Climacteric Symptoms & Hormone Therapy Hyoung Moo Park, M.D. Department Of Obstetrics and Gynecology Chung Ang University College of Medicine & Hospital E mail : hmpark@hananet.net Abstract After menopause, estrogen deficiency from the loss of ovarian function results in various symptoms and metabolic changes, which lead to an increased risk of chronic diseases. Troublesome menopausal symptoms, vasomotor and/or psychological, are the first to develop, and various kinds of disorders related to estrogen deficiency such as genitourinary atrophy, involutional osteoporosis, cardiovascular, and Alzheimer's diseases follow. Among these, two major long term consequences of ovarian failure are osteoporosis and cardiovascular disease, which are also the major causes of morbidity, mortality and financial costs. Hormone therapy by using estrogen with or without progesterone, is most consistently effective for the treatment of acute and some intermediate menopause related symptoms such as vasomotor symptoms and vaginal dryness, and therefore has been recommended as the first line measure to prevent and treat the acute symptoms of estrogen deficiency. It also has been reported that hormone therapy reduces the risks of some long term sequelaes, suggesting both therapeutic and preventive roles in postmenopausal women. However, it is clear that hormone therapy is not a panacea and is not suitable for all postmenopausal women because of side effects and some concerns about cancer risks. The rate of long term compliance is also low at present. Recent RCTs showed that hormone therapy does not seem to be effective in improving cognition and preventing CHD and dementia. However, there is a growing consensus that the early initiation of hormone therapy provides protection from CVS and CNS, the two most important areas, whereas RCTs have disagreed with observational data. This means that in young women at early menopause, "a window of therapeutic opportunity" exists for hormone therapy, since treatment during this period may provide cardio and neuroprotection. More studies are urgently needed on this controversy. Current recommendations suggest treatment with the lowest effective dose for the shortest period of time and individualized treatment based on patient s risk and benefit ratio. Keywords : Menopause; Symptom; Sormone; Benefit; Risk; Early initiation 11
Short & long term consequences of menopause 2 60~70 1 5 20~30 7 25~35 10 20 Incidence of climacteric symptoms in Korean women 61 48 47 46 44 39 35 28 28 22 16 12 12
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Clinical manifestation of hot flush (sensation) (heart rate) 5~35 1~7 0.1~0.9 14
Management of hot flushes paced respiration 15
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Risk of cognitive impairment & dementia in WHI memory study 95%CI 95%CI 1.34 0.95~1.89 1.07 0.74~1.55 1.49 0.83~2.66 2.05 1.21~3.84 24
Risk of invasive breast cancer in WHI 95% 5.6 1.24 1.01~1.54 6.8 0.77 0.59~1.01 25
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