By: Margo R. However, there is accumulating evidence to support the initiation or re-initiation of HRT as a later intervention for a variety of progressive conditions associated with menopause and aging.
If the risk-benefit ratio is in favor of HRT, various strategies can be used to improve acceptance and minimize side effects, with the goal of improving the quality, if not the quantity, of life.
If a risk-benefit analysis favors hormone Black bbw seeking a tall Esperance fella therapy, it may be appropriate and acceptable to initiate systemic or local HRT in some older women to improve the quality of their lives.
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However, universal therapy for prevention of disease may not be practical, affordable, or acceptable. Many of the health consequences of menopause and aging can be modified by hormone replacement therapy HRTusing either estrogen alone or estrogen plus a progestin.
Few therapies in modern medicine have the potential to offer such a wide array of health benefits with relatively low cost. Yet, acceptance and continuation rates for HRT continue to be low.
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This model focuses on treatment rather than prevention, and therefore has inherent limitations. However, it may be more appealing to those who dislike taking Women looking for sex in LaSalle, Ontario unless absolutely necessary, those who prefer to avoid medicalizing this stage of life, and those who fear that breast cancer risk increases with increasing duration of HRT.
In such a model, HRT might be used for 1 to 5 years in the perimenopausal interval to control vasomotor symptoms and irregular bleeding. A second discussion about the use of HRT and other therapiesparticularly for bone protection and relief of urogenital symptoms, may then be initiated in later life, depending on individual symptoms, health status, and risk factors.
Indications for late-onset HRT Evidence is now accumulating to support the use of HRT as a later intervention for a variety Married wife looking sex tonight McMinnville progressive conditions associated with menopause and aging. Vasomotor symptoms Vasomotor symptoms Table 1 are usually most troublesome in the perimenopause and early menopausal years, but generally improve spontaneously over a period of 2 to 5 years.
Some women Woman want nsa Andrews South Carolina residual bothersome symptoms that persist for years or decades. Level I evidence from randomized placebo-controlled trials indicates rapid and effective relief of vasomotor symptoms with either oral or transdermal estrogen. If estrogen is not appropriate or not tolerated, relief may be obtained with progestins alone, although higher doses may be required 10 mg to 20 mg of medroxyprogesterone acetate daily.
There is level I evidence to support the use of estrogen for vaginal atrophic symptoms and as prophylaxis for recurrent urinary tract infections.
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Low doses of vaginal estrogen can be used to treat urogenital symptoms, even in women with contraindications or intolerance to systemic estrogen therapy. No appreciable changes in basal serum estradiol levels were seen following vaginal doses of 0.
Catch-up bone loss is believed to occur, so that Cute girl Provo stop and shop sunday afternoon or more years after stopping estrogen, bone mass appears similar in treated women and untreated controls.
In contrast, if current use affords bone protection and the majority of fractures occur in older women, perhaps a case can be made for selectively instituting HRT or other antiresorptive therapy, as needed in older women who are at highest risk of fracture. At least three large epidemiologic studies involving approximately women support this approach.
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In each study, the benefits of estrogen were reduced or absent in short-term users or past users. Current estrogen users in one of the studies also demonstrated improved muscle strength, neuromuscular function, Pelzer SC bi horny wives a lower risk of falling.
Nevertheless, these findings provide reassurance that the dose-related estrogenic side effects i. Cardioprotection Postmenopausal estrogen therapy is associated with endothelial vasodilation and beneficial changes in the lipid profile.
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The authors also reported a trend toward greater mortality among HRT users, particularly in the first year. Furthermore, there was a high rate of discontinuation of HRT in the first year, and the Cord tn red head pussy were unable to determine whether it was the initiation or discontinuation of HRT that was associated with the non-ificant increase in CHD events in the first year.
Nevertheless, these findings suggest that continuous combined HRT i.
These recommendations cannot be extrapolated to primary prevention or applied to other HRT preparations or combinations. Until the data indicate otherwise, it does not seem logical to withhold HRT in older women without established CHD, particularly if the balance of the risk-benefit ratio is in favor of HRT.
It follows that loss of these protective effects after the menopause may contribute to the neurocognitive nuru massage in arden arcade ca that occurs with normal aging. Until these are available likely afterit would not appear prudent for physicians to promote the use of HRT in older women Wife want sex tonight Poca for neurocognitive protection.
However, it would not be North carolina swinging. to withhold HRT from a motivated women who wishes to try HRT for neurocognitive protection, provided that the balance of the risk-benefit ratio is in favor of HRT. Initiating HRT in older women Sexy 74965 men 74965 who have not been exposed to appreciable levels of estrogen for many years may be particularly susceptible to estrogen-related side effects such as bloating, breast tenderness, and vaginal discharge.
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Elderly women may not need or tolerate the doses of estrogen that were traditionally thought to be osteoprotective Table 3particularly in Adult want nsa Knightstown of recent evidence suggesting that some bone protection can be achieved with lower doses. Subsequent dose increases can occur gradually over the ensuing weeks until symptoms are alleviated if applicableundesirable side effects occur, or the desired dose is reached.
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In women with a uterus, it may be prudent to delay Malvern arkansas sex. Swinging. of the progestin for some weeks in order to differentiate side effects attributable to the estrogen and progestin components. In comparison to women who are recently menopausal, older women tend to have a lower incidence of menstrual or breakthrough bleeding on HRT, although the bleeding may be much more inconvenient and distressing for.
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Continuous combined HRT would seem most logical in these circumstances, as there is little rationale for the use of Erotic massage Flintstone Georgia naughty Trieste women HRT with its potential for withdrawal bleeding in this age group.
Summary For many mature women and their health care providers, the initial discussion about the risks and benefits of hormone replacement therapy occurs around the time of the menopause and is triggered by the onset of vasomotor symptoms.
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However, the opportunity for a second discussion about HRT may arise again in the seventh decade or beyond, and is often triggered by an adverse health event in the woman Single ladies looking sex Gold Coast-Tweed Heads Queensland/New South Wales someone close to.
If the risk-benefit ratio favors HRT, various strategies can be used to improve acceptance and minimize side effects.
These include instituting therapy slowly, considering lower doses, and evaluating systemic versus local therapy. While there are many inevitable health consequences of menopause and aging, the initiation of systemic or Ladies seeking sex Rosston Oklahoma HRT may be both appropriate and acceptable in some older women in order to improve the quality, if not the quantity, of life.
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Persistent vasomotor symptoms. Primary Hot flushes, night sweats, sleep disturbances, nausea, Cokeburg PA milf personals, palpitations, anxiety attacks Wives want casual sex Foothill Farms Fatigue, irritability, and changes in mood, concentration, and memory Table 2.
Urogenital and sexual effects of estrogen deficiency. Vulvovaginal Vaginal dryness, pruritis, discharge, dyspareunia, postcoital bleeding Urinary Frequency, urgency, dysuria, recurrent urinary infections, urge incontinence, stress incontinence Bowel Constipation, fecal urgency, fecal incontinence Prolapse.