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((Hormone replacement therapy)) ((Hormone replacement therapy)) Menopause)) ((Menopause)) And.

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Presentation on theme: "((Hormone replacement therapy)) ((Hormone replacement therapy)) Menopause)) ((Menopause)) And."— Presentation transcript:

1 ((Hormone replacement therapy)) ((Hormone replacement therapy)) Menopause)) ((Menopause)) And

2 Objective:- Climacteric and menopause is one phase Climacteric and menopause is one phase in womans life in womans life It is associated with health changes and It is associated with health changes and diseases diseases Hormone replacement therapy needed to Hormone replacement therapy needed to improve quality of life and prevent medical improve quality of life and prevent medical complications which follow menopause complications which follow menopause

3 Menopause is the last menstrual period the average age is 51 years. Menopause is the last menstrual period the average age is 51 years. Climacteric is transition from fertility to infertility from 45-55 years. Climacteric is transition from fertility to infertility from 45-55 years. Women live 40% of her life in menopause. Women live 40% of her life in menopause. The first endocrine change in menopause is fall in inhibin(glycoprotein) from ovaries which inhibit the release of FSH and LH from pituitary,so FSH and LH rise. The first endocrine change in menopause is fall in inhibin(glycoprotein) from ovaries which inhibit the release of FSH and LH from pituitary,so FSH and LH rise.

4 Causes of menopause A)Premature ovarian failure Menopause occuring before 45 years,low oestrogen,high FSH&L Menopause occuring before 45 years,low oestrogen,high FSH&L May be associated with autoimmune pathology. May be associated with autoimmune pathology. B) Surgical menopause Menopause after oophorectomy,after hysterectomy menopause occurs about 3 years earlier the natural menopause. Menopause after oophorectomy,after hysterectomy menopause occurs about 3 years earlier the natural menopause.

5 C) After chemotherapy or radiotherapy as breast cancer or lymphoma. Diagnosis of menopause History(age,disease,surgery,treatment) History(age,disease,surgery,treatment) Clinical examination Clinical examination Investigations Investigations Low oestrogen(E2 10-50pg/ml) Low oestrogen(E2 10-50pg/ml) High FSH&LH >10IU/L High FSH&LH >10IU/L Total cholesterol increase Total cholesterol increase HDL cholesterol decrease HDL cholesterol decrease LDL cholesterol increase LDL cholesterol increase

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7 D.Diagnosis:- PMS PMS Depression Depression Thyroid disease Thyroid disease Phaeochromocytoma,carcinoid syndrome. Phaeochromocytoma,carcinoid syndrome. Clinical features 1.Early changes:- Vsomotor symptoms(disturbance in the thermoregulator in the hypothalamus) occur in 70% of women. Vsomotor symptoms(disturbance in the thermoregulator in the hypothalamus) occur in 70% of women. Frequency – few to several times per day. Frequency – few to several times per day.

8 Duration –weeks to years. Duration –weeks to years. Hot flushes followed by sweating. Hot flushes followed by sweating. Psychological symptoms Psychological symptoms Insomnia,poor concentration,irritability, Insomnia,poor concentration,irritability, anxiety and lethergy. anxiety and lethergy. 2. Intermediate changes(2-4 years,collagen ) 2. Intermediate changes(2-4 years,collagen ) Wrinkled skin,small breasts. Wrinkled skin,small breasts. Genital tract,thin and dry vagina,acidity Genital tract,thin and dry vagina,acidity reduced infection,dysparunia and reduced infection,dysparunia and genital prolapse. genital prolapse. Urinary symptoms,frequency,dysuria,urgency, Urinary symptoms,frequency,dysuria,urgency, and stress incontnence. and stress incontnence.

9 3.Late changes(>10 years) Bones,osteoporosis(colles fracture,fracture Bones,osteoporosis(colles fracture,fracture of neck femur and vertebral crush fracture) of neck femur and vertebral crush fracture) CVS,stroke and heart attacks. CVS,stroke and heart attacks. Treatment:Hormone Replacement Therapy Principles Principles Depend on the presence and severity of Depend on the presence and severity of symptons. symptons. Patient decision. Patient decision. Careful counselling before treatment. Careful counselling before treatment.

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11 Examination:- BP,breast examination(mammogram) BP,breast examination(mammogram) Pelvic examination,look for oestrogen Pelvic examination,look for oestrogen sensitive tumours(fibroid,endometriosis, sensitive tumours(fibroid,endometriosis, endometrial carcinoma) endometrial carcinoma) Benefits of HRT Cure early symptons of menopause. Cure early symptons of menopause. Prevent fractures in about 50%. Prevent fractures in about 50%. Reduce heart attacks in about 40%. Reduce heart attacks in about 40%. Reduce bladder dysfunction. Reduce bladder dysfunction. May prevent against bowel carcinoma and May prevent against bowel carcinoma and Alzheimer disease. Alzheimer disease.

12 Contraindications of HRT Absolute:- Present or suspected pregnancy Present or suspected pregnancy Suspicion of breast cancer Suspicion of breast cancer Suspicion of endometrial cancer Suspicion of endometrial cancer Active liver disease Active liver disease Uncontrolled hypertension Uncontrolled hypertension Cofirmed VTE Cofirmed VTERelative:- Presence of fibroid Presence of fibroid Past history of benign breast disease Past history of benign breast disease Uconfirmed VTE Uconfirmed VTE Chronic liver disease Chronic liver disease Migraine Migraine

13 Preparations of HRT Natural oestrogens(from plants or animal) Oestradiol valerate 1-2mg Oestradiol valerate 1-2mg Congugated equine oestrogens Congugated equine oestrogens Oestrone 1.25mg Oestrone 1.25mgProgestogens Medroxyprogesterone acetate 10mg Medroxyprogesterone acetate 10mg Dydrogesterone 10mg Dydrogesterone 10mg Norethisterone 1mg Norethisterone 1mg Norgesterel 0.15mg Norgesterel 0.15mg

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15 Post-hysterectomy : use only oestrogens Add progestogens at least for 12 days of 28 days for non-hysterectomized patient. 28 days for non-hysterectomized patient. Combined oral oes. And prog. (pills 28 days) Combined oral oes. And prog. (pills 28 days) Combined oes. And prog. In patch(weekly) Combined oes. And prog. In patch(weekly) Oestrogen patch Oestrogen patch Oestrogen gel rubbed into the skin daily Oestrogen gel rubbed into the skin daily Inplant s\c for one year Inplant s\c for one year Vaginal(cream,pessary,tablet for local symptoms) Vaginal(cream,pessary,tablet for local symptoms)

16 Tibolone:- Synthetic steroid Synthetic steroid Has oestrogenic,progestogenic and androgenic effect Has oestrogenic,progestogenic and androgenic effect Used 1year after menopause 2.5mg daily Used 1year after menopause 2.5mg daily Raloxifene SERM:- Selective oestrogen receptor modulator Selective oestrogen receptor modulator Prevent osteoporosis Prevent osteoporosis Does not stimulate breast and endometrial Does not stimulate breast and endometrial receptors receptors May worsen vasomotor symptons May worsen vasomotor symptons

17 Side effcts of HRT(first 12 weeks) Breast tenderness and nipple sensitivity Breast tenderness and nipple sensitivity Appetite rise and weight gain Appetite rise and weight gain Calf cramps Calf cramps Patient must reviewed 6 months then annually(BP,breast,pelvic examination)

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