You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.



Individualizing Hormone Therapy: Principles and Practice

  • Authors: Author: Morris Notelovitz, MD, PhD
Start Activity

Target Audience and Goal Statement

This activity is intended for gynecologists and primary care physicians.

The goal of this activity is to inform clinicians who prescribe hormone therapy about the essentiality of individualization of therapy based on a biologic evidence-based approach.

On completion of this continuing medical education offering, participants will be able to:

  1. Understand why the current practice of generic "hormone replacement therapy" for menopausal women is inappropriate.
  2. Explain the principles of "low-dose adjustive hormone therapy."
  3. Discuss which formulations of hormone therapy could be or would not be appropriate for a given patient.

Accreditation Statements

    For Physicians

  • Medical Education Collaborative, a nonprofit education organization, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medical Education Collaborative designates this educational activity for a maximum of 1 hour in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

    Contact This Provider

    For Pharmacists

  • Medical Education Collaborative, Inc. has assigned 1 contact hours (0.10 CEUs) of continuing pharmaceutical education credit. ACPE universal program number: 815-999-01-055-H01. Certificate is defined as a record of participation.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

The credit that you receive is based on your user profile.


Individualizing Hormone Therapy: Principles and Practice


Suggested Reading

Ansbacher R. The pharmacokinetics and efficacy of different estrogens are not equivalent. Am J Obstet Gynecol. 2001;184:255-263.

Archer DF. Progestogen effects on coronary arteries: the need for definitive clinical trials. Menopause. 2001;8:1-2.

Birge SJ. Maintaining mental health with hormone replacement therapy. Eur Menopause J. 1996;3:164-169.

Caillouette JC, Sharp, CF, Zimmerman GJ, Roy S. Vaginal pH as a marker for bacterial pathogens and menopausal status. Am J Obstet Gynecol. 1997;176:1270-1277.

Collins P, Rossario GMC, Sarrel PM, et al. Estradiol 17-beta attenuates acetylcholine-induced coronary arterial constriction in women but not in men with coronary heart disease. Circulation. 1995;92:24-30.

Cummings SR, Browner WS, Bauer D, et al. Endogenous hormones and the risk of hip and vertebral fractures among older women. N Engl J Med. 1998;339:733-738.

Ettinger B, Genant HK, Steiger P, Madvig P. Low-dosage micronized 17-beta-estradiol prevents bone loss in postmenopausal women. Am J Obstet Gynecol. 1992;166:479-488.

Fantl JA, Cardozo L, McClish DK, et al. Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis. First Report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol. 1994;83:12-18.

Genant HK, Lucas J, Weiss S, et al. Low-dose esterified estrogen therapy. Effects on bone, plasma estradiol concentrations, endometrium and lipid levels. Arch Intern Med. 1997;157:2609-2615.

Kuiper GG, Carlsson B, Grandien K, et al. Comparison of the ligand binding specificity and transcript tissue distribution of estrogen receptors alpha and beta. Endocrinology. 1997;138:863-870.

Groome NP, Illingworth PJ, O'Brien M, et al. Measurement of dimeric inhibin B throughout the human menstrual cycle. J Clin Endocrinol Metab. 1996;81:4:1401-1405.

Gruber DM, Huber JC. Tissue specificity: the clinical importance of steroid metabolites in hormone replacement therapy. Maturitas. 2001;37:151-157.

Herrington DM, Rebousin DM, Brosnihan KB, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med. 2000;343:522-529.

Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998;280:605-613.

Jewelewicz R. New developments in topical estrogen therapy. Fertil Steril. 1997;67:1-12.

Kuchel GA, Tannenbaum C, Greenspan SL, Resnick NM. Can variability in the hormonal status of elderly women assist in the decision to administer estrogens? J Women's Health Gend Based Med. 2001;10:109-116.

LeBlanc ES, Janowsky J, Chan BKS, Nelson HD. Hormone replacement therapy and cognition. Systematic review and meta-analysis. JAMA. 2001;285:1489-1499.

Levrant SG, Barnes RB. Pharmacology of estrogens. In: Lobo RA, ed. Treatment of the Postmenopausal Woman: Basic and Clinical Aspects. New York, NY: Raven Press Ltd; 1994:57-68.

Meigs JB, D'Agostino RB, Wilson PWF, et al. Risk variable clustering in the insulin-resistance syndrome. Diabetes. 1997;46:1594-1600.

Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. N Engl J Med. 340:1801-1811.

Miller PD, Baran DT, Bilzekian JP, et al. Practical clinical application of biochemical markers of bone turnover. J Clin Densitometry. 1999;2:323-342.

Nachtigall LE, Raju UMA, Banerjee S, et al. Serum estradiol-binding profiles in postmenopausal women undergoing three common estrogen replacement therapies: association with sex-hormone-binding globulin, estradiol, and estrone levels. Menopause. 2000;7:243-250.

NIH Consensus Development Panel on Osteoporosis, Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285:785-793.

Notelovitz M. Estrogen therapy and osteoporosis: principles and practice. Am J Med Sci. 1997;373:2-12.

Notelovitz M. Estrogen therapy in the management of problems associated with urogenital aging: a simple diagnostic test and the effect of the route of hormone administration. Maturitas. 1995;22(suppl):31-33.

Notelovitz M, Cassel D, Hille D, et al. Efficacy of continuous sequential transdermal estradiol and norethindrone acetate in relieving vasomotor symptoms associated with menopause. Am J Obstet Gynecol. 2000;182:7-12.

Notelovitz M, Lenihan JP, McDermott M, Kerber IJ, Nanavati N, Arce J. Initial 17beta-estradiol dose for treating vasomotor symptoms. Obstet Gynecol. 2000;95:726-731.

Notelovitz M. How to adjust estrogen therapy to patient response. Patient Care. 2000;29:99-115.

Oldenhave A, Jaszmann IJ, Haspels AA, et al. A survey based on 5313 women 39 to 60 years old. Am J Obstet Gynecol. 1993;168:772-780.

Rader DJ. Inflammatory markers of coronary risk. N Engl J Med. 2000;343:1179-1182.

Simons J, Klaiber E, Wiita B, et al. Differential effects of estrogen-androgen and estrogen-only therapy on vasomotor symptoms, gonadotropin secretions, and endogenous androgen bioavailability in postmenopausal women. Menopause. 1999;6:138-146.

Simpson ER, Mahendroo MS, Means, GD, et al. Aromatase cytochrome P450, the enzyme responsible for estrogen biosynthesis. Endocrinol Rev. 1994;15:342-355.

Stanczyk F. Structure-function relationships, potency and pharmacokinetics of progestogens. In: Lobo RA, ed. Treatment of the Postmenopausal Woman: Basic and Clinical Aspects. New York, NY: Raven Press Ltd; 1994:69-89.

Watts, NB, Notelovitz M, Timmons MC, Addison WA, Wiita B, Downey LJ. Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms, and lipid-lipoprotein profiles in surgical menopause Obstet Gynecol. 1995;85:529-537.

Weiss SR, Ellman H, Dolker M. A randomized controlled trial of four doses of transdermal estradiol for preventing postmenopausal bone loss. Transdermal Estradiol Investigator Group. Obstet Gynecol. 1999;94:330-336.

Williams JK, Honore EK, Washburn SA, Clarkson TB. Effects of hormone replacement therapy on reactivity of atherosclerotic coronary arteries in cynomolgus monkeys. J Am Coll Cardiol. 1994;24:1757-1761.