Discover the 5 essential steps for menopause hormone therapy, including benefits, risks, and how to make informed decisions for a smoother transition through menopause.
This document provides a step-by-step guide to menopausal hormone therapy. It discusses assessing candidates for therapy, treatment options including different hormones and administration routes, starting treatment, and follow up and stopping treatment. It addresses indications, contraindications, and recommendations for using hormone therapy in symptomatic menopausal women with risk factors like age, obesity, diabetes, or smoking. The guide emphasizes using the lowest effective dose for the shortest time needed to manage menopausal symptoms.
This document discusses menopause and hormone replacement therapy (HRT). It begins with an introduction to menopause and its stages. It then describes the common symptoms women experience during menopause. The document discusses the different types, causes, and management of menopause. It provides details on the use of HRT for managing menopause symptoms and preventing long-term health issues. Guidelines for the appropriate use of HRT are summarized. The document concludes by stating that HRT, when used correctly, can effectively relieve menopause symptoms and protect bone health.
Menopausal hormone therapy (MHT) also called postmenopausal hormone therapy and hormone replacement therapy. Here is presentation on Menopausal hormone therapy by Dr. Laxmi Shrikhande
This document discusses menopausal hormone therapy (MHT), also known as hormone therapy (HT). It defines key terms and outlines the history and background of MHT, including findings from the Women's Health Initiative trial in the late 1990s that raised safety concerns and led to a decline in MHT use. The document discusses guidelines for evaluating candidates for MHT and outlines potential benefits and risks to consider for individual patients. It also provides tables listing FDA-approved MHT drug products available in the US, including oral, transdermal, and vaginal estrogen therapies alone or in combination with progestogens.
This document provides information on a peer group discussion about hormonal replacement therapy presented by Ms. Santosh Kumari. It defines HRT, describes the benefits which include relief of menopausal symptoms and reduction of osteoporosis risk. It also outlines the risks such as a small increased risk of breast cancer and cardiovascular disease. Different preparations of HRT are discussed and indications and contraindications provided.
This document summarizes options for treating menopause symptoms including hormone replacement therapy and bioidentical hormones. It discusses formulations, dosages, administration routes, side effects and risks of both approaches. Specifically, it notes that bioidentical hormones have an identical chemical structure to human hormones, while synthetic hormones only mimic some functions. Transdermal delivery and lower doses of bioidentical hormones may provide a more favorable risk-benefit profile.
Menopause role of isoflavones by dr alka mukherjee nagpur m.s.indiaalka mukherjee
Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(-)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women
Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed.
Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit.
It’s packed with nutrition
Soy is low in saturated fat and calories. It’s also high in these beneficial nutrients:
• fiber
• protein
• omega-3 fatty acids
• antioxidants
It may help to reduce your risk of heart disease
Eating tofu and other soy-based foods a few times a week can help you cut back on some animal-based protein sources, such as steak or hamburger, that are high in saturated fat and cholesterol.
This document provides a step-by-step guide to menopausal hormone therapy. It discusses assessing candidates for therapy, treatment options including different hormones and administration routes, starting treatment, and follow up and stopping treatment. It addresses indications, contraindications, and recommendations for using hormone therapy in symptomatic menopausal women with risk factors like age, obesity, diabetes, or smoking. The guide emphasizes using the lowest effective dose for the shortest time needed to manage menopausal symptoms.
This document discusses menopause and hormone replacement therapy (HRT). It begins with an introduction to menopause and its stages. It then describes the common symptoms women experience during menopause. The document discusses the different types, causes, and management of menopause. It provides details on the use of HRT for managing menopause symptoms and preventing long-term health issues. Guidelines for the appropriate use of HRT are summarized. The document concludes by stating that HRT, when used correctly, can effectively relieve menopause symptoms and protect bone health.
