There are an abundance of hormone therapies that are aimed at replacing hormones due to the natural process of menopause, cancer and more recently feminizing hormone therapy
There are an abundance of hormone therapies that are aimed at replacing hormones due to the natural process of menopause, cancer and more recently feminizing hormone therapy (Unger, 2016). Here we will discuss estrogen therapy and its role in the treatment of menopause. There are a number of associated symptoms with menopause including the typical vasomotor symptoms (hot flashes, night sweats and flushing), sleep disturbances, atrophic vaginitis, fatigue, and decreased libido (Valdes, 2022). Due to these symptoms and more, quality of life can be severely diminished. Menopause is also associated with the alkalinization of the vaginal canal, raising the PH to 6.5-7 which is correlated with increased risk of UTI’s and cervical tumors (Valdes, 2022). Treatment depends on symptoms to be treated. Systemic treatment is warranted for the vasomotor symptoms such as hot flashes while local treatment is for symptoms specifically involving the uterus or vagina (Valdes, 2022). Side effects include nausea, bloating, headaches, breast tenderness and leg cramping. Risks include breakthrough vaginal bleeding and an elevated risk for breast or endometrial cancer (Valdes, 2022) which is why estrogen therapy is not recommended for long term therapy.
Unger C. A. (2016). Hormone therapy for transgender patients. Translational andrology and urology, 5(6), 877–884. https://doi.org/10.21037/tau.2016.09.04
Valdes A. & Bajaj T. (2022) Estrogen Therapy. StatPearls [internet]. Treasure island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541051/
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According to Adams et al. (2017), low doses of estrogens and progestins prevent conception by blocking ovulation, and estrogen–progestin combinations are used for hormone replacement therapy during and after menopause. The authors state that the long use of these combinations has serious adverse effects. Estrogen is a general term that includes three different hormones which are estriol, estrone, and estradiol. Both estrogen and progesterone are used for several therapeutic goals. They are used to prevent pregnancy and treat symptoms of menopause (Adams et al., 2017).
In addition, Adams et al. (2017) state that therapy with hormonal contraceptives increases the risk of cardiovascular adverse effects such as hypertension and thromboembolic disorders. The estrogen part of the pill can lead to venous and arterial thrombosis which may lead to pulmonary embolism or a stroke. In addition, it may cause uterine bleeding, elevated plasma glucose, and retinal disorders (Adams et al., 2017).
According to Adams et al. (2017), menopause occurs due to a decrease in estrogen secretion by the ovaries. It is often managed with hormone replacement therapy. This therapy includes estrogen, sometimes combined with progestin. Women who use estrogen-progestin combination therapy have a high risk of stroke, breast cancer, dementia, venous thromboembolism, and myocardial Infarction. However, they have a lower risk of hip fractures and colorectal cancer. In addition, women who only take estrogen do not have an increased risk of breast cancer or myocardial Infarction, but they do have an increased risk of stroke and thromboembolic disorders. Women who take estrogen should be educated about adverse effects that include edema, breast tenderness, abdominal cramps, acute pancreatitis, appetite changes, acne, mental depression, headache, fatigue, nervousness, weight gain, and nausea (Adams et al., 2017).
According to Kim et al. (2021), hormone therapy reduced the risk of Alzheimer’s and neurodegenerative disease, especially in women who are 65 years old or older. The authors also state that diseases such as Parkinson’s disease, multiple sclerosis, dementia, and amyotrophic lateral sclerosis are reduced with the use of oral hormone therapy (Kim et al., 2021).
According to Shifren et al. (2019), hormone therapy is the most effective treatment for managing menopausal symptoms, such as hot flashes and night sweats. The authors also state that hormone therapy is beneficial for bone mineral density, urogenital tract, and even reducing the risk of fractures. In addition, low doses of estrogen can be applied in the vaginal area to improve sexual quality of life. Transdermal estrogen therapy has more benefits than oral therapy, especially for women who are obese or have many risk factors for developing cardiovascular diseases. Moreover, all estrogen patches have estradiol which is a natural hormone that is produced by the ovaries during the reproductive years (Shifren et al., 2019).
