Postmenopausal Hormone Therapy-Local and Systemic: A Pharmacologic Perspective.

Every woman, if she lives long enough, will transition into menopause, and as the US population ages, women will be spending more time in a postmenopausal state than before. For postmenopausal women, the decision to initiate menopausal hormone therapy should be individualized. A thorough evaluation of the patient's cardiovascular, venous thromboembolic, cancer, and fracture risk should be considered along with the woman's quality of life.

Managing Genitourinary Syndrome of Menopause in Breast Cancer Survivors Receiving Endocrine Therapy.

Patients with breast cancer receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM). GSM can decrease quality of life and is undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy because of unknown levels of systemic absorption of estradiol. In this article, we review the available literature for treatment of GSM in patients with breast cancer and survivors, including nonhormonal, vaginal hormonal, and systemic hormonal therapy options.

Correction: Genitourinary syndrome of menopause.

In the article by A.C. Moreno, S.

Genitourinary syndrome of menopause in breast cancer survivors:Treatments are available.

When treating the genitourinary syndrome of menopause (GSM) in women with breast cancer or at high risk of breast cancer, clinicians must balance the higher cancer risks associated with hormonal treatments against the severity of GSM symptoms, which can be exacerbated by breast cancer treatments. Options for patients who need hormonal therapy include locally applied estrogens, dehydroepiandrosterone (DHEA), and estrogen receptor agonists/antagonists, which vary in their impact on breast cancer risk.

ERAAs for menopause treatment: Welcome the 'designer estrogens'.

Estrogen receptor agonist-antagonists (ERAAs) selectively inhibit or stimulate estrogen-like action in targeted tissues. This review summarizes how ERAAs can be used in combination with an estrogen or alone to treat menopausal symptoms (vasomotor symptoms, genitourinary syndrome of menopause), breast cancer or the risk of breast cancer, osteopenia, osteoporosis, and other female midlife concerns.

Medical management of urinary incontinence in women.

Urinary incontinence is common, underreported, and undertreated. Primary care physicians should be comfortable discussing urinary incontinence with their female patients and managing it with conservative treatment.

Buccal Bone Thickness in the Esthetic Zone of Postmenopausal Women: A CBCT Analysis.

Purpose: To compare bone thickness buccal to the teeth in the esthetic zone of postmenopausal women, premenopausal women, younger men and older men.

Methods: Retrospective data were randomly selected from 4 groups: 59 premenopausal women, 60 postmenopausal women, 60 men less than age 50, and 60 men more than 50. Half-root and bone crest landmarks were identified on each participant's cone beam computed tomography for teeth 7 to 10 and 23 to 26.

Update: A Review of Women's Health Fellowships, Their Role in Interdisciplinary Health Care, and the Need for Accreditation.

While Women's Health (WH) Fellowships have been in existence since 1990, knowledge of their existence seems limited. Specialized training in WH is crucial to educate leaders who can appropriately integrate this multidisciplinary field into academic centers, especially as the demand for providers confident in the areas of contraception, perimenopause/menopause, hormone therapy, osteoporosis, hypoactive sexual desire disorder, medical management of abnormal uterine bleeding, office based care of stress/urge incontinence, and gender-based medicine are increasing popular and highly sought after. WH fellowship programs would benefit from accreditation from the American Board of Medical Subspecialties and from the American College of Graduate Medical Education, as this may allow for greater recruitment, selection, and training of future leaders in WH.

Risks and effectiveness of compounded bioidentical hormone therapy: a case series.

After the publication of the Women's Health Initiative, attitudes towards management of menopausal symptoms changed dramatically. One alternative that has received much media attention is the use of bioidentical hormone therapy (BHT). The media and celebrity endorsements have promoted a number of misconceptions about the risks and benefits associated with the various forms of BHT.

Can the FRAX tool be a useful aid for clinicians in referring women for periodontal care?

Objective: This study aims to compare periodontitis severity in postmenopausal women whose FRAX (World Health Organization Fracture Risk Assessment Tool) scores indicate a major risk for osteoporotic fracture (OPF) versus controls.

