Indications For Hormone Replacement Therapy Research Articles

Evaluation of the usefulness of antymüllerian hormone and inhibin B as markers of ovarian activity in patients with Turner syndrome - preliminary results.

Spontaneous puberty occurs in 30% of patients with Turner Syndrome. Its absence is an indication for hormone replacement therapy (HRT). No reliable markers of spontaneous puberty have been defined to date. To evaluate the usefulness of antymüllerian hormone (AMH) and inhibin B assessment in predicting ovarian function and spontaneous puberty in girls with TS. The study included 35 TS patients treated with human recombinant growth hormone (rhGH). Gonadal axis function parameters (LH, FSH and estradiol) were evaluated at the age of physiological puberty (10-12 years, mean 10.5 years), before introduction of HRT. Ad-ditionally AMH and inhibin B levels were assessed. In follow up patients were divided into 2 groups: with (SP) and without (WP) spontaneous puberty. Spontaneous puberty was defined as Tanner stage 2 or higher breast development. WP patients were observed until the mean age of 16y. SP occurred in 16 patients (mean age 10 years). Patients with SP presented with significantly lower mean FSH level (1.14-91.1 mIU/ml, mean mIU/ml 24.5 vs. 7.7-196.4 mIU/ml, mean 66.5 mIU/ml, p = 0.002), higher mean estradiol (10.5-68.8 pg/ml, mean 28.4 pg/ml vs. 6.1-26.0 pg/ml, mean 14.9 pg/ml, p = 0.005), AMH (0.0-3.11 ng/ml, mean 0.8 ng/ml vs. 0.0-0.002 ng/ml, mean 0.003 ng/ml, p = 0.001) and inhibin B (0.0-110.0 pg/ml, mean 29.1 pg/ml vs. 0.0-11.0 pg/ml, mean 1.06 pg/ml, p = 0.026) levels. In three SP patients without elevated FSH level (FSH < 35 mIU/ml) we found zero concen-tration levels of AMH and inhibin B. SP patients had mosaic (non 45,X) karyotype in 87.5% and WP patients only in 47%. AMH and inhibin B assessment may be a valuable complement to the diagnosis of ovarian function in patients with TS. Low levels of these parameters may indicate a risk of ovarian failure even in patients with spontaneous puberty and without hypergonadotropic hy-pogonadism.

Japan Society of Obstetrics and Gynecology and Japan Society for Menopause and Women's Health 2017 guidelines for hormone replacement therapy.

Hormone replacement therapy (HRT) plays a large part in maintaining and improving the quality of life (QOL) of postmenopausal women. Despite this obvious role, the use of HRT has stagnated in Japan as well as the United States, since the interim report of the HRT trial of Women's Health Initiative study was published in 2002. The Japan Society of Obstetrics and Gynecology and Japan Society for Menopause and Women's Health formulated the Guidelines for Hormone Replacement Therapy in 2009, which was subsequently revised in 2012, with the aim of organizing perceptions about HRT and allowing people to provide or receive HRT with a sense of security. Later on, in light of changes in indications for HRT and attitudes toward its impact on cancer risks, amendments were made again in 2017. With the establishment of the 2017 guidelines, practitioners in Japan are able to address various issues related to HRT with more appropriate judgment. Moreover, the practice of reliable, safe and effective HRT is expected to promote further efforts toward improvement or maintenance of QOL in patients.

Menopause in CKD

Most women with dialysis-dependent chronic kidney disease (CKD) stage 5 (CKD stage 5D) are in the postmenopausal age group. Early menopause is reported for all CKD stages (stages 3-5D). The traditional definition of menopause is not applicable in CKD stage 5(D) because menses can resume with hormone replacement therapy or kidney transplantation. Treatment of vasomotor symptoms continues to be the primary indication for hormone replacement therapy, with no dosing studies done specifically for CKD or kidney transplantation populations. Similarly, the risk for cardiovascular disease and osteoporosis in menopause is well described in healthy women, but the role that menopause plays in accelerating the risk further in CKD/kidney transplantation is yet to be explored. Lack of data and specific guidance on management make the long-term effects of menopause one of the most under-recognized and neglected patient problems in clinical nephrology. The efficacy and side effects of widely available therapeutic options in healthy women for menopause-related clinical manifestations, be it hormone replacement therapy for vasomotor symptoms or antiresorptive agents for osteoporosis, are to be tested in kidney transplantation and CKD populations. Longitudinal clinical trials are in need to define menopause in CKD and determine the role that CKD plays in menopause transition and menopause on CKD manifestations.

Changing the change.

Four years ago, I was a Foundation Year 2 doctor on a four-month General Practice (GP) placement in a rural Hertfordshire practice. In the short time that I was there, it became increasingly clear that something was lacking: menopausal health care and, perhaps even more concerning, accurate knowledge of this field within primary care. I was first aware of this at the very local level, although it didn’t take long to ascertain the problem was far more widespread. In the first instance, all I knew was that I kept seeing women, largely in their mid-late 40s, who – for one reason or another – were no longer coping with life. The vast majority of these women were in work and, for the most part, had partners and families at home. For the past 20 or so years they had been successfully juggling their professional, personal and social lives and, yet, suddenly here they were: sitting bewildered in a junior doctor’s consultation room, asking where it had all gone wrong. Dry eyes, insomnia, palpitations, anxiety, irritability, irregular menstrual bleeding, headaches; no matter the presenting symptom(s), it was abundantly clear that the real issue often ran deeper than the surface presentation. And this did not escape the patients in question. On an almost daily basis, I was asked whether their symptoms and concerns were ‘‘related to hormones’’, ‘‘could it be menopause?’’ or told emphatically ‘‘I know this is peri-menopause, but what can I do to make things more bearable?’’ Much of the time, I felt powerless to help. In most cases, if these women had sought advice previously, it wasn’t that my colleagues had failed to recognize their symptoms as potentially (peri-)menopausal. Indeed, whilst an unfortunate few had been told they were likely depressed, suffering stress or ‘‘just getting older’’, most had received acknowledgement that hormonal changes were afoot and some had been offered treatment in the form of hormone replacement therapy (HRT). Nevertheless, those who had not been prescribed HRT (appropriately or otherwise) were left floundering, and those who had been given hormones and had not responded as expected continued to struggle. I thought back to medical school, scanning my memory for useful nuggets concerning the ‘‘change of life’’ but couldn’t remember the menopause being discussed other than in the ‘‘be aware’’ category. Rather embarrassingly, it transpired that the sum total of my knowledge was that vasomotor symptoms were an indication for HRT. Palpitations, vaginal atrophy, nausea and aching joints were simply not on my radar; I was not even aware that HRT could be prescribed transdermally. A recent four-month stint in Obstetrics & Gynaecology had been no help; gynaecology on-calls and labour ward duties had left me none the wiser. I felt out of my depth. I asked one of the partners in my practice for advice, and wondered if there was a local menopause clinic to which we could refer those women we were unable to help further. I remember him shaking his head, saying there was no such service, despite it being badly needed. I was given the name of a private gynaecologist, with the suggestion that this could be passed onto those patients who wished (and were able) to go down that route. It felt as though we could do more. Fast-forward two years. Now a GP specialty trainee, I was once again in primary care and found myself facing a familiar challenge. I approached a local practice lead in Women’s Health, and asked if we could arrange a session to discuss HRT and how to prescribe it appropriately. I was told it was simple: ‘‘Open MIMS and turn to the section on Hormone Replacement Therapy. Start at the top and work your way down, depending on whether the woman needs continuous or sequential therapy. They don’t need progesterone if they have had a hysterectomy’’. That was it. I hoped that my GP Specialty Training Programme (GPSTP) release sessions would shed some light. However, the entirety of menopause was covered in 15min by a fellow trainee who admitted he hadn’t known the first thing until swotting up the previous evening. The session’s facilitator cheerfully told us that the key thing, when prescribing HRT, was to look at the price tag. ‘‘Transdermals are to be used as a last resort’’, we were told.

Hormone Replacement Therapy for Menopause

Hormone replacement therapy (HRT) may be a risky topic for a male author to write, but it was suggested by a reader; I am certainly not speaking from personal experience, as with previous columns! This has always been an interesting topic to me because, like many drug therapy issues, it is a therapeutic dilemma, a balance between benefits and risks. Risk-benefit decisions seem to be easier when the cure of a disease is the benefit. It is a little more difficult when the benefit is symptom relief or disease prevention, making the role of the patient in choosing a treatment decision even more important. Philip J. Schneider, MS, FASHP, FFIP, is clinical professor and associate dean of the College of Pharmacy at the University of Arizona in Phoenix. Letter to the EditorThe Journal for Nurse PractitionersVol. 10Issue 1PreviewRegarding Philip J. Schneider's article “Hormone Replacement Therapy for Menopause,”1 I would like to comment that there are new indications for hormone replacement therapy and estrogen replacement therapy being studied that may broaden the lens by which we as health care providers guide our prescribing protocols. Important findings particularly suggest a reduced risk of Alzheimer disease and studies are additionally reviewed with important findings relative to Parkinson disease, frontotemporal dementia, and HIV-associated neurocognitive disorder in the article by Dye et al. Full-Text PDF

Questioning the cardioprotective action of hormone replacement therapy in postmenopausal women

This article comments on the point of view by Rosano et al. and outlines that the only indications for hormone replacement therapy, at the lowest effective dose for the shortest possible time, should be limited to younger, recently menopausal women who are not at high risk for cardiovascular disease and with unsustainable menopausal symptoms, without any illusory attempt to prevent chronic diseases.

Vasomotor symptoms and cardiovascular risk

Climacteric complaints are the main indication for hormone replacement therapy (HRT) in the clinical practice. Observational studies demonstrating a protective effect of HRT on cardiovascular disease (CVD) were conducted in early menopausal, young, symptomatic women. Vasomotor symptoms correlate with lower level of plasma antioxidant activity, an increased cardiovascular reactivity to stressful situations, elevated cholesterol, higher sympathetic nerve activity, impaired flow-mediated dilation, hypertension and a higher risk of aortic calcification. All the available findings indicate that hot flushes can be seen as a marker for underlying vascular changes among mid-life, otherwise healthy, climacteric women. Thus, young, healthy symptomatic postmenopausal women differ from those without vasomotor symptoms with regard to cardiovascular risk factors. Therefore, responses to HRT can change in terms of cardiovascular outcomes according to the baseline vasomotor complaints. This point may explain, at least in part, the negative/null effects of HRT on cardiovascular disease observed in the trials where HRT was given to largely asymptomatic, elderly women.

Use of oral contraceptives and postmenopausal hormone replacement: Evidence on risk of stroke

Estrogen and progesterone affect endothelial function, coagulation factors, platelet function, lipids, and inflammation and have neuroprotective effects in experimental animals. Oral contraceptives containing low-dose estrogen increase the risk of ischemic stroke, but the absolute risk is low. Risk factors further increasing the risk of stroke in users of oral contraceptives include smoking, hypertension, diabetes, hyperlipidemia, migraine with aura, and thrombophilia. Progestin-only contraceptives do not increase the risk of stroke and are preferable in women with cerebrovascular disease or risk factors. Hormone replacement therapy (HRT) with estrogen alone or combined with progesterone increases the risk of ischemic stroke by 40% with no effect on hemorrhagic stroke. Stroke risk increases with the dose of estrogen. The time between menopause and the initiation of HRT does not influence ischemic stroke risk. The only indication for HRT is the treatment of vasomotor symptoms; if needed for this purpose, the lowest dose of estrogen should be used for the shortest possible duration.

Hormone Replacement Therapy and Stroke

Stroke is the third most common cause of death in women and a major cause of disability. Stroke occurs in older age in women compared with men. High premenopausal estrogen concentrations in women are thought to be protective against stroke and cardiovascular disease. Estrogens are essential for normal reproductive function and they exert complex and diverse non reproductive actions on multiple tissues such as neuroprotective effects, vasodilatation, improved vascular reactivity, antithrombotic effects and lipid lowering effects. After menopause estrogen concentrations are depleted and in the past estrogen replacement therapy was considered as a potential protective agent against both cardiovascular disease and stroke. Although the use of hormone therapy was originally associated with a reduction in the risk of heart disease by about 50% in observational studies, the results regarding stroke have been less clear. In order to investigate the effect of hormone therapy on stroke risk, randomized controlled trials of cardio-and/or cerebrovascular-disease prevention in women with established heart disease have been designed. The Heart Estrogen-Progestin Replacement Study included stroke as secondary outcome. This study did not show any differences in myocardial infarction (MI) or coronary death (HR 0.99; 95%CI 0.80-1.22) and in stroke rate. In another study, the Women Estrogen Stroke Trial, 17 beta estradiol 1 mg/placebo was administered to women with previous ischemic stroke or transient ischaemic attack (TIA) having a mean age 71. No differences in stroke rate (RR 1.1; 95% CI 0.8-1.4) and in mortality rate (RR 1.2; 95% CI 0.8-1.8) were found, while a trend showing an increased rate of fatal strokes (RR 2.9; 95% CI 0.9-9.0) and for more severe non-fatal strokes (% patients with final National Institutes of Health Stroke Scale (NIHSS) 0-1: 19 % vs. 33%; p = 0.12) was observed. The Women's Health Initiative, a primary prevention study, where conjugated equine estrogen (CEE) plus medroxyprogesterone acetate/placebo was utilized, was stopped because of an excess in breast cancer and increased stroke rates (RR 1.4; 95% CI 1.1-1.8). Recently, a meta-analysis including 39,769 women participating in 28 trials has been published. Twelve studies were of secondary prevention and the overall stroke rate was 2%. In the hormone replacement therapy (HRT) arm there was a 29% increased rate of ischemic stroke (Number Needed to Harm, NNH:147). Furthermore, a 56% increased rate of death or dependency after stroke and a tendency of more fatal stroke were observed. Additionally, a higher stroke risk was reported in the first year of treatment. There seems to be no indication for hormone replacement therapy in the prevention of stroke in women. Further studies are needed to discover why estrogens have different effects on the heart and brain. Conventional risk-factors which could increase the risk of estrogen therapy need to be identified and as well as more restrictive inclusion and exclusion criteria such as coagulation parameters and intimal thickness should be adopted before new randomized trials are started.

Hormone replacement Up-to-date. Menopause in women and hormone replacement therapy (HRT). Indications for HRT in postmenopausal women

It has been generally accepted that it is quite sensible to administer hormone replacement therapy (HRT) in women to compensate for the estrogen deficiency that occurs as they approach menopause and that, given its broad-ranging efficacy, it has a huge benefit to offer to these women. However, it has been demonstrated in 2002 in the NIH-initiated Women's Health Initiative (WHI) trial that HRT may be associated with risk depending on whom it is used for. Thus, HRT has had a high profile in recent years. While the findings from the WHI trial are compelling in their own right, on closer examination, it has become clear that they do not necessarily translate into local practice here in Japan. Again, a further examination of HRT as a treatment modality reveals that the benefit and risk profile of HRT varies greatly depending on the timing for its initiation,the kind of estrogen or progesterone used and their route of administration and dosing. Therefore, in deciding to go for HRT, it needs to be weighed carefully for its benefit and risk in individual patients, and informed consent obtained for its administration, in view of the risk associated with its use versus its enormous benefit.

Systemic lupus erythematosus and hormone replacement therapy

The indications for hormone replacement therapy (HRT) in postmenopausal women is the treatment of climacteric symptoms and the prevention of osteoporosis. Women with systemic lupus erythematosus (SLE) are more likely to have a premature menopause, osteoporosis and cardiovascular disease. HRT can induce SLE flares and cardiovascular or venous thromboembolic events. Therefore it should not be used in women with active disease or those with antiphospholipid (aPL) antibodies. In general, it should be used only for patients without active disease, a history of thrombosis or aPL antibodies. Non-oral administration of estrogen is recommended because of its lesser effect on coagulation. With regard to the progestogen, progesterone or pregnane derivatives are preferred. Otherwise, non-estrogen-based strategies should be used.

Hormone replacement therapy and WONCA/COOP functional status: a cross-sectional population-based study of women in Israel

Background Current indications for hormone replacement therapy (HRT) for menopausal women include symptom relief, but recent studies have raised concerns about the safety of HRT. Little data are available on the effect of HRT on functional status of women taking hormonal preparations after menopause.Objective To assess the association between hormonal replacement therapy and functional status in menopausal women.Methods A cross-sectional survey, population-based study of 682 menopausal women between the ages of 50 and 70 years registered with six family physicians in central Israel. The main outcome measure was the functional status measured by the WONCA/COOP charts.Results A total of 587 women (86%) completed questionnaires. Univariate analysis showed an association between current use of HRT and improved functional status. However this association was diminished in a regression analysis which controlled for sociodemographic status and health variables. The contribution of HRT to functional status was small but was found to be significant in the domains of general health status (1.9%, p < 0.002), sleep (0.9%, p < 0.044), physical activities (2.1%, p < 0.001) and feelings (1.0%, p < 0.033). The contribution of HRT to daily activities, social activities, change in health status and pain was not significant.Conclusions HRT use had a small contribution to improved functional status in half of the domains measured by the WONCA/COOP charts.