Menopausal hormone therapy (MHT) also called postmenopausal hormone therapy and hormone replacement therapy. Here is presentation on Menopausal hormone therapy by Dr. Laxmi Shrikhande
This document discusses menopausal hormone therapy (MHT), also known as hormone therapy (HT). It defines key terms and outlines the history and background of MHT, including findings from the Women's Health Initiative trial in the late 1990s that raised safety concerns and led to a decline in MHT use. The document discusses guidelines for evaluating candidates for MHT and outlines potential benefits and risks to consider for individual patients. It also provides tables listing FDA-approved MHT drug products available in the US, including oral, transdermal, and vaginal estrogen therapies alone or in combination with progestogens.
This document provides information on a peer group discussion about hormonal replacement therapy presented by Ms. Santosh Kumari. It defines HRT, describes the benefits which include relief of menopausal symptoms and reduction of osteoporosis risk. It also outlines the risks such as a small increased risk of breast cancer and cardiovascular disease. Different preparations of HRT are discussed and indications and contraindications provided.
This document summarizes options for treating menopause symptoms including hormone replacement therapy and bioidentical hormones. It discusses formulations, dosages, administration routes, side effects and risks of both approaches. Specifically, it notes that bioidentical hormones have an identical chemical structure to human hormones, while synthetic hormones only mimic some functions. Transdermal delivery and lower doses of bioidentical hormones may provide a more favorable risk-benefit profile.
Menopause role of isoflavones by dr alka mukherjee nagpur m.s.indiaalka mukherjee
Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(-)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women
Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed.
Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit.
It’s packed with nutrition
Soy is low in saturated fat and calories. It’s also high in these beneficial nutrients:
• fiber
• protein
• omega-3 fatty acids
• antioxidants
It may help to reduce your risk of heart disease
Eating tofu and other soy-based foods a few times a week can help you cut back on some animal-based protein sources, such as steak or hamburger, that are high in saturated fat and cholesterol.
This document discusses the history and scientific evidence around hormone replacement therapy (HRT) and its relationship to breast cancer. It notes that while early studies found HRT improved quality of life and reduced fractures, the large Women's Health Initiative studies from the 1990s-2000s found HRT increased risks of breast cancer, heart disease, and blood clots. However, sub-analysis indicated lower risks for younger women using HRT short-term. Current recommendations are that HRT may be used at lowest effective dose for shortest time to treat menopausal symptoms.
This document summarizes hormone replacement therapy (HRT) options for post-menopausal women. It discusses the reasons for HRT, including relieving symptoms and improving quality of life. It then describes various estrogen and progestin drug regimens used in HRT. The benefits of HRT for vasomotor symptoms, sleep, mood, the genital tract and other areas are outlined. Risks including certain cancers are also reviewed. Different drug formulations and their advantages and disadvantages are compared. Special situations and contraindications are covered as well.
Menopausal Harmone Therapy & Indian Gynaecologists Dr Sharda Jain Lifecare Centre
This document discusses menopause and menopausal hormone therapy (MHT). It provides information on:
1) The average age of menopause for Indian women is 46.2 years. Premature menopause, which occurs before age 40, increases risks for cardiovascular disease, diabetes, and metabolic syndrome.
2) Lessons learned from the WHI study show that the risks of MHT depend on factors like age of starting treatment, type of estrogen and progestogen used, and whether the uterus is present. Not all progestogens have the same safety profile.
3) The choice of progestogen is important as some, like medroxyprogesterone acetate (MPA), may
This document discusses menopause and hormone therapy. It covers topics like the definition of menopause, common symptoms during menopause, medical intervention guidelines, and safety and benefits of hormone therapy. It provides information on different hormone therapy options, guidelines from medical societies on hormone therapy use, and the effects of hormone therapy on conditions like osteoporosis and cardiovascular disease.
The document discusses menopause management options, focusing on phytoestrogens as a natural alternative to hormone replacement therapy (HRT). It notes that phytoestrogens from soy and other plants can act as selective estrogen receptor modulators (SERMs) to provide estrogenic effects without the health risks of HRT. Isoflavