Hormone Replacement Therapy in Premature Ovarian Failure Amita Suneja Professor UCMS & GTBH
HRT in POF Vs Natural Menopause <ul><li>True example of  replacement therapy  Vs extension therapy </li></ul><ul><li>Start...
Tailor HRT According to Type of POF
Type I POF - Prepubertal
Individualize the Treatment
 
14 years Turner’s mosaic
<ul><li>Counseling of the girl & parents </li></ul><ul><li>COC pills </li></ul><ul><li>Occasionally can conceive </li></ul>
 
Types of HRT Regimens
Estrogen Preparations- Indian Market Market name Molecule Strength Prep Dose Evalon Estriol succinate 1.0mg Tab 8-16mg/day...
Transdermal Estrogens Estragel 1.5mg/2.5g  OD EstaSpray  0.375mg BD
Currently there appears to be no clear advantage of the transdermal over the oral route <ul><li>Oral estrogens </li></ul><...
Progesterone preparations-Indian Market Drug Route Sequential (10-14 days) continuous MPA Oral 5mg daily 2.5mg daily Noret...
Various options <ul><li>Tibolone </li></ul><ul><li>Steroid </li></ul><ul><li>Metabolites are active </li></ul><ul><li>Mild...
Type III POF - Iatrogenic <ul><li>Sudden & precipitous fall of estrogens – severe symptoms VMS,  risk of CHD, osteoporosis...
HRT in Surgical Menopause
HRT in Cancer Survivors
Stem Cell Transplant - POF
HRT - POF
Premature ovarian failure  Not your failure
Upcoming SlideShare
Loading in...5
×

Hrt

978

Published on

this presentation is about hormone replacement therapy in premature ovarian failure.

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
978
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
35
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Hrt

  1. 1. Hormone Replacement Therapy in Premature Ovarian Failure Amita Suneja Professor UCMS & GTBH
  2. 2. HRT in POF Vs Natural Menopause <ul><li>True example of replacement therapy Vs extension therapy </li></ul><ul><li>Started at time of diagnosis AND continued till natural age of menopause </li></ul><ul><li>No long-term ill effects (WHI study) as estrogen years are not increased </li></ul><ul><li>Full dose long-term Vs low dose short-term </li></ul><ul><li>5-10% will resume spontaneous ovulation & menstruation </li></ul>
  3. 3. Tailor HRT According to Type of POF
  4. 4. Type I POF - Prepubertal
  5. 5. Individualize the Treatment
  6. 7. 14 years Turner’s mosaic
  7. 8. <ul><li>Counseling of the girl & parents </li></ul><ul><li>COC pills </li></ul><ul><li>Occasionally can conceive </li></ul>
  8. 10. Types of HRT Regimens
  9. 11. Estrogen Preparations- Indian Market Market name Molecule Strength Prep Dose Evalon Estriol succinate 1.0mg Tab 8-16mg/day Premarin CEE 0.625mg Tab 0.625mg/day Progynova Esradiol valerate 1.0mg/2mg Tab 2mg/day Estraderm patch Or Susten 50 Estradiol 25/50/100 ц g patch 1 every 4 days 50 ц g E 2 Gel Or Sandrena gel Estradiol 1.5mg/2.5g 1mg/gm Dermal gel Once a day Estaspray Estradiol 0.375mg Dermal spray 1-3 accutations/day Premarine gel CEE 0.625mg/gm Daily x 2weeks Vaginal gel then twice a week Evalon gel Estriol 1mg/gm E 2 Gel Estradiol 0.025mg/gm
  10. 12. Transdermal Estrogens Estragel 1.5mg/2.5g OD EstaSpray 0.375mg BD
  11. 13. Currently there appears to be no clear advantage of the transdermal over the oral route <ul><li>Oral estrogens </li></ul><ul><li>Blood levels </li></ul><ul><li>Lipoproteins </li></ul><ul><li>LDL ↓ </li></ul><ul><li>HDL ↑ </li></ul><ul><li>Lpa ↓ </li></ul><ul><li>Prevent oxidation yes </li></ul><ul><li>TGL ↑ </li></ul><ul><li>CRP ↑ </li></ul><ul><li>SHBG, TBHG ↑ </li></ul><ul><li>Coagulation factors ↑ </li></ul><ul><li>Transdermal </li></ul><ul><li>more stable, square dose curve </li></ul><ul><li>↓ or same </li></ul><ul><li>same </li></ul><ul><li>↓ or same </li></ul><ul><li>yes </li></ul><ul><li>same </li></ul><ul><li>No effect </li></ul><ul><li>No effect </li></ul><ul><li>less effect </li></ul>
  12. 14. Progesterone preparations-Indian Market Drug Route Sequential (10-14 days) continuous MPA Oral 5mg daily 2.5mg daily Norethisterone Oral 1mg daily 0.3 mg daily Norethindrone Oral 2.5mg daily 0.5mg daily Dydrogesterone Oral 10mg daily 5mg daily Drospirenone Oral - 2mg daily Natural progesterone Oral 300mg daily 200mg daily Natural progesterone Vaginal 200mg daily 100mg daily Natural progesterone Vaginal gel 45mg daily 45mg daily LNG-IUS Intra-uterine _ 20mcg daily
  13. 15. Various options <ul><li>Tibolone </li></ul><ul><li>Steroid </li></ul><ul><li>Metabolites are active </li></ul><ul><li>Mildly estrogenic progestogenic </li></ul><ul><li>androgenic </li></ul><ul><li>Amenorrhoea </li></ul><ul><li>Good for VMS, libido, bones </li></ul><ul><li>No change in breast density </li></ul><ul><li>Endometrial bleeding -5% </li></ul><ul><li>0.625 mg premarin + MPA 5mg 12 days </li></ul><ul><li>Estragel/estaSpray </li></ul><ul><li>+ LNG IUS or MPA </li></ul><ul><li>Angeliq 1 OD </li></ul>
  14. 16. Type III POF - Iatrogenic <ul><li>Sudden & precipitous fall of estrogens – severe symptoms VMS, risk of CHD, osteoporosis, suicidal depression </li></ul><ul><li>Lack of androgens – lack of energy & libido </li></ul><ul><li>Need to start ET early while in the hospital & full dose or may be higher dose </li></ul>
  15. 17. HRT in Surgical Menopause
  16. 18. HRT in Cancer Survivors
  17. 19. Stem Cell Transplant - POF
  18. 20. HRT - POF
  19. 21. Premature ovarian failure Not your failure
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×