Methods: Participant charts from the Case/Cleveland Clinic Postmenopausal Wellness Collaboration 853-sample database were selected based on the following inclusion criteria: (1) aged between 51 and 80 years; (2) menopause for more than 1 year but less than 10 years; (3) nonsmoker; (4) hemoglobin A1c less than 7; and (5) no glucocorticoid, hormone, RANKL (receptor activator of nuclear factor-κB ligand) inhibitor, or bisphosphonate therapy within 5 years. FRAX score was calculated, and participants were organized into two groups: women with major OPF risk (FRAX scores >20%) and controls.

Paroxetine: a first for selective serotonin reuptake inhibitors - a new use: approved for vasomotor symptoms in postmenopausal women.

In the USA, over 30 million women are in or near menopause. Menopause is associated with a cluster of issues. Vasomotor symptoms (VMS) are the number one complaint of most menopausal women.

Update on contraceptive options: a case-based discussion.

As health care providers, we must engage our female patients in a dialogue about their contraceptive and fertility decisions. Empowering and educating our patients about their bodies' hormones, the menstrual cycle, and the risk of unintended pregnancy are central to effective contraceptive counseling. Selecting an appropriate method for a patient and her medical profile is rewarding and challenging in view of new medications, novel delivery systems, and evolving research.

Bioidentical hormone therapy: clarifying the misconceptions.

Many women are turning to bioidentical hormone therapy on the basis of misconceptions and unfounded claims, eg, that this therapy can reverse the aging process and that it is more natural and safe than approved hormone therapy. The aim of this article is to clarify some of the misconceptions.

Assessing risks and benefits of nonhormonal treatments for vasomotor symptoms in perimenopausal and postmenopausal women.

Background: Vasomotor symptoms (VMS); (hot flushes and night sweats) are the most common menopausal complaint for which women seek treatment. Several therapies can be considered to help manage these complaints. The objective of this review is to assess the risks and benefits of available and emerging therapeutic options for the management of menopausal VMS.

How menopause affects oral health, and what we can do about it.

After menopause, women become more susceptible to periodontal disease. We believe the problem is due in large part to estrogen deficiency with resulting bone loss and inflammatory processes. Osteoporosis and periodontal disease are best diagnosed early so that treatment can be started sooner and fractures and tooth loss can be prevented.

An observational study on the adherence to treatment guidelines of osteopenia.

Background: Osteopenia/low bone mineral density (BMD) can lead to osteoporosis and is far more prevalent than osteoporosis. The National Osteoporosis Foundation (NOF) has recommendations for prevention and treatment of low BMD; however, the condition remains underrecognized and undertreated. We assessed practice patterns between physician knowledge of low BMD and prescribing of additional pharmacological therapies as defined by the NOF guidelines.

The evolution of women's health education: the Cleveland Clinic's women's health fellowship as a model.

Our goal in this paper is twofold. First, it provides a brief overview of the macrotrends in women's health education over the last 25 years. Second, these trends are a backdrop for a discussion of women's health education as exemplified by a detailed review of the curriculum for the Women's Health fellowship at the Cleveland Clinic Foundation.

Newer hormonal therapies: lower doses; oral, transdermal, and vaginal formulations.

Hormonal therapy remains the gold standard for treating menopausal symptoms. In addition, some formulations are indicated for preventing and treating bone loss. In this article, we review some of the hormonal regimens that have been approved in the past 5 years.

Repeat dual-energy X-ray absorptiometry (DXA) resulting from reminder letters for women with a baseline abnormal DXA.

The objective was to assess the effects of reminder letters on women returning for repeat bone density. We queried our clinical data repository to identify all women undergoing dual-energy X-ray absorptiometry (DXA) during the entire 2003 calendar year. Women with abnormal DXAs were entered into a database for reminder letters.

Secondary osteoporosis: are we recognizing it?

Background: As a growing percentage of Americans will be reaching their elderly years in the next decade, the prevalence of osteoporosis and its effects will have an even greater impact on the healthcare system. Advancements in bone research and development of newer treatments have allowed for the establishment of more refined guidelines and a growing awareness of the need to prevent, screen, and diagnose osteoporosis. Thus, more women are now being screened with dual x-ray absorptiometry scans (DXA) than ever before.