offer some lifestyle changes and possible alternative treatments for coping with
menopausal symptoms. In doing so, women will be better able to make decisions about
their own health and take control of their transition through menopause.
INFORMATION BROCHURES
 “Menopause & Hormones”
o www.fda.gov/womens/menopause/mht-FS.html
o FDA & U.S. Department of Health and Human Services
o Can be printed for distribution
 “Facts About Postmenopausal Hormone Therapy”
o www.nhlbi.nih.gov/health/women/pht_facts.pdf
o A 24-page color brochure; NIH publication # 05-5200
1
“Patient Consult: Hormone Replacement Therapy.” U.S. Pharmacist. Vol 27:09.
http://www.uspharmacist.com/index.asp?show=article&page=8_939.htm
HORMONE REPLACEMENT THERAPY
Protocols & Procedures, 2
o $50.00 for 100 copies; can be ordered online or 301-592-8573
 “La menopausia y las hormonas”
o www.fda.gov/womens/menopause/mht-FSspan.html
o FDA & U.S. Department of Health and Human Services
o Can be printed for distribution
 “Important Herbs Used for Menopausal Problems”
o www.holistic-online.com/remedies/hrt/hrt_herbs_for_menopause.htm
o Can be modified and printed for distribution
INFORMATION ON BOARD
 Premature Menopause
o What is it?
o What causes it?
o Why is it important to me?
 Perimenopause, Menopause, & Postmenopause
o What is it?
o What causes it?
o Why is it important to me?
 Symptoms
o Menstrual irregularities
o Lower sex drive
o Hot flashes & sleep problems
o Body & skin changes
o Mood changes
o Loss of bone density
o Vaginal & bladder problems
 Treatment
o Estrogen (Premarin, Climara, Estraderm, Ogen, Cenestin, Estrace,
Menest)
o Progesterone (Provera, Cycrin, Amen)
o Combination therapy (Prempro, Premphase, Femhrt)
 Forms of hormone replacement therapy
o Pills (tablets)
o Vaginal creams
o Patches
o Suppositories
o Injections
o Creams (topical)
o Vaginal Rings
 Lifestyle changes
o Balanced diet & exercise
o Stress management techniques
 Alternative Treatments
o Chasteberry
o Black cohosh
HORMONE REPLACEMENT THERAPY
Protocols & Procedures, 3
o Dong quai
o Soy products
 Isoflavones
o Flaxseed oil
o Vitamin E
o Natural hormonal products
REFERRALS
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Los Angeles Free Clinic (323) 653- 1990
LA County Health Information Line (800) 427-8700
Medi-Cal Information Line (800) 430-4263
LAC/USC Referral Line (323) 226-4970
Partnership for Prescription Assistance (888) 477-2669
www.menopause.org
www.arhp.org
FORMS/QUESTIONNAIRES
 “Hormone Replacement Therapy Trivia”
o A questionnaire form with five True-False questions that women can
answer about menopause and hormone replacement therapy.
o An answer sheet to the questionnaire is given afterwards.
o The questionnaire and answers are available in English & Spanish.
HORMONE REPLACEMENT THERAPY
Protocols & Procedures, 4
HORMONE REPLACEMENT THERAPY
TRIVIA
1) 8 more women out of 10,000 on HRT will get breast cancer compared to
those on placebo. TRUE.
In the WHI (Women’s Health Initiatives) trial, the size of health risks for each
individual woman was small but significant. The risk of breast cancer increased
to 38/10,000 per year compared to 30,000 on placebo.
2) Menopause isn’t all that different from woman to woman. FALSE.
Every woman s different, and each makes the transition through menopause in a
unique way. Some have few or no symptoms, while others may struggle with hot
flashes and other discomforts.
3) If you are under age of 45, you’re too young to be menopausal. FALSE.
It’s unusual for women to go through menopause before age 45. But it’s not
impossible. Whatever the underlying problem may be, when a woman’s ovaries
stop working or are surgically removed before the age of 40, she’s had a
premature menopause.
4) HRT is the only preventative treatment for osteoporosis. FALSE.
HRT should not be the first line of treatment for preventing diseases. If you’re
taking HRT solely to prevent osteoporosis and fractures, consider stopping it
because there are other medications that can help prevent osteoporosis. Other
preventative drug therapies include the family of drugs known as
bisphosphonates, which can reduce the breakdown of bone. Still other options
are the selective estrogen receptor modulators, or SERMs, which are a new
class of synthetic estrogens that act like estrogen.
5) Once you start HRT, you are on it for life. FALSE.
HRT is a very effective treatment for relieving menopausal symptoms such as hot
flashes and night sweats. However, once those symptoms subside, there’s no
reason for you to continue therapy due to increased associated risks of blood
clots, strokes, and breast cancer. Discuss with your physician whether it’s better
for you to stop taking hormones altogether or to go for a more gradual approach.
HORMONE REPLACEMENT THERAPY
Protocols & Procedures, 5
TRIVIALIDADES DE
TERAPIA HORMONAL SUSTITUTIVA
1. Píldoras del control de la natalidad y terapia del reemplazo de la
hormona son iguales – FALSO
2. Si usted está bajo edad de 45, usted es demasiado joven ser menopausal
– FALSO
3. La menopausia no es toda la que diferente de mujer a la mujer – FALSO
4. 8 fuera de 10.000 personas en terapia del reemplazo de la hormona
consigue el cáncer de pecho contra placebo – VERDAD
5. Una vez que usted comience terapia del reemplazo de la hormona, usted
tiene que tomarla para la mentira – FALSO