Therapeutic options

A. Contraindications to hormone replacement therapy: Family or individual history of breast cancer; estrogen dependent neoplasia; undiagnosed genital bleeding; and a history of or active thromboembolic disorder.

B. Hormone replacement therapy should be considered to relieve vasomotor symptoms, genital urinary tract atrophy, mood and cognitive disturbances, and to prevent osteoporosis and cardiovascular disease. It also may be considered to help prevent colon cancer, Alzheimer's disease, and adult tooth loss.

C. Effective doses of estrogen for the prevention of osteoporosis are: 0.625 mg of conjugated estrogen, 0.5 mg of micronized estradiol, and 0.3 mg of esterified estrogen.

D. In those women with a uterus, a progestin should be given either continuously (2.5 mg of medroxyprogesterone acetate per day) or in a sequential fashion (5-10 mg of medroxyprogesterone (Provera) for 12-14 days each month).

E. Combination estrogen with progestin (Prempro), 0.625 mg of estrogen and 2.5 mg of medroxyprogesterone, one tablet every day.

F. Estrogen cream. Application 1/4 of an applicator(0.6 mg) daily for 1-2 weeks, then 2-3 times/week will usually relieve urogenital symptoms. This regimen is used concomitantly with oral estrogen.

G. Treatment of low libido consists of micronized testosterone cream (1 mg/mL) applied to the inner surface of both forearms daily. Start with 1 mg/day and increase to 2.5 mg/day if necessary.

References: See page 195.

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