hormone therapy whats the harm激素治疗有什么危害课件

Bio identicalHormones LucijaVrabi De man MDSlovenianMenopausalSociety LjubljanaSlovenia9thCroatiancongressonGynaecologicalEndocrinology HumanReproductionandMenopauseBrijuni 5 8 9 2013 FountainofYouth LucasCranachsenior 1546 DetailfromPrimaveraS Botticelli 1482 Theideaofeternalyouthisnotsomethingnew Thepaintingfromthe16thcenturyshowsthetransformationofoldwomenintoyoungwomen Eternaldesire BUTthereality AWoman sPhasesofLife 80years Expectedlenghtofwomen slife 4 LackofEstrogen Aftermenopause estrogenlevelis reduced inparticular oestradiol 120pg mlto18pg mlTheconsequencesare climactericsymptoms impairedqualityoflife PerimenopausalTransition Decreasedlevelodestrogens ClimactericSymptoms Hotflashes mostcommon NightsweatsIrregularbleedingSleepproblemsMoodchangesDepressionHeadacheWeightgainandslowedmetabolismThinninghairanddryskinLossofbreastfullnessFatigue tiredness occasionalpalpitationsThemedium termconsequences uro genitalatrophy vaginaldryness thedeclineinsexualdesireLong termconsequences cardiovasculardiseases osteoporosis 6 HormonalTherapy Forseveraldecades gynecologistshavebeensuccessfullyusingvariousformsofhormonal replacement therapy HT fortreatingclimactericsymptoms After2002 asaresultofWomen sHealthInitiative WHI data theuseofHRThasdecreased l 2002 28 postmenopausalwomenuseHT l 2004 only12 Menon 2007 HormonalTherapy ManywomenusingHRTbecameconcernedANDstoptreatmentimmediatelyBeforehealthcareprovidershadtimetofurtheranalyzetheWHIfindings theconsumermediabegantoreportabout natural bioidentical CurrentStatus Bioidenticalhormones arecurrentlyverypopularInourdailyclinicalpractisewemeetwomeninterestedinBHOnadailybasiswearealsofacedwitharticlesregardingBH inthepressandothermedia whicharemisleading Misleadinginfo Aggresivemarketingandmisleadingunprofesionalinfoabout synthetic hormones suchas Source WhatAreBio identicals Theterm bioidentical wascreatedbymarketersNotascientificterm nouniformdefinitioninanymedicaldictionaryMedicalexplanation hormoneswhichhaveexactlythesamechemicalstructureasthosefoundinthehumanbody Terminology ThetermoriginatedintheUSApredominantelyconjugatedequineestrogen CEE wasusedinHRT animalorigin horses BIOIDENTICAL somethingnew natural BIO notartificial fromplants IDENTICAL thesameashormonesinhumanbodyInEurope 17 betaestradiol notCEE wasusedinHRTfromthebeginning Bio identicalHormonesinConventionalHT Customcompounded Bioidenticalhormones Custom compoundedHTCouldbepreparedindifferentdosagesandformssucsas creams gels sublingualtablets suppositoriesCliniciansprescribethem pharmacystsmakethemAlsocommerciallypreparedinstandardproportions Bi est 20 estradiol 80 estriolTri est 10 estradiol 10 ofestrone 80 estriol testosterone DHEAS Bio identical PromotorscreateagressivemarketingBH 1 Moreeffective2 Safer3 Prescribedandcompoundedintotailored exactdosages accordingwomen sneed4 More natural Biochemicallysimilartonativehormones Plantderived Madewithoutchemicalsynthesis Effectivenes BHTpromoters 1 Moreeffective EstrogenDose EstrogenisessentialforalleviatingclimactericsymptomsInconventionalHRT exactdosesofhormonesareknownDoseofestrogensisadjustedbasedonclinicalimprovement symptomreliefDoseofhormonesisdeterminedinclinicaltrialsneededfordrug HRTapproval CEE conjugatedequineestrogen E2 estradiol FrielP HinchcliffeC WrightJ HormoneReplacementwithEstradiol ConventionalOralDosesResultinExcessiveExposuretoEstrone AlternMedRev2005 10 1 36 41 EstrogenDose Trendis decreasingE2dose Progestogendose Whyprogestagensshouldbeused Womenwithintactuterus Theonlyabsoluteindicationfortheuseofprogestagens progesteron isintoreduceriskofendometrialhyperplasiaandendometrialcancerthatisassociatedwithunopposedestrogentherapyDoseofhormonesisdeterminedinclinicaltrialsneededfordrug HRTapprovalWeiderpassE AdamiH O BaronJA etal Riskofendometrialcancerfollowingestrogenreplacementwithandwithoutprogestins JNatlCancerInst1999 91 1131 1137 Transformationaldoseofprogestagens BioidenticalEvidenceBased BHTpromoters MoreeffectiveEvidencebased NOclinicaltrials NOdata Safety BHTpromoters 2 Safer ApprovalofEstrogenDrug Toobtainapprovalforanestrogendrug themanufacturermustconductatleast1 2clinicaltrials randomized placebo controlled Forindication hotflashes adrugmustbestatisticallysuperiortoplaceboinreducingthefrequencyandintensityofhotflashes 12weeks ThemanufacturermustestablishthelowesteffectivedosetoalleviatesymptomsBoothbyetal BioidenticalHormoneTherapy Areview Menopause 2004 ApprovalofProgestagenDrug Requirementsareevenmorecomplicatedbecauseofhealthrisk endometriumhyperplasia Manufacturermustconductanendometrialhyperplasiapreventionstudy Duration12 24monthsTheacceptablerateofhyperplasiais1 orlessBoothbyetal BioidenticalHormoneTherapy Areview Menopause 2004 Safety Statisticalsignificance p 0 001 with1mg17 E2 Vir KurmanRetal Obstet Gynecol 2000 96 373 379 Incidenceofendometrialhyperplasia1176post menopauseW 1year Incidence PreventionofendometrialhyperplasiaNOTenoughforendometrialprotection Achievedwith200mgoforalmicronizedprogesteroneor80mgprogesteroneskincream 16nmol lserumprogesterone Safety 2 9nmol lserumprogesterone Serumprogesteronelevels achievedwith1 BHprogesteronecreamusuallyused to1teaspoondaily Safety BHTpromoters 2 safer Evidencebased NO Tailoreddose BHTpromoters 3 Prescribedandcompoundedintotailored exactdosagesaccordingto womensneeds SalivaTesting Treatment individualizedforeachpatientbasedonlaboratorymeasurementsmakessenseonlyforacertainclassofdrugsSexhormonesarenotsuchadrugBUTDespitethisfact salivatestingsarerecommendedbyBHpromotorstofindoutwhichhormonesaredeficient SalivaTesting Hormonelevelsvary onthetimeofdayonthedietoftheindividualpoorreproducibilityandlargerinterassayvariabilityunderminetheprecisionofsalivahormonetestingSalivatestingisnotsuitablemethodDoseofestrogensisadjustedbasedonclinicalimprovement symptomrelief NOTlabvalues Boothbyetal BioidenticalHormoneTherapy Areview Menopause 2004 BioidenticalEvidenceBased BHTpromoters Prescribedandcompoundedintotailored exactdosages accordingtowomen sneed Evidencebased NO Bio identicals BHTpromoters 4 More natural Biochemicallysimilartonativehormones Plantderived Madewithoutchemicalsynthesis ClassificationofSteroids 4groups 1 ClassAsteroids2 ClassBsteroids3 ClassCsteroids4 ClassDsteroids ClassificationofSteroids ClassA foundinnature formulatedintodrugswithoutundergoinganychemicalmodifications conjugatedequineestrogens simplyextractedfrompregnantmare surine ClassB theyaresemisynthetic theyneedtobechemicallysynthesizedfromprecursors anaturalstartingmaterial soy Mexicansweetpotatoes containsterols diosgenin stigmasterol precursorsforthesynthesisofsteroids estradiol estrone estriol progesterone dehydroepiandrosterone testosterone cortisol aldosteroneetcnaturalprecursor diosgenin estradiolrequiresatleast15chemicalreactions ClassificationofSteroids ClassC aresynthesizedbyaprocesscalled totalsynthesis havethesamechemicalstructureasthatofthenaturallyoccurringhormone andthesamebiologicalactivity differentiatingbetweenBandCclassesofsteroidhormonesisverydifficult preciseanalyticalproceduresrequiredClassD includessteroidsNOTidenticaltohumanhormones MPA NETA ethinylestradiol Bio identicalsEvidenceBased BHTpromoters More natural Biochemicallysimilartonativehormones Plantderived Madewithoutchemicalsynthesis Evidencebased Biochemicallysimilartonativehormones Plantderived Madewithoutchemicalsynthesisx Control ControlovertheBH IntheUSA notunderregulatory FDA controlNocontrolofcontent purity stability CreamswithBH classifiedasdietarysupplements l 1994 DietarySupplementHealthEducationAct evenpoorercontrolAlsoavailableonline difficulttocontrolEurope SLO BHareregulatedandshouldbecontroledusanyotherdrug ACOGopinion In2005 theAmericanCollegeofObstetriciansandGynecologists ACOG issuedastatement thereisnoscientificevidencetosupportclaimsofincreasedefficacyorsafetyofBHBHhavenot