Symposium - Relevance of Progesterone in Mid Reproductive Years

Presenters

Needs Assessment and Description
The relevance of including progestin in a menopausal hormone therapy (MHT) regimen lies in offering endometrial protection against the unopposed effects of estrogen in women with a uterus. However, the benefits of including progestin in MHT (i.e., reduced risk of endometrial disorders such as hyperplasia and cancer) with the use of estrogen alone are to be balanced against potential risks and medication intolerance. Concepts of dose, duration and route of administration are relevant for maximizing benefit and minimizing risks of progestin in MHT users. With the increasing spectrum of therapeutic options (progestin pills, creams, inserts and intrauterine systems) that are now available, women and their healthcare providers are increasingly confused as to the optimal progestin regimen for use in menopausal women desiring combined MHT therapy. After attending this live course, healthcare providers will understand concepts related to dose, duration and route of administration for maximizing benefit and minimizing risks of progestin in MHT users.

Learning Objectives
At the conclusion of this session, participants should be able to: 

1. Individualize risk versus benefit of including progestin in a MHT regimen. 
2. Appreciate that both dose and duration of exposure are key determinants of progestin’s efficacy against estrogenmediated endometrial pathology. 
3. Identify strategies for minimizing progestin-related side effects. 
4. Design treatment plans for women of varying ages and differing risk profiles who are considering initiating MHT. 
5. Individualize treatment plans utilizing various progestin formulations in varying doses and regimens.

ACGME COMPETENCY
Patient Care

TEST QUESTION
A 53-year-old woman with bothersome vasomotor symptoms unresponsive to non-hormonal strategies presents to discuss trial of menopausal hormone therapy. Her last menstrual period was 4 months prior to this visit. Her personal history is significant for obesity, a long-standing history of oligomenorrhea and benign endometrial polyps. Her mammographic exams have been unremarkable other than evidence of dense breast tissue; her mother died of breast cancer at age 68. After participating in this session, in my practice I will counsel the patient that: 

1. Short-term estrogen use without progesterone is a safe option for her. 
2. Use of transdermal progesterone cream offers the most optimal safety profile. 
3. Intrauterine progesterone system offers a safe option of progesterone delivery with minimal effects on breast tissue. 
4. Risks of adding progesterone to menopausal hormone regimen outweigh potential for benefit. 
5. She should undergo hysterectomy. 
6. Not applicable to my area of practice.