In addition, according to Shifren et al. (2019), there is no significant increase in the risk of heart disease in women who get estrogen or estrogen-progestogen therapy who were younger than 60 years or within 10 years since the time menopause started. The authors also state that although venous thrombotic complications increase with oral estrogen, there is no increased risk with the use of transdermal estradiol. In addition, there is a slight increase in the risk of breast cancer with estrogen-progestogen therapy, but only after using it for about four years. Moreover, there is no increased risk of developing breast cancer with short-term use of estrogen-progestogen therapy or in women who use only estrogen (Shifren et al., 2019).
Shifren et al. (2019), state that oral estrogen use increases the risk of gallbladder diseases but it does not happen with the use of transdermal estradiol. Overall, starting hormone therapy in women older than 60 years or more than ten years after the beginning of menopause has an increased risk of complications (Shifren et al., 2019).
References
Adams, M. P., Holland, N., & Urban, C. Q. (2017). Pharmacology for nurses. A pathophysiologic approach. (5th ed.). Pearson Education. https://online.vitalsource.com/books/9780134255378
Kim, Y. J., Soto, M., Branigan, G. L., Rodgers, K., & Brinton, R. D. (2021). Association between menopausal hormone therapy and risk of neurodegenerative diseases: implications for precision hormone therapy. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 7(1). https://doi.org/10.1002/trc2.12174
Shifren, J. L., Crandall, C. J., & Manson, J. A. E. (2019). Menopausal hormone therapy. The Journal of the American Medical Association, 321(24), 2458– 2459. https://doi.org/10.1001/jama.2019.5346
Sinusitis and bronchitis are inflammatory processes due to infections. Often, they are related to viral illnesses and antibiotics are not warranted. This is true of bronchitis and sinusitis treatment. In a study review, Smith et al, (2017) found no statistical significance in using antimicrobial therapy with bronchitis and cough. They did find they find that there may be some small benefit in some populations such as geriatrics with multiple comorbidities. Although often I see Z-Packs prescribed for these ailments, the risk of increasing resistance of pathogens occurs when antibiotics are over prescribed for what are often viral illnesses (Smith et al, 2017). In cases of pharyngitis, use of antibiotics is warranted if cultures are positive for strep. In this case, penicillin related treatments are widely used such as amoxicillin (Nakao et al, 2019). This has a gross impact on practice implications due to the threat of creating antimicrobial resistant organisms. Clinicians need to be certain of what they are treating and prescribe accordingly. Although I’ve seen some clinicians prescribe antibiotics to patients with likely viral symptoms just to keep the patient happy to keep their HCAP scores up. But that’s an argument for another day entirely.
Nakao, A., Hisata, K., Fujimori, M., Matsunaga, N., Komatsu, M., & Shimizu, T. (2019). Amoxicillin effect on bacterial load in group A streptococcal pharyngitis: comparison of single and multiple daily dosage regimens. BMC pediatrics, 19(1), 205. https://doi.org/10.1186/s12887-019-1582-8
Smith, S. M., Fahey, T., Smucny, J., & Becker, L. A. (2017). Antibiotics for acute bronchitis. The Cochrane database of systematic reviews, 6(6), CD000245. https://doi.org/10.1002/14651858.CD000245.pub4
Bronchitis refers to the inflammation of the bronchial tubes, the airways that carry air to one’s lungs. Symptoms of bronchitis include fatigue, chest discomfort, sinus congestion and bad breath. In order to treat bronchitis, many antibiotics are used such as Amoxicillin, Deoxycycline, Erythromycin, Azithromycin, and Cefuroxime (Smith et. al., 2014). Often times, if bronchitis is caused by a viral infection, antibiotics are rendered useless. Bronchitis leads to more inappropriate antibiotic prescriptions in adults (Harris et. al., 2016). When a patient is taking an antibiotic for a diagnosis that may not call for antibiotics, they are increasing the prevalence of antibiotic resistant bacteria. Appropriate antibiotic prescribing is critical as it results in fewer adverse effects in patients.
References Harris, A. M., Hicks, L. A., & Qaseem, A. (2016). Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Annals of Internal Medicine, 164(6), 425. https://doi.org/10.7326/m15-1840
Smith SM, Smucny J, Fahey T. Antibiotics for Acute Bronchitis. JAMA. 2014;312(24):2678–2679. doi:10.1001/jama.2014.12839
