Climacteric DR.HISHAM AL HAMMAMI 2020 POWERPOINT سن الضهي DR HISHAM AL-HAMMAMI

1. 35-‫ا‬ ‫ن‬
35 - CLIMACTERIC
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
1

2. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ول‬ ‫و‬ ‫ا‬ ‫ن‬-‫ا‬ ‫ن‬ ‫د‬ ‫و‬
MENOPAUSE AND PERI- AND
POSTMENOPAUSE
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
2

3. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
3
‫ر‬‫ا‬ ‫ن‬‫در‬ ‫ص‬ ‫دث‬ ‫ث‬ ‫ا‬ ‫رأة‬ ‫ا‬ ‫ة‬ # $ ‫ر‬ ‫ا‬ % ‫ا‬#
‫و‬ ‫ا‬ ‫دات‬ ‫رو‬ ‫ا‬ ‫ج‬ ‫إ‬ # ‫ص‬ % ‫ا‬ ‫ؤدي‬ ‫ا‬ + ‫وظ‬ ‫ا‬‫ك‬ ‫ذ‬ ‫/ن‬ 0.
‫ن‬ ‫دم‬ ‫ا‬ $ ‫ط‬ ‫ھو‬.
‫ا‬ ‫ن‬:
6 ‫ط‬ ‫دورة‬ ‫ر‬ ‫آ‬.
‫ث‬ ‫ط‬ ‫دون‬ ‫دة‬ ‫وا‬.
50-55.

4. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
4
‫ا‬ ‫د‬ ‫ا‬ ‫ت‬ ً !" ‫ا‬ ‫أ$ل‬ ‫ض‬ ‫ا‬ & '‫د‬ ! ‫د(ت‬ "،!‫و‬ ، *+" ‫و‬ !,‫ز‬
‫رة‬+ , ‫ر‬ /" ‫0ون‬ ‫$د‬‫ط‬‫ة‬ ‫ا‬.
‫دث‬ "4‫ا‬4006 ‫رى‬ 8‫ا‬ ‫ت‬ ‫و‬ ‫ا‬ ‫0ل‬ ‫د‬ *"‫و‬ ، ‫رة‬‫ر"ق‬ ‫ا‬atresia.
‫وغ‬ ‫ا‬ ‫د‬ ,menarche:400,000
‫و(دة‬ ‫ا‬ ‫د‬ ,:1.5‫ون‬oocytes.

5. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
5
HORMONAL CHANGES
‫در‬‫أن‬‫;س‬ ‫ا‬ ‫ن‬ ‫دث‬‫و=ف‬ ‫>ل‬ %$/‫ا‬ + ‫وظ‬ ? +‫ض‬.
•‫إ‬ @‫ظ‬ ‫ر‬ A 6 ‫ط‬ ‫دورات‬.
•‫رة‬ ‫ز‬A ‫وث‬ ‫ط‬.
•‫م‬ ‫ر‬ ‫ا‬ ‫ط‬ C D ‫#رط‬.
•+‫ط‬ ‫ا‬ ‫و‬ ‫زا‬ ‫ا‬ ‫د@ت‬ ‫ا‬ ‫دة‬ ‫ز‬
•$ $ ‫ا‬ ‫رق‬ ‫ا‬ ‫و‬ ‫ا‬ ‫ت‬ ‫ا‬
•‫ر‬ ‫=د‬3-5‫وات‬.
‫ر‬ ‫ظ‬‫ت‬ G/‫ور‬D ‫ا‬‫ا‬‫ك‬ ‫و‬ ‫ا‬،‫ن‬ ‫ل‬ =‫ا‬C
‫وات‬.

6. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
6
HORMONAL CHANGES
‫ا‬ ‫ض‬ ‫ر‬‫ء‬
‫ج‬ ‫إ‬ #
‫>ل‬ ‫ن‬ ‫رو‬ ‫ا‬
‫ن‬ ‫ر‬ ‫ر‬ A
‫ا‬ ‫م‬ ‫ا‬
substantial
amounts
‫د‬ ‫وات‬ ‫دة‬‫ن‬
‫ا‬.
•‫ا‬‫و‬‫ا‬‫$و‬tone‫ل‬ $‫$د‬ ‫ا‬ ،‫ظم‬ ‫وا‬ ،‫و‬.
•‫ص‬‫ت‬ ‫ا‬.
•‫>ون‬ ‫=د‬@‫ؤو‬ ‫أ‬‫/ن‬‫دة‬ ‫ز‬‫ن‬ ‫رط‬ّ‫ر‬ ‫ا‬ ‫ط‬‫م‬
‫6دي‬ ‫ا‬ ‫ن‬ ‫رط‬ ‫أو‬.

7. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
7
OVARIAN SENESCENCE
‫ا‬ ‫د‬،‫+رز‬ ‫و‬ C D ‫$و‬ ‫ا‬ G ‫ا‬‫رون‬ ‫رو‬ ‫ا‬‫رو‬ K # ‫إ‬‫ن‬.
‫ل‬ $ $ = ‫و‬ ‫ت‬ ‫ر‬ ‫ود‬ ‫و‬viable.
‫ج‬ ‫إ‬FSH‫و‬LH# ‫ض‬ ‫ر‬ # > ‫ت‬ >
‫وي‬ ‫ا‬ D.
CholesterolAndrostenedione and Testosterone)LH(
Estrogen.

8. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
8
‫وي‬ ‫ا‬ ‫ل‬ > ‫ا‬ ‫ل‬ ‫ل‬ 6‫دات‬ ‫رو‬ $.‫ل‬‫دات‬ ‫رو‬ ‫ا‬‫ا‬ ‫$ون‬ ‫ا‬ ‫ا‬‫$ون‬ ‫>ظر‬ ‫وا‬ ‫ر‬
‫زرق‬ ‫ا‬.
Cmpd B:‫رون‬ ‫>و‬ ‫>ور‬،Cmpd S:II->‫زو‬ ‫د‬‫زول‬ ‫>ور‬،DH:‫ز‬G >‫درو‬ ‫ھ‬،DHEA:‫رون‬ ‫درو‬ ‫دروإ‬ ‫د‬،
DOC:
>‫زو‬ ‫د‬‫رون‬ ‫>و‬ ‫>ور‬،LH:‫ون‬ ‫ر‬ ‫ا‬‫ن‬ ‫$و‬ ‫ا‬،P450c:‫و>روم‬ ‫ا‬P450.

9. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ن‬ !‫"رو‬ 4‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
9
‫ا‬ ‫ن‬ ‫6د‬
‫م‬ $ ‫*ض‬ "E2‫م‬ $ >*"‫"ر‬ ‫$د‬E1

10. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
10
‫ت‬ !‫درو‬ 8‫ا‬
ANDROGENS
‫ا‬ ‫ن‬ ‫د‬ ‫ء‬ ‫ا‬‫ت‬ ‫درو‬ @‫ا‬ ‫ن‬ ‫أ=ل‬ ‫ت‬ > َ‫ن‬،َ‫$ن‬ O‫ن‬ ‫أ‬ @‫إ‬َ‫>ن‬ ‫ن‬
‫أ>6ر‬.
‫+رط‬ ‫ا‬ P ‫و‬ ‫ا‬ ‫ر‬ ‫و‬‫6دي‬ ‫ا‬ ‫م‬ ‫ص‬
‫ا‬ ‫ن‬ ‫د‬
‫دوران‬ ‫ا‬ # $ ‫ا‬ ‫ت‬ ‫درو‬ @‫ا‬ ‫وى‬ # ‫ض‬ + ‫ا‬ ‫د‬ ‫و‬.

11. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫"رون‬ !‫رو‬ ‫ا‬
PROGESTERONE
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
11
‫ص‬+ ‫ت‬ ‫و‬ % ‫إ‬ ‫رون‬ ‫رو‬ ‫ا‬ ‫ج‬ ‫إ‬.
‫ــ‬ # > ‫ر‬ A
•‫ول‬ ‫ا‬ ‫و‬ ‫ا‬ ‫ت‬ ‫ز‬ ‫ا‬ ‫ض‬ ‫ر‬Estradiol% ‫إ‬Estrone sulfate
•‫$و‬ ‫ا‬ ‫ن‬ ‫رو‬ ‫ا‬ ‫ت‬G ‫ت‬ ‫و‬ ‫ص‬ ‫إ‬.
•‫دة‬ ‫ز‬ % ‫ا‬ ‫ؤدي‬ ‫=د‬ ، ‫ل‬ ‫وا‬ ‫ا‬ ‫ھذه‬(‫ا‬ٌ‫م‬ ِ ْ‫ا‬ِ "َ*mitosis‫ر‬ ‫ا‬ ‫ط‬ ‫ا‬ # ‫ن‬ ‫رو‬ ‫رض‬ ‫ا‬.
‫ر‬ ‫ا‬ ‫ط‬ ‫ا‬ # ‫#رازي‬ ‫ا‬ ‫ول‬ ‫ا‬ C ‫رون‬ ‫رو‬ ‫ا‬ ‫ب‬ A.
‫ـ‬ ً‫ة‬‫د‬ / ‫ا‬ ‫ن‬ ‫ول‬ ‫رة‬ # ‫را#ق‬ ، ‫ق‬:
•‫ظم‬ ‫ر‬ A $ ‫زف‬.
•‫$و‬ ‫وذ‬ @ C ‫م‬ ‫ر‬ ‫ا‬ ‫ط‬ C D ‫#رط‬.
•‫م‬ ‫ر‬ ‫ا‬ ‫ط‬ ‫ن‬ ‫رط‬ ‫دة‬ ‫ز‬.

12. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫د‬ ‫ا‬ ‫ت‬ ‫ا‬
GONADOTROPINS
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
12
‫ن‬ ‫رو‬ ‫ا‬GnRHLH‫و‬.FSH
‫أن‬ ‫د‬‫وا=ل‬ $D ‫ا‬‫$ـ‬CNS‫رات‬ 6;‫واز‬%$/‫ط‬
‫م‬ ‫ا‬ ‫رارة‬ ‫در‬ ‫م‬ ‫ظ‬‫ا‬P‫ن‬ ‫ر‬ ‫دة‬ ‫ز‬ ? + ‫ا‬
‫ا‬‫$د‬ ‫ا‬ # ‫رق‬ ‫وا‬ ّ‫م‬‫د‬–‫ا‬ ‫ت‬ ‫ا‬.
‫ـ‬ ‫وذ‬ ‫ا‬ ‫م‬ ‫ا‬FSH<20–40IU / L.

13. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ر‬ ‫ر‬ ‫ا‬ ‫ھرات‬ ‫ظ‬ ‫ا‬
Clinical Manifestations
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
13

14. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ت‬ ‫ا‬‫ا‬hot flashes.
‫رق‬ ‫ا‬Insomnia.
0 ‫ا‬Irritability.
‫زاج‬ ‫ا‬ ‫ت‬ ‫طرا‬ ‫ا‬Mood disturbances.
‫/راض‬ ‫ا‬)‫>رة‬ ‫ا‬(
$ ‫ا‬ ‫و‬ ‫ا‬ ‫ور‬ ‫ا‬.
‫دي‬ ‫ا‬ ‫ول‬ ‫ا‬ ‫$س‬.
‫$دي‬ ‫ا‬ ‫ن‬ @‫>و‬ ‫ا‬ ‫دان‬ #.
‫د‬ ‫ا‬ ‫د@ت‬ ‫ا‬)‫ط‬ ‫و‬ ‫ا‬(
‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬.
‫ر‬ ‫زھ‬ ‫ا‬ ‫وع‬ ‫ن‬ ‫رف‬ ‫ا‬Dementia of the Alzheimer's type
)‫وارد‬possible.(
/‫و‬ ‫ا‬ $ ‫ا‬ ‫راض‬ ‫ا‬)‫وا‬ ‫ر‬ A =G/.(
‫ون‬ ‫>و‬ ‫ا‬ ‫ن‬ ‫رط‬ ‫6ل‬ ‫ت‬ ‫رط‬ ‫ا‬)‫وا‬ ‫ر‬ A =G/.(
‫راض‬ ‫ا‬)‫رة‬ ; ‫ا‬(
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
14
‫ن‬ !‫"رو‬ (‫ا‬ ‫دان‬ C DE "
TABLE 35-1. CONSEQUENCE OF ESTROGEN LOSS

15. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
15
‫ا‬ ‫/راض‬ ‫ا‬
GENERAL SYMPTOMS
‫ا‬ ‫ت‬ ‫ا‬)85%‫ء‬ ‫ا‬ ‫ن‬. (
•‫ن‬ /‫ز‬ @ ‫ء‬ ‫ا‬ ‫ھؤ@ء‬ ‫ف‬D‫>ل‬‫ر‬ >.
•‫وا‬ ‫د‬ /40%‫ا‬ ‫ت‬ ‫ا‬ ‫#[ن‬ ، ‫ت‬ D ‫ا‬ ‫ء‬ ‫ا‬ ‫ن‬‫ھ‬‫ا‬‫ة‬‫>6ر‬ ‫ا‬ً /‫إز‬.
•‫دث‬A‫وا‬8-15‫و‬ ‫رة‬.
•‫ق‬ّ‫ر‬ ‫را#ق‬ ‫=د‬‫دوار‬ ‫ا‬ ،‫ن‬ + ‫وا‬ ،.
•‫رأة‬ ‫ا‬ ‫و=ظ‬ ‫=د‬‫ز‬‫ا‬ ‫دة‬‫و‬ ‫ء‬ /‫ل‬ + ‫ا‬.
•A ‫ء‬ ‫ا‬ %‫ط‬‫ت‬ > ‫ا‬‫ت‬ ّ‫و‬ ‫ا‬ ،+ ‫ا‬ ‫ا@دو‬ ‫أو‬ ،.

16. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
6 ‫ا‬ ‫ا8,راض‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
16

17. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
$ ‫ا‬ ‫و‬ ‫ا‬ ‫/راض‬ ‫ا‬
UROGENITAL SYMPTOMS
‫ن‬ ‫و‬ ‫ر‬ ‫ا‬ ‫ج‬G ‫ا‬
‫وري‬ ‫ا‬ ‫ل‬ ‫ا‬ ‫ب‬ ‫ا‬
‫وظ‬ $ ‫>ل‬@ P >
C ‫أن‬ C ‫ط‬‫>ل‬
# >‫$س‬ ‫ا‬ 0 ‫أو‬
‫و‬ ‫ا‬.
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
17
‫ب‬ A‫ن‬ ‫رو‬ ‫ا‬
C # ‫و‬ =‫ر‬ ‫رة‬ ‫ظ‬
‫=$وي‬ ‫إ#راز‬( pH > 7.0 ).
‫ق‬‫و‬ ‫ل‬ ‫ا‬ ‫=طر‬‫ق‬
‫و‬ ‫ق‬ّ‫ز‬ ‫و‬
‫وري‬ ‫ا‬ ‫ل‬ ‫ا‬ ‫ب‬ ‫ا‬:
0/‫ز‬ ‫ف‬ +.
‫ت‬.
‫دة‬ ‫د‬ ‫ع‬ ‫رة‬ /.
‫و‬ ‫ا‬ ‫/راض‬ ‫ا‬
‫دد‬‫ت‬G ‫ا‬.
‫و‬ ‫ا‬ ‫ر‬ ‫ز‬ ‫ا‬.
$ $ ‫ا‬ ‫وال‬ ‫ا‬
nocturia
‫ا‬‫و‬ ‫ا‬ ‫$س‬.

18. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬OSTEOPOROSIS
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
18
‫ن‬ ‫رو‬ ‫ا‬ ‫ن‬ ‫ن‬ ‫ر‬ ‫ا‬‫وز‬ ‫ظم‬ ‫ا‬ ‫رات‬ > ‫ط‬
‫م‬ ‫ظ‬ ‫ا‬ ‫ب‬ >‫ر‬ %$/ ‫ظم‬ ‫ا‬ ‫ت‬ ‫=درة‬lay down bon
‫م‬ ‫ظ‬ ‫ا‬ $=osteopenia‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬ ‫و‬osteoporosis
•‫طول‬ ‫ا‬ # ‫دان‬ #<1.5‫ش‬ ‫ا‬
•‫ورك‬ ‫ا‬ ‫و‬ ‫م‬D ‫ا‬ ‫ور‬ >:
•‫د‬10–15، ‫ا‬ ‫ن‬ %$/> ‫وز‬‫و‬‫ر‬‫ا‬‫م‬ ‫ظ‬‫د‬ /‫ا‬ ‫$ك‬ ‫ء‬ ‫ا‬/‫د‬
‫ل‬ ‫ر‬ ‫ا‬‫ـ‬3-5‫ف‬ ‫أ‬.
•‫و=ت‬ ‫ن‬ ‫د‬ ‫ظم‬ ‫ا‬ ‫ر=ق‬ ‫دث‬ $> ،‫>ر‬ ‫أ‬ ‫ء‬ ‫ا‬ ‫د‬ / ‫ن‬ ‫رو‬ ‫ا‬ ‫دان‬ # ‫ن‬ > $>‫>ر‬ ‫أ‬.
•‫ري‬ + ‫ا‬ ‫ود‬ ‫ا‬‫و‬‫ذ‬ + ‫ا‬ ‫ق‬ /‫ر‬ >$ ‫رض‬ ‫ا‬ ‫م‬ ‫ظ‬ ‫ا‬ ‫أ>6ر‬ ‫ھ‬.
‫ر‬ ‫ر‬ ‫ا‬ ‫ت‬ G ‫ا‬

19. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬OSTEOPOROSIS
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
19
‫طورة‬ ‫ا‬ ‫ل‬ ‫/وا‬‫طورة‬ ‫ا‬ ‫ل‬ ‫/وا‬
$ / D=
‫ل‬ ‫ا‬ ‫م‬ ‫ا‬
‫و‬ ‫ض‬ ‫ا‬‫وي‬ _‫ا‬ ‫رق‬ ‫ا‬
‫ا‬ ‫ط‬‫ة‬‫ا‬‫ر‬
‫ول‬‫ول‬ > ‫ا‬
‫ن‬ ‫د‬ ‫ا‬
‫درق‬ ‫ا‬ ‫ط‬ ‫#رط‬
‫إ‬‫دام‬‫أو‬ ‫دات‬ ‫رو‬ ‫ا‬‫ج‬G @‫ا‬ ‫دات‬

20. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫د‬ ‫د‬ ‫ا‬ ‫ظ‬ ‫ا‬ # 6> ‫ا‬ ‫س‬ = ‫دة‬ /‫إ‬ ‫ب‬6‫ج‬G ‫ا‬ ‫ن‬ ‫=ل‬ ‫ا‬ %$/ ‫ور‬
‫ا‬ ‫ن‬ ‫د‬ ‫ء‬ ‫ا‬ ‫د‬ / ‫دوا‬ ‫ا‬ ‫ج‬G %D‫و‬‫ر‬ CT_‫ا‬ ‫و#ق‬
)-2.0(–)-2.5(SD+‫ر‬ >$ # ‫إ‬ ‫طورة‬ ‫ل‬ / >-2.5SD
‫ر‬ > ‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬ ‫رف‬T>-2.5SD
‫ر‬ ‫ا‬T)(T score:‫ا‬‫ت‬ #‫را‬‫ا‬‫ر‬)SDs(‫ظ‬ ‫ا‬ ‫د‬ ‫ا‬ # 6> ‫ا‬ ‫/ن‬‫ط‬ ‫ا‬ ‫ت‬ ‫ا‬ ‫ت‬ c ‫ا‬ ‫د‬ / ‫وى‬D ‫ا‬‫ت‬
D‫و‬%‫ظ‬ ‫ا‬ ‫د‬ ‫ا‬ # 6> ‫ا‬ d‫ص‬‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬
‫ر‬≤65‫طورة‬ ‫ل‬ ‫/وا‬ ‫دون‬ ‫ء‬ ‫ا‬ # ‫ر‬≤50‫د‬ /‫ا‬ ‫ء‬ ‫ا‬‫$وا‬‫دھ‬ /‫ن‬‫طورة‬ ‫ل‬ ‫/وا‬.
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
20
‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬OSTEOPOROSIS

21. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
21
‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬OSTEOPOROSIS
‫ص‬ ‫إ‬‫طر‬‫ور‬ > ‫ا‬‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬ ‫/ن‬ ‫ا‬
•1200% ‫ا‬1500ً ‫و‬ ‫وم‬ > e$
•400% ‫ا‬600‫ن‬ # ‫دة‬ ‫و‬Dً ‫و‬
•‫و‬ ‫ا‬‫ر‬‫وزن‬ ‫ا‬ ‫ل‬
•‫ن‬ ‫ل‬G=@‫ا‬‫ول‬‫ول‬ > ‫ا‬
•‫ن‬ ‫د‬ ‫ا‬ ‫ف‬ ‫إ‬
•‫;>د‬ $ ‫درق‬ ‫ا‬ ‫ور‬D ‫ض‬ ‫ا‬ ‫و‬ ‫ر‬ ‫ا‬ ‫ج‬G ‫ا‬ ‫ون‬ $ ‫ن‬ ‫ذ‬ ‫ا‬ % ‫ر‬ ‫ا‬ ‫ص‬ # ‫ب‬‫/دم‬ ‫ن‬
‫دة‬ ‫زا‬ /‫ر‬ ‫م‬ $

22. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
22
•Estrogen)±Progestin(
•‫ن‬ ‫ر>ب‬ ‫ا‬ ‫ج‬G ‫ا‬Estrogen‫و‬Progestin‫ص‬‫ن‬ ‫د‬ ‫ور‬ > ‫ا‬ ‫إ‬
‫ـ‬ ‫ا‬ ‫دود‬ ‫;س‬ ‫ا‬24%C ،‫إ‬+‫ض‬34%‫ورك‬ ‫ا‬ ‫ور‬ > #
•‫د‬‫ا‬ ‫ن‬ ‫رو‬ @‫ا‬ ‫ل‬ ‫@ت‬SERMs)raloxifene(
•‫ور‬ > ‫ا‬ ‫ن‬ =‫و‬ ‫ا‬ # ‫دة‬ + ‫أ‬ ‫د‬ ‫و‬‫ر‬ + ‫ا‬
•bisphosphonates)alendronate(
•# #=‫و‬ ‫ا‬‫و‬ ،%$/‫أ‬ ‫ت‬ /‫ر‬# ،‫ج‬G/‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬
•$ $= ‫رات‬ 6;.
•‫>ل‬ ‫ذ‬ ‫ؤ‬ ‫أن‬ ‫ب‬& '.
•Calcitonin.
•‫درق‬ ‫ا‬ ‫رات‬ ‫ون‬ ‫ھر‬.
‫دوا‬ ‫ا‬ ‫ج‬G ‫ا‬
‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬OSTEOPOROSIS

23. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ا‬ ‫و‬ ‫ر‬ ‫ا‬ ‫ج‬G ‫ا‬
OVARIAN HORMONE THERAPY
‫ت‬ ‫ط‬ @‫ا‬‫ا‬ ‫ت‬ ‫ا‬
" ‫ا‬ ‫و‬ ‫ا‬ ‫ور‬ ‫ا‬
‫م‬ ‫6ظ‬ ‫ا‬ ‫"ر$ق‬ ‫ن‬ $‫و‬ ‫ا‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
23
‫د‬ ‫+وا‬ ‫ا‬‫دا‬ ‫ر‬ ‫ؤ‬ ‫أو‬ ‫$د‬‫ا‬ ‫راض‬ ‫أ‬‫ب‬‫د‬ '6 ‫ا‬ ‫ر‬I ‫ا‬
arteriosclerotic‫ر‬ ‫زھ‬ ‫ا‬ ‫وداء‬
‫طر‬ ‫ا‬‫دي‬ ‫ور‬ ‫ا‬ ‫ر‬ ‫ا‬
‫و‬E‫ر‬ ‫ا‬ ' ‫ا‬
‫دي‬ ‫ا‬ ‫ن‬ ‫رط‬

24. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
6 ‫ا‬ ‫ا‬ ‫و‬ ‫ر‬ ‫ا‬ ! 6 ‫ا‬ ‫ر‬ ‫"د‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
24
‫ج‬N, +‫"6ط‬ (‫أ‬ ‫!ب‬ ً ‫ر‬ ‫0ن‬ " ‫ن‬ ‫"ز‬ ( "‫وا‬ ‫ا‬ ‫ء‬ ‫ا‬!‫"رو‬ ‫ا‬‫0س‬ 6 ‫ر‬ P.
‫م‬ ‫ر‬ ‫ا‬ ‫ط‬ ‫ن‬ ‫رط‬ ‫دوث‬ ‫ن‬ ‫ق‬C‫را‬ ‫ا‬ ‫ن‬ " !‫رو‬ ‫ا‬ ‫ء‬ ‫ا,ط‬.
‫ن‬ 6" ‫أن‬ ‫0ن‬ ‫ا‬ ‫ن‬ 0 ‫ا‬ ‫ث‬ ‫ط‬ ‫ا‬ ‫ع‬ ‫ط‬ ‫ن‬ P‫"ر‬ "‫وا‬ ‫ا‬ ‫ت‬ ‫ر‬ ‫ا‬‫ن‬ !‫"رو‬ 4‫ا‬‫وا‬‫ن‬ " !‫رو‬
‫ر‬ " ‫0ل‬I 0‫"ر‬I ‫ا‬.
•‫"0ون‬ ‫$د‬‫ت‬ " !‫رو‬ ‫ا‬‫دي‬ ‫ا‬ ‫ن‬ ‫رط‬ ‫دوث‬ ‫طر‬ ‫ا8ھم‬ ‫'ر‬ 6 ‫ا‬<<‫ء‬ ‫ا,ط‬ ‫!ب‬ R ‫أ‬ ‫د‬ "6‫ن‬ !‫"رو‬ 4‫ا‬‫ف‬ * "
‫"6رض‬ ‫ا‬ ‫ن‬‫ت‬ " !‫رو‬.
‫ن‬ ‫ر‬ 08 >‫ط‬ " ‫ا‬ ‫زف‬ ‫ا‬ ‫او‬ ‫ر‬ " ‫ا‬ ‫د‬ ‫د‬I ‫ا‬ ‫زف‬ ‫ا‬ ,‫"د‬4‫ر‬ C‫آ‬ ‫,ن‬ ‫ث‬ ‫ا‬ ‫و‬ ‫ر‬ ‫ا‬ ! 6 ‫ا‬ ‫ن‬ ‫ر‬ I‫أ‬.
‫دم‬ " " " ‫ا‬ ‫و‬ ‫ا‬ ‫ا8,راض‬ ‫ول‬ 8‫ا‬ ‫ر‬ ‫ا‬ ‫ھم‬ ‫"ر0ز‬ ‫ن‬‫ت‬ !‫"رو‬ 4‫ا‬C 6 ‫و‬ ‫ا‬‫ق‬ ‫"ط‬ ‫ل‬ ‫ا‬
‫ا‬ ‫ت‬ ‫0ر‬ ‫ا‬!‫"رو‬ 4‫ا‬،‫ب‬ ‫,دة‬ $ ‫ق‬C‫و‬ ‫دم‬ " " ‫أن‬ ‫0ن‬ " ‫ا‬ ‫ت‬ ‫ا‬ ‫أو‬ ‫ت‬ ‫وط‬U ‫ا‬-‫دو‬ ! ‫ا‬‫رورة‬ ‫ن‬
‫د‬ ‫أ‬ C ‫إ‬‫ت‬ " !‫رو‬ ‫ا‬.

25. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ت‬N " ‫6د(ت‬‫ن‬ !‫"رو‬ 4‫ا‬E " (‫ا‬SERMS
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
25
•‫ط‬ ‫وا‬‫ت‬ ‫رو‬ ‫ا‬‫ط‬ ‫را‬ ‫ا‬ ‫د‬ ‫ل‬ ‫ا‬ ‫ل‬G ‫ن‬ ‫م‬ ‫ا‬ # ‫و‬ ‫ا‬ #‫أ‬-‫ا‬% ‫إ‬ ‫ل‬
+$ ‫ت‬ 6‫ور‬ ‫ط‬ 6 ‫أو‬ ‫ل‬ + ‫م‬ ‫ث‬ ‫واة‬ ‫ا‬‫ن‬ ‫رو‬ K.
•‫ت‬G ‫ن‬ ‫=ل‬ ‫ا‬ %$/ ‫ن‬ /‫و‬ ‫ود‬ ‫و‬ ‫رف‬‫ن‬ ‫رو‬ ‫ا‬،‫و‬ + ‫أ‬.
•‫ل‬ ‫ا‬ ‫+س‬ C ‫دات‬ ‫>ل‬ ‫ط‬ ‫ر‬ +$ ‫ط‬ ‫روا‬ ‫ك‬ ‫ھ‬،‫و‬ # ‫ط‬+$.
•‫دام‬ ‫ا‬ %SERMs%$/ ‫ول‬D $ ‫ق‬ ‫ا‬ ‫ھذه‬ ‫ن‬ ‫دة‬ + @‫ا‬ % ‫ا‬%$/‫رات‬ 6; ‫ا‬ ‫ض‬
‫و‬ ‫ا‬‫ول‬ ‫راد‬ K‫ط‬ ‫ا‬.
•SERMs‫ن‬ ‫د‬ ‫ا‬Clomiphene‫و‬Tamoxifen‫و‬Raloxifen.
•‫ن‬ + >‫و‬ ‫را‬Raloxifen:
•‫6ر‬ > ‫ا‬ ‫رض‬ @‫ري‬ ‫ظ‬ ‫ا‬‫6دي‬ ‫ا‬ =‫أ‬ ‫أو‬ ‫م‬ ‫ر‬ ‫ا‬ ‫ط‬ #.
•‫م‬ ‫ظ‬ ‫ا‬ ‫ر=ق‬ ‫ن‬ ‫و‬ ‫ظم‬ ‫ا‬ ‫رات‬ > # ‫ن‬ ‫+ف‬ ‫ن‬ + >‫و‬ ‫را‬ ‫ا‬ ‫أن‬ ‫دو‬.
•‫أن‬ ‫دو‬‫ن‬ + >‫و‬ ‫را‬ ‫ا‬‫ن‬ ً@‫د‬ /‫و‬ ‫ا‬ >‫ر‬ ‫ا‬ ‫/راض‬ ‫ا‬ % ‫ا‬ ‫ء‬.

26. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ا‬ ‫ن‬ ‫د‬ ‫ا‬ ! 6 ‫ا‬ ‫و‬ ‫ة‬ ‫ا‬ ‫ط‬ ‫ل‬ ‫"6د‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
26
‫ة‬ ‫ا‬ ‫ط‬ ‫ت‬N ‫"6د‬
•‫ن‬ ‫ا‬ C ‫دم‬ " ‫ا‬ ‫رورة‬ " ‫ا‬ ‫رات‬ /" ‫ا‬ ‫ف‬ * " ‫طر‬.
•‫ھو‬ ‫ا8ھم‬ ‫ر‬ U" ‫ا‬‫ن‬ ‫"د‬ ‫ا‬ ‫ف‬ ‫إ‬.
•‫وزن‬ ‫ا‬ + , ‫طرة‬ ‫ا‬.
•‫"ظ‬ ‫ا‬ ‫ر‬ ‫ا‬ ‫ر‬.
•‫م‬ ‫د‬ ‫ا‬ ‫ن‬ ‫ل‬ $ ‫"وى‬ ‫ذات‬ ‫ر‬ 0‫أ‬ ' ‫"واز‬ E‫ذا‬P ‫ول‬ ".
•‫ص‬ ‫0ل‬I ‫و‬،‫أدو‬ ‫ر‬ "6"‫ت‬ " " ‫ا‬‫ا‬ ‫ن‬ ‫6د‬ ‫ء‬ ' ‫أھ‬ ‫ذات‬
‫دم‬ ‫ا‬ ‫وم‬ I C ‫طراب‬ ‫ا‬ ‫ن‬ ‫د‬ "‫وا‬ ‫ا‬.

27. ‫ا‬ ‫راض‬ ‫ا‬–‫ا‬ ‫ا‬
‫ا‬ ‫ن‬ C ‫د‬ ‫ا‬ ! 6 ‫ا‬ ‫و‬ ‫ة‬ ‫ا‬ ‫ط‬ ‫ل‬ ‫"6د‬
02،‫ر‬ ‫أ‬19
DR.HISHAM AL-HAMMAMI PROFESSOR OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SYRIAN PRIVATE UNIVERSITY
27
‫ت‬ 0‫ر‬ ‫وق‬ "‫ن‬ !‫"رو‬ ‫"وإ‬ * ‫ا‬)Phytoestrogens(‫أ‬ + , ‫ن‬E ‫ز‬ " ‫واد‬ ‫و‬
‫د‬ " ‫ا‬ ‫و‬ ‫ر‬ ‫ا‬ ! 6 ً 6 ‫ط‬ ُN ‫د‬.
‫ء‬ ‫ا‬ + , ‫!ب‬‫ل‬ 0‫در‬ ‫"0ون‬ ‫أن‬:
‫وھ‬ ‫ا‬ ‫ج‬N6 ‫ا‬ +"placebo‫ا8,راض‬ ‫6ض‬ ‫*ف‬ ‫$د‬.
‫رة‬ +" ‫أو‬ ‫دة‬ * ‫ر‬ P I6 ‫ا‬ ‫رات‬ " ‫ا‬ ‫6ض‬ ‫أن‬ ‫ت‬ ‫إ‬ ‫"م‬.
‫ت‬ !" ‫ا‬ ‫ھذه‬ R ‫""6رض‬ ‫ذي‬ ‫ا‬ ‫'را‬ ‫ا8$ل‬ ‫م‬ ‫ظ‬ " ‫ا‬ ‫و‬ ‫م‬ " ‫ا‬.