Physiology of Menopause and the Women's Health Initiative

Physiology of Menopause and the Women’s Health Initiative

Michelle Berlin, M.D., M.P.H.Co-Director, OHSU Center for Women’s HealthVice Chair, OHSU Dept of OBGYN

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Key Objectives and Goals

1) Review the changes in hormones that happen at menopause

2) Discuss the major effects of these changes

3) Briefly review the Women's Health Initiative

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Overview

• What is menopause?(Hint: it’s not just that your periods stop)

• What do all the terms mean?• That major study released in 2002..

Menopause Basics• Definition: cessation of periods for 1

year– Average age: 51– Most common age range: 45-55

• What causes menopause?– Ovaries stop producing estrogen and

progesterone – Estrogen levels decrease as you reach

the menopause, which causes the ovaries to stop producing an egg each month (ovulation).

www.nhs.uk/Conditions/Menopause/Pages/Causes.aspx

https://medlineplus.gov/menopause.html

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Menopause Basics

• Perimenopause (“menopausal transition”)– when periods can become irregular– have some symptoms intermittently– not truly in menopause until no menses x 12

months

• Postmenopausal: after the menopause

www.nhs.uk/Conditions/Menopause/Pages/Causes.aspx

https://medlineplus.gov/menopause.html

What organs are affected?

Many if not all..

Terminology

• HRT: hormone replacement therapy– HT: hormone therapy– MHT: menopausal hormone therapy

• What hormones?– E: estrogen– P: progesterone– E+P: estrogen + progesterone

• also called PERT: progesterone & estrogen replacement therapy

Terminology (cont)

• Genitourinary Syndrome of Menopause (GSM)– Aka “atrophic vaginitis”

• Women’s Health Initiative (WHI)

Women’s Health Initiative (WHI)

• WHI = 6 studies• 160,000+ women

– 50-79 years of age– enrolled 1993-1998

• 40 clinical centers

Women’s Health Initiative (WHI)

• Estrogen + Progesterone

• Estrogen only

Had hysterectomy: Estrogen only

“intact uterus”:Estrogen + Progesterone

WHI: Estrogen + Progestin Study

• Designed to evaluate if using HRT– decreases the risk of heart disease– increases the risk of breast cancer

WHI: Estrogen + Progestin Study• 16,600+ women• post-menopausal

– 50-79 years of age– “intact uterus” (had not undergone

hysterectomy)• Assignment:

– half of group: estrogen + progestin– half of group: placebo (“sugar pill”)

Are the people studied appropriate?

• 16,600+ women• post-menopausal

– 50-79 years of age– “intact uterus” (had not undergone

hysterectomy)

WHI: Estrogen + Progestin Study Results

Heart disease 29%

Stroke 41%

Blood clot 13%

Breast cancer 26%

Colon cancer 37%

Hip fracture 33%

Study Results

Additional lives lost/saved

for each 10,000 women

Heart disease 29% 7

Stroke 41% 8

Blood clot 13% 18

Breast cancer 26% 8

Colon cancer 37% 6

Hip fracture 33% 5

Another way to look at the results..

Placebo HRT (Estrogen +

Progesterone)

Additional/Fewer

Cases

Heart disease 30 37 7 more Stroke 20 29 8- 9 more Blood clot 16 34 18 more Breast cancer 30 38 8 more Colon cancer 16 10 6 fewer Hip fracture 15 10 5 fewer

AMA July 8, 2002

Comparing 10,000 women in one year taking a placebo to 10,000

women taking HRT:

WHI: Estrogen Only Study

• Designed to evaluate if using Estrogen only– decreases the risk of heart disease– increases the risk of breast cancer

WHI: Estrogen Only Study

• 10,739 women• post-menopausal

– 50-79 years of age– had undergone hysterectomy

• Assignment:– half of group: estrogen only– half of group: placebo (“sugar pill”)

Are the people studied appropriate?

• 16,600+ women• post-menopausal

– 50-79 years of age– had undergone hysterectomy

Another way to look at the results..

Placebo Estrogen

only

Additional/Fewer Cases

Heart

disease - 54 49 5 fewer

Stroke 32 44 12 more Blood clot 15 21 6 more Breast

cancer - 33 27 7 fewer

Colon

cancer - 16 17 6 fewer

Hip fracture 17 11 6 fewer

JAMA April 14,2004

Comparing 10,000 women in one year taking a placebo to 10,000

women taking Estrogen only:

Timing Hypothesis

“The current study suggest that younger women who use (estrogen) may be at reduced risk of (heart disease) but this possible association may be due to chance.”

PERSONAL HEALTH

Rethinking the Use of Hormones to Ease Menopause Symptoms By JANE E. BRODY

AUGUST 29, 2016 6:45 AM August 29, 2016 6:45 am 150

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