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An Evolving View of Menopausal Hormone Therapy

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   The controversy over the beneficial effects and safety of hormone therapy (HT) has swung like a pendulum over the last 30 years. Oral conjugated estrogens were first marketed for menopausal symptom relief in the 1930’s. In the 1970’s, HT was cast in a new role as a health-promoting therapy after studies suggested it reduces the risk of heart disease, osteoporosis, and Alzheimer’s disease. Many more women started using HT and were encouraged to do so by their prescribers.

   In the 1990’s, 2 large clinical trials evaluated HT for the prevention of cardiovascular disease. Unexpectedly, these trials found NO reduction in risk. In fact, the results suggested HT may actually increase the risk of heart disease and breast cancer. Within 6 months after these results were published, more than half of American women who were taking HT stopped.

   Over the last 3 years, provocative new information has been published suggesting HT may be safer in some women than previously thought. While guidelines, package inserts and “black-box” warnings have not yet changed, the consensus of expert opinion on HT appears to be shifting.

   This issue will bring you up to date on the risk-benefit profile of HT, including newer information about the risks of heart disease and breast cancer. The established benefits of HT are reviewed, and current recommendations for use are summarized. Tables provide a quick guide to available products and usual doses. The Patient Connection answers questions women frequently ask about HT and includes an inset to help you quickly identify those who should avoid estrogen.


Publication Date: 07/01/2008
Expiration Date: 07/01/2011
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Martha Stassinos, Pharm.D., Clinical Pharmacist Specialist, Veteran’s Administration, Northern California, and Adjunct Professor, Touro University College of Pharmacy, Vallejo, Ca. Dr. Stassinos participates in the VA Women’s Health Advisory Committee and precepts residents specializing in women’s health and diabetes.

Disclosure Statement

Dr. Stassinos reports no financial or other relationship with any product discussed in this issue or its manufacturer.

Guest Editorial Advisor

Leslie A. Shimp, M.S., Pharm.D., Professor of Pharmacy, University of Michigan College of Pharmacy.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Recognize perimenopausal and menopausal symptoms and the potential effect of these symptoms on quality of life.
    2. Be familiar with the different formulations of hormone replacement products. Describe the potential advantages and disadvantages of oral and non-oral dosage forms.
    3. Describe how age and time since menopause affect the interpretation of the WHI hormone therapy (HT) study results. Help a woman considering HT assess her specific risk-benefit profile.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc. Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Editor and CE Administrator

Terry M. Baker, PharmD

Associate Editor and CE Coordinator

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Ron Finley, RPh
Department of Clinical Pharmacy
University of California San Francisco
San Francisco, CA

Associate Member of the UCSF Memory and Aging Center
Alzheimer's Research Center

Consultant Pharmacist to the Institute on Aging-On Lok Senior Health
Institute on Aging Alzheimer's Day Care Center

Angie S. Graham, PharmD
Drug Information Coordinator
Stanford Hospital and Clinics
Stanford University Medical Center
Stanford, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA

Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor
Department of Pharmacotherapy
College of Pharmacy
Washington State University
Elder Services of Spokane
Spokane, WA

Candy Tsourounis, PharmD
Professor of Clinical Pharmacy
Medication Outcomes Center
Department of Clinical Pharmacy
School of Pharmacy
University of California, San Francisco
San Francisco, CA

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Jocelyn Chan, PharmD
Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K. Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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