Allison Taylor, MD, with the Center for Women's Health in Wichita, KS, presented about perimenopause and hormone therapy during a Women's Connection July 9, 2013, at Corporate Caterers. The event is sponsored by Via Christi Health.

1. .
ALLISON A. TAYLOR, M.D.
CENTER FOR WOMEN’S HEALTH

2.  Definitions
 Physiology of the menstrual cycle
 Pathophysiology of perimenopause
 Symptoms of perimenopause
 TREATMENT

3.  The permanent cessation of menstrual
cycles
 Decrease in the amounts of estrogen,
progesterone, and androgens produced
by the ovaries
 Mean age – 51
 Natural process, not a disease

4.  Technically means “around menopause”
 Time period during which the body
makes its natural transition toward
permanent infertility (menopause)
 Estrogen, progesterone and androgens
are fluctuating, but periods are still
present
 Typically occurs sometime during 40’s
 For some, it may occur as early as in their
30’s

5.  A transition, not an event
 ovarian function is declining but still
present
 3 to 5 years before periods stop
 PERIMENOPAUSE MAY LAST 2 TO 10
YEARS

7.  Ovarian cycle
 Endometrial cycle
 Pituitary hormone
cycle
 Sex hormone cycle
ALL OCCUR IN TANDEM

8.  Structures
› Hypothalamus
 Links nervous system to
endocrine system
› Pituitary gland
› Ovaries
› uterus
 hormones
› LH
› FSH
› Estrogen
› Progesterone

9.  FSH
 Ovaries
› Cohort of follicles
 Secrete estrogen
› Dominant follicle
 Estrogen
 Fully mature
 LH surge
› Rupture of follicle
 Ovulation

10.  Finite number of eggs
 “Aging eggs”
› Less responsive
 Decreased fertility
 Increased incidence of birth defects

11.  Estrogen levels
› normal
› Decreased
› Often elevated
 Progesterone level
› Often decreased
› (largely because of the lack of ovulation)

12.  THE RATIO OF PROGESTERONE TO
ESTROGEN IS ESSENTIAL TO NORMAL
FUNCTION OF THE FEMALE BODY
 After ovulation, that ratio should be 20:1

13. Low estrogen is not necessarily the problem
 Intermittently elevated FSH
 Elevated, normal or depressed estraiol
 Depressed progesterone

14.  Progesterone
deficiency same as
estrogen excess
› PMS
› Sleep disturbances
› Hot flashes
› Menstrual irregularities
› Breast tenderness
› Mood disturbances
 Depression
 Fatigue
 “mental fogginess”
› Decreased libido
› Weight gain
› Water retention

15.  OCP’s
› Treats menstrual irregularties
› May make other symptoms worse
 Antidepressants
› Side effects
 Breast proliferation
› Multiple breast biopsies
 Thyroid function
 Diuretics

16.  The “other” female hormone
 Produced by the ovaries
 Effects on various organs in the body
› Breast – decreases growth, promotes differentiation
› Bone – stimulates osteoblasts (lay new bone)
 Estrogen inhibits osteoclasts
› Increases thyroid activity
› Stimulates normal sex drive
› Natural diuretic
› Decreases uterine muscle contractions
› Binds GABA receptors
 Decrease anxiety and depression

17.  Progesterone
 Estradiol
 FSH, LH
› Salivary
› Blood

18.  Prometrium
› Micronized progesterone
› Plant source
 Compounded
› Transdermal
› Oral
› Sublingual/ buccal
› Local (vaginal)

19.  Pills
 Sublingual/ buccal
 Creams
› Vaginal
› topical

20.  Continuous
› everyday
 Cyclic
› During luteal phase (typically, days 12-28 or
14-30)

21.  Not FDA regulated
 Made by compounding pharmacies
 Typically, plant sources

22.  Low dose OCP’s
 Cyclic
progesterone
 SSRI’s (prozac,
effexor)

23.  EXERCISE
 High fiber, low fat diet
 Maintain regular sexual
activity
 Decrease alcohol
intake
 Stop smoking
 Daily sunlight
 RELAXATION AND
STRESS REDUCTION