Menopause hormone therapy

Anna Fenton discusses some more complex cases of menopause hormone therapy in perimenopausal women.

Topics

Intro.
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Case 1: A request for MHT to prevent osteoporosis and dementia.
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Case 1: bone density scan shows low bone mass on both hip and lumbar spine.
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Do doses of MHT need to be higher for osteoporosis prevention?
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Lifestyle and exercise advice for bone density
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Case 2: History of DVT so prescribed an SSRI but patient insists on MHT
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DVT - provoked or unprovoked?
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Additional investigations to consider
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Case 2: provoked DVT following fracture, do we now prescribe DHT?
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Case 3: Breast cancer 10 years prior
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Case 3: What about topical estrogen?
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Case 3: Stubborn patients and multidisciplinary decision making
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Case 3: Do we increase our breast imaging frequency?
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Case 4: History - hysterectomy & pelvic clearance for endometriosis, transdermal E patches, abdominal pain, hot flushes. Asking for progesterone.
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Take-home messages
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Take home messages

MHT is the most effective option for managing perimenopausal and menopausal symptoms
MHT prevents bone loss although the effect is dose dependent
Transdermal estrogen, based on observational data, is safer than oral estrogen with respect to VTE risk
There is a window of opportunity with MHT use early in menopause to reduce the risk of coronary artery disease and all -cause mortality
Consider the entire medical history of the patient when prescribing MHT and this includes considering the use of a progestogen in women with a history of complicated endometriosis

Resources

Perimenopause or Menopausal Transition Australasian Menopause Society
Lifestyle and behavioural modifications for menopausal symptoms Australasian Menopause Society
NonHormonal Treatments for Menopausal Symptoms Australasian Menopause Society

Presenter

Anna Fenton

Gynaecological Endocrinologist

Anna completed her medical degree at the University of Auckland School of Medicine, a PhD at the University of Melbourne and post-doctoral research in San Francisco. She was involved in establishing the New Zealand branch of the Australasian Menopause Society and has served on the board of Osteoporosis New Zealand and as President of the Australasian Menopause Society. She is a previous Co-Editor-in-Chief of Climacteric, the journal of the International Menopause Society. She was the founding partner of Auckland Bone Density, the first physician-led private bone density service in New Zealand. Anna is currently the clinical leader for the Te Whatu Ora Waitaha Bone Density Service and works in private practice as a gynecological endocrinologist. She is actively involved in postgraduate teaching and public education.