Hormone Replacement Therapy in Menopausal Patients

Educational Objectives

The goal of this program is to improve the use of hormone replacement therapy (HRT) in menopausal patients. After hearing and assimilating this program, the clinician will be better able to:

1. Implement use of HRT in patients with osteoporosis.

Summary

Menopause: cessation of menstruation and hormone production; encompasses 3 phases; perimenopause — the transition period lasting 5 to 7 yr before menopause, characterized by declining ovarian hormone production and accompanying symptoms (eg, hot flashes, night sweats, vaginal dryness, increased urinary tract infections); menopause — defined as the absence of menstrual periods for ≥1 yr; postmenopause — the phase following menopause; symptoms include hot flashes, insomnia, mood swings, and urogenital issues, which may persist without intervention; other effects of menopause include increased risk for osteoporosis, weight gain, muscle loss, and cardiovascular changes

Relevance of menopause to urology: recognize the integral connection between vulvar health and bladder health; maintaining vulvar health is paramount to overall bladder function, especially in postmenopausal patients; vaginal atrophy is highly preventable; urologic community is not proactive about ensuring optimal vulvar health and preventing vaginal atrophy, leading to increased health care costs

Treatment options: include lifestyle modifications (eg, exercise, support groups, prioritizing mental health); nonhormonal options include selective serotonin reuptake inhibitors

Hormone replacement therapy (HRT): Women's Health Initiative (Manson et al [2013]), which evaluated the safety and efficacy of HRT, was halted because of adverse cardiovascular events; however, reanalysis of the data showed that systemic HRT, when initiated ≤10 yr of menopause or before 60 yr of age, is actually safe and offers numerous benefits (preventative against colon and endometrial cancer, osteoporosis, lower urinary tract symptoms, and cardiovascular disease); systemic HRT is safe, effective, and evidence-based; HRT involves replacing not only estrogen and progesterone but also testosterone, especially in postmenopausal patients with low libido; the speaker disapproves of treatment with bioidentical HRT with pellets (eg, bioidentical testosterone)

Local HRT (LHRT): counteracts the effects of menopausal changes; vaginal atrophy results from hormonal changes and neglect, leading to significant anatomic changes including vaginal thinning, reduced blood flow, loss of rugal folds, decreased vaginal length, and changes in the vestibule; loss of good microbiome increases the risk for bacterial infections; proactive measures, eg, HRT, can prevent vaginal atrophy and lead to significant health care cost savings; ensuring vulvar health is crucial as it directly impacts bladder health, given the anatomic similarities between the vulva and the bladder; addressing issues, eg, vestibulodynia or genitourinary syndrome of menopause is essential for maintaining overall urogenital health; prescribe Food and Drug Administration-approved LHRT options; educate patients on the importance of LHRT and demonstrate proper application technique; screening perimenopausal, menopausal, and postmenopausal patients is important; the speaker opines that LHRT is safe in patients with breast cancer; nonhormonal options include selective estrogen receptor modulators

Readings

Langer RD, Hodis HN, Lobo RA, et al. Hormone replacement therapy - where are we now?. Climacteric. 2021;24(1):3-10. doi:10.1080/13697137.2020.1851183; Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368. doi:10.1001/jama.2013.278040; Morris G, Talaulikar V. Hormone replacement therapy in women with history of thrombosis or a thrombophilia. Post Reprod Health. 2023;29(1):33-41. doi:10.1177/20533691221148036; Vigneswaran K, Hamoda H. Hormone replacement therapy - Current recommendations. Best Pract Res Clin Obstet Gynaecol. 2022;81:8-21. doi:10.1016/j.bpobgyn.2021.12.001.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Uloko was recorded at the 30th Annual Perspectives in Urology: Point Counterpoint, held March 10-12, 2023, in San Diego, CA, and presented by Grand Rounds in Urology. For information about upcoming CME activities from this presenter, please visit Grandroundinurology.com. Audio Digest thanks the speakers and Grand Rounds in Urology for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.25 CE contact hours.

Lecture ID:

UR471403

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.