Effect of hormone replacement therapy, tibolone and raloxifene on serum lipids, apolipoprotein A1, apolipoprotein B and lipoprotein(a) in Greek postmenopausal women

The aim of this study was to assess the effect of estrogen, two regimens of continuous combined hormone replacement therapy (HRT), tibolone and raloxifene on serum lipid, apolipoprotein A1 and B and lipoprotein(a) levels in Greek postmenopausal women. A total of 350 postmenopausal women were studied in a prospective open design. Women were assigned to one of the following regimens depending on the presence of risk factors for osteoporosis, climacteric symptoms and an intact uterus: conjugated equine estrogen 0.625 mg (CEE, n=34), continuous combined CEE 0.625 mg plus medroxyprogesterone acetate (MPA) 5 mg, (n=80), continuous combined 17β-estradiol 2 mg plus norethisterone acetate (NETA) 1 mg (n=58), tibolone 2.5 mg (n=83) and raloxifene HCl 60 mg (n=50). Forty-five postmenopausal women with no indications for HRT served as controls. Total cholesterol (TC), low-density lipoprotein (LDL) cholestrol and high-density lipoprotein (HDL) cholesterol, triglyceride (TG), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and lipoprotein(a) (Lp(a)) levels were assessed in each subject at baseline, and at 6 and 12 months of therapy. All therapy regimens lowered TC levels compared to baseline (4.2-8.0% decrease). This effect was more prominent in the subgoup of women with high baseline TC levels (9.1-20.4% decrease). LDL cholesterol decreased significantly in CEE, CEE/MPA and raloxifene groups (−11.2%, −11.9% and −11.0%, respectively). Hypercholesterolemic women exhibited a steeper decrease in LDL cholesterol (10.6-27.8% in all therapy groups). TG levels increased significantly in the CEE and CEE/MPA groups (23.7% and 21.8%, respectively), while estradiol/NETA had no effect on TG levels. Tibolone decreased TG levels markedly, by 20.6%, while raloxifene had no TG-lowering effect. HDL cholesterol and ApoA1 were increased by CEE and CEE/MPA (HDL cholesterol, 7.4% and 11.8%, respectively; ApoA1, 17.8% and 7.9%, respectively) and decreased by tibolone (HDL cholesterol, −13.6%; and ApoA1, −9.9%). All therapy regimens except raloxifene lowered Lp(a) levels, with tibolone having the more pronounced effect (−13.2 to −29.0%). In conclusion, each therapy regimen had a different effect on lipid-lipoprotein levels, exerting favorable and unfavorable modifications. Hypercholesterolemic women seemed to benefit more from the cholesterol-lowering effect of estrogen replacement therapy/HRT. The choice for a particular regimen should be based on individual needs, indications and lipid-lipoprotein profile.

Hormone replacement therapy: to use or not to use?

The main indication for hormone replacement therapy (HRT) is to control menopausal symptoms and improve quality of life. Ideally, withdrawal of HRT should be attempted after 4-5 years of therapy. HRT reduces fracture risk and remains appropriate therapy for osteoporosis, particularly in women with symptoms. HRT is not appropriate for primary or secondary cardioprotection. HRT leads to a small increase in breast cancer incidence, which increases with duration of therapy and age. HRT increases the risk of thromboembolism. Patient management and therapy should be reviewed annually with risk-benefit counselling.

The SOGC Statement on the WHI Report On Estrogen and Progestin Use in Postmenopausal Women

The recent Women’s Health Initiative study report evaluated the long-term benefits and risks of hormone replacement therapy among healthy postmenopausal women. The report showed that the risk-benefit profile of continuous combined hormone replacement therapy was not consistent with the primary Prevention of coronary heart disease. The Women’s Health Initiative study of continuous combined hormone replacement therapy is a landmark study and the results provide valuable information for patients and clinicians. However, the most common indication for hormone replacement therapy is menopausal symptoms, for which it is effective, not prevention of disease and the most common use is for less than three years. Nevertheless, even short-term use has small effects on some outcomes. This statement discusses how the findings of the Women’s Health Initiative study can be applied to reach appropriate clinical decisions.

