Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Hormone replacement therapy Paul B. Marshburn MD & Bruce R. Carr MD To cite this article: Paul B. Marshburn MD & Bruce R. Carr MD (1992) Hormone replacement therapy, Postgraduate Medicine, 92:4, 145-159, DOI: 10.1080/00325481.1992.11701471 To link to this article: http://dx.doi.org/10.1080/00325481.1992.11701471
Published online: 17 May 2016.
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Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [RMIT University Library]
Date: 20 June 2016, At: 09:02
-(£tME Hormone replacement therapy credit article
Protection against the consequences of menopause Paul B. Marshburn, MD Bruce R. Carr, MD
Postgraduate Medicine 1992.92:145-159.
Preview After the menopause, a woman's risk of cardiovascular disease increases sharply. In this article, Drs Marshburn and Carr describe the benefits that hormone replacement therapy can provide in regard to this and other postmenopausal problems. They also discuss the risks associated with such therapy, make screening recommendations, and weigh the relative merits of cyclic versus continuous therapy.
As women approach the menopause, ovarian follicles become depleted and serum concentrations of gonadotropins (luteinizing hormone and follicle-stimulating hormone) rise. Eventually ovarian follicular development fails in spite of rising levels of gonadotropins, and menstrual function ceases. Sherman and colleagues' have demonstrated that hormonal changes begin about 5 years before the menses stop completely. Therefore, signs and symptoms of hypoestrogenemia develop before menopause in many women. These include hot flushes, neuropsychological changes, urogenital atrophy, urge and stress urinary incontinence, skin atrophy, osteoporosis, and atherosclerosis. The approximate time course of the appearance of symptoms is presented in figure 1. Virtually all symptoms of menopause result from lack of estrogen, and appropriate hormone replacement
therapy can alleviate most of them. On average, one third of a woman's life takes place after menopause. During that time, her risk of cardiovascular disease and osteoporosis rises dramatically. Long-term hormone replacement therapy can greatly reduce these potentially lethal risks and also ameliorate the signs and symptoms of hypoestrogenemia. Combining such therapy with the institution of other preventive health measures can significantly extend a woman's life and improve its quality. Noncardiovascular protection Increased cardiovascular risk may be the most life-threatening consequence of menopause, but several noncardiovascular consequences also deserve attention. Hot flushes result from aberrant thermoregulatory control. The changes in control are secondary to the impact of estrogen
VOL 92/NO 4/SEPTEMBER 15, 1992/POSTGRADUATE MEDICINE • ESTROGEN REPLACEMENT
withdrawal on catecholamine function in the hypothalamus. Peripheral vasodilation accompanied by sweating and the perception of cutaneous heat is very annoying and induces insomnia, depression, and irritability. About 75% of all postmenopausal women experience hot flushes, which may occur for several months or several years. The best treatment is hormone replacement therapy. 2 Reduced estrogen levels also give rise to atrophy of the vagina, urethra, trigone of the bladder, and pubococcygeal muscle. Atrophic vaginitis is a condition of thinning and friability of the vaginal mucosa that is accompanied by itching, burning, vaginal dryness, dyspareunia, and, at times, vaginal bleeding. Stress incontinence and urge incontinence are aggravated by hypoestrogenemia because it causes urethral epithelial thinning, decreased urethral tone, and bladder trigone irritability. Hormone replacement therapy reverses the symptoms of atrophic vaginitis and often relieves the symptoms of urge and stress incontinence. 3-5 Anxiety, depression, irritability, and fatigue increase after menopause. These central nervous system-related symptoms have been thought to be due,
continued
145
Postgraduate Medicine 1992.92:145-159.
Appropriate honnone replacement therapy has been found to diminish the risk of ann and hip fractures.
fractures when administered with supplemental calcium. 10 Thus hormone replacement therapy should be considered and discussed with patients. In addition, physicians need to educate women about known epidemiologic risk factors for osteoporosis: sedentary life-style, calciumdeficient diet, thin body habitus, and smoking.
Figure 1. Typical time course of menopausal symptoms.
Adapted, with permission, from Van Keep PA and Kellerhals J. The aging woman. Front Harm Res 1973;2:160-73.
at least in part, to sleep loss from hot flushes. However, an independent salutary effect of hormone replacement therapy on poor memory, anxiety, and worry about oneself has been reported. 6•7 Osteoporosis is a reduction in the quantity of bone rather than a change in its chemical composition. The incidence of hip frac-
146
tures in white women increases from 0.3 per 1,000 at age 45 to 20 per 1,000 at age 85, and 80% of these fractures are associated with osteoporosis. 8 Appropriate hormone replacement therapy has been found to diminish the risk of arm and hip fractures by 50% to 60
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Hormone replacement therapy Paul B. Marshburn MD & Bruce R. Carr MD To cite this article: Paul B. Marshburn MD & Bruce R. Carr MD (1992) Hormone replacement therapy, Postgraduate Medicine, 92:4, 145-159, DOI: 10.1080/00325481.1992.11701471 To link to this article: http://dx.doi.org/10.1080/00325481.1992.11701471
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [RMIT University Library]
Date: 20 June 2016, At: 09:02
-(£tME Hormone replacement therapy credit article
Protection against the consequences of menopause Paul B. Marshburn, MD Bruce R. Carr, MD
Postgraduate Medicine 1992.92:145-159.
Preview After the menopause, a woman's risk of cardiovascular disease increases sharply. In this article, Drs Marshburn and Carr describe the benefits that hormone replacement therapy can provide in regard to this and other postmenopausal problems. They also discuss the risks associated with such therapy, make screening recommendations, and weigh the relative merits of cyclic versus continuous therapy.
As women approach the menopause, ovarian follicles become depleted and serum concentrations of gonadotropins (luteinizing hormone and follicle-stimulating hormone) rise. Eventually ovarian follicular development fails in spite of rising levels of gonadotropins, and menstrual function ceases. Sherman and colleagues' have demonstrated that hormonal changes begin about 5 years before the menses stop completely. Therefore, signs and symptoms of hypoestrogenemia develop before menopause in many women. These include hot flushes, neuropsychological changes, urogenital atrophy, urge and stress urinary incontinence, skin atrophy, osteoporosis, and atherosclerosis. The approximate time course of the appearance of symptoms is presented in figure 1. Virtually all symptoms of menopause result from lack of estrogen, and appropriate hormone replacement
therapy can alleviate most of them. On average, one third of a woman's life takes place after menopause. During that time, her risk of cardiovascular disease and osteoporosis rises dramatically. Long-term hormone replacement therapy can greatly reduce these potentially lethal risks and also ameliorate the signs and symptoms of hypoestrogenemia. Combining such therapy with the institution of other preventive health measures can significantly extend a woman's life and improve its quality. Noncardiovascular protection Increased cardiovascular risk may be the most life-threatening consequence of menopause, but several noncardiovascular consequences also deserve attention. Hot flushes result from aberrant thermoregulatory control. The changes in control are secondary to the impact of estrogen
VOL 92/NO 4/SEPTEMBER 15, 1992/POSTGRADUATE MEDICINE • ESTROGEN REPLACEMENT
withdrawal on catecholamine function in the hypothalamus. Peripheral vasodilation accompanied by sweating and the perception of cutaneous heat is very annoying and induces insomnia, depression, and irritability. About 75% of all postmenopausal women experience hot flushes, which may occur for several months or several years. The best treatment is hormone replacement therapy. 2 Reduced estrogen levels also give rise to atrophy of the vagina, urethra, trigone of the bladder, and pubococcygeal muscle. Atrophic vaginitis is a condition of thinning and friability of the vaginal mucosa that is accompanied by itching, burning, vaginal dryness, dyspareunia, and, at times, vaginal bleeding. Stress incontinence and urge incontinence are aggravated by hypoestrogenemia because it causes urethral epithelial thinning, decreased urethral tone, and bladder trigone irritability. Hormone replacement therapy reverses the symptoms of atrophic vaginitis and often relieves the symptoms of urge and stress incontinence. 3-5 Anxiety, depression, irritability, and fatigue increase after menopause. These central nervous system-related symptoms have been thought to be due,
continued
145
Postgraduate Medicine 1992.92:145-159.
Appropriate honnone replacement therapy has been found to diminish the risk of ann and hip fractures.
fractures when administered with supplemental calcium. 10 Thus hormone replacement therapy should be considered and discussed with patients. In addition, physicians need to educate women about known epidemiologic risk factors for osteoporosis: sedentary life-style, calciumdeficient diet, thin body habitus, and smoking.
Figure 1. Typical time course of menopausal symptoms.
Adapted, with permission, from Van Keep PA and Kellerhals J. The aging woman. Front Harm Res 1973;2:160-73.
at least in part, to sleep loss from hot flushes. However, an independent salutary effect of hormone replacement therapy on poor memory, anxiety, and worry about oneself has been reported. 6•7 Osteoporosis is a reduction in the quantity of bone rather than a change in its chemical composition. The incidence of hip frac-
146
tures in white women increases from 0.3 per 1,000 at age 45 to 20 per 1,000 at age 85, and 80% of these fractures are associated with osteoporosis. 8 Appropriate hormone replacement therapy has been found to diminish the risk of arm and hip fractures by 50% to 60