Indications for hormone replacement therapy

Postmenopausal primary ovarian insufficiency may lead to the clinical picture of the climacteric syndrome and to metabolic changes inducing specific diseases due to oestrogen deficiency. In symptomatic states of oestrogen deficiency, Hormone Replacement Therapy (HRT) is indicated for therapeutic reasons. If there is an increased risk for osteoporosis, for cardiovascular diseases or for Alzheimer's Disease, the preventive administration of HRT has to be discussed. In the combined presence of an increased metabolic risk and of subjective symptoms, HRT is still the best choice. Recent alternatives to classical HRT are Tibolone and, in the later postmenopause, Raloxifene. Incorrect media reports lead to insecurity and to concerns about the use of sexual steroids after menopause. HRT can be accompanied by a small weight increase of 200-500 g. However, more important in most women is the normal trend to weight gain in the 40s and 50s. HRT does not increase blood pressure. If there are some hints for an abnormal coagulation system in the personal or family history of a patient, thrombophilia should be excluded before the begin of HRT. The risk to have an endometrial carcinoma during HRT is not increased, but endometrial cancers are more frequent with unopposed estrogen administration. The incidence of breast cancer increases continuously with ageing. If 1000 women start HRT at the age of 50 and continue for five years, two more cases of breast cancer are diagnosed within the next 20 years. This small increase of morbidity is not accompanied by an increased mortality due to breast cancer: mortality does not change. The data available today show a clear decrease of total mortality up to the age of 75 years in women using oestrogens and speak in favour of HRT. If HRT is used for less than five years, cancer risk is not increased. The gain in Life Quality primes significantly. For the indication of long term HRT, the risks and benefits have to be evaluated individually.

"Clinical Indications for Hormone Replacement Therapy"

"Clinical Indications for Hormone Replacement Therapy"

Swedish gynecologists' and general practitioners' views on the climacteric period, Knowledge, attitudes and management strategies

To investigate attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynecologists and general practitioners (GPs) in Sweden. In 1996 a questionnaire was sent to all Swedish gynecologists (n=1323) and every third general practitioner (GP) (n=1397) regarding indications, contraindications, treatment regimens and their own (or their wives') use of estrogens. Answers were received from 53% of the GPs and from 80% of the gynecologists. Fifteen per cent of the GPs often considered it difficult to evaluate the advantages and disadvantages of hormone replacement therapy compared to 2% of the gynecologists (p<0.001). Almost 100% of the physicians considered hot flushes, night sweats and osteoporosis to be indications for HRT. Significantly more GPs compared to gynecologists (50% vs 24%) stated that estrogen increased the risk of developing a deep vein thrombosis. Significantly more GPs performed measurements of blood pressure, weight, lipoproteins and palpated the breasts before starting treatment and at the follow-up visits. Significantly more gynecologists performed pelvic examination, vaginal sonography, endometrial biopsy and mammography. Among the female doctors who were either postmenopausal or had climacteric symptoms 72% of the GPs and 88% of the gynecologists were current users of HRT (p<0.01). Corresponding figures for the wives were 68% vs 86% (p<0.001). As earlier contraindications to HRT nowadays have turned into indications it is reasonable that more GPs compared to gynecologists consider it difficult to evaluate advantages and disadvantages of HRT and more gynecologists than GPs took the first initiative to discuss HRT with their patients. The information that far more female doctors and doctors' wives, compared to the Swedish female population, were using HRT is important information when discussing HRT compliance with patients.

Reduction of intraocular pressure in a glaucoma patient undergoing hormone replacement therapy

Objectives: To show the reducing effect of estrogens and progestins on the elevated intraocular pressure (IOP) in the case of a 56-year-old woman showing typical climacteric complaints, who was admitted to the menopause outpatient unit. She also suffered from a primary open-angle glaucoma treated with betaophtiole eye drops with intraocular pressures of 16–20 mmHg under this local therapy. Methods: IOP patterns were monitored by means of standardised daily pressure profiles four times a day before as well as 4 and 12 weeks after the beginning of hormone replacement therapy (HRT). The local glaucoma therapy remained unchanged. Results: During HRT, IOP levels were reduced from 16–20 mmHg before therapy to 12–15 mmHg at week 4 and to 13–15 mmHg at week 12 after the beginning of HRT. Conclusion: The finding of a close chronological relationship between the onset of menopause and the development of a glaucoma is a potentially new indication for HRT.

Perimenopausal and postmenopausal hormone replacement therapy: Part 2. Hormonal Regimens and Complementary and Alternative Therapies

As midwives increasingly provide care to women throughout the lifecycle, they need to become familiar with a variety of treatments for perimenopausal and postmenopausal problems and preventive measures for the potentially disabling conditions that can accompany aging. This article reviews various regimens of hormone replacement therapy. It discusses types of estrogen and progestin, appropriate dosages, routes of administration, and duration of therapy. It offers guidelines for initiation, contraindications, and required follow-up. It addresses the management of side effects and problems. The article briefly reviews a variety of complementary and alternative therapies including various self-help measures, such as nutrition and exercise, and selected herbal treatments. Part 1 of this article, which appeared in the January/February 1996 issue of JNM, reviewed the literature on recommended therapeutic and preventive indications for hormone replacement therapy, providing guidelines for the provision of informed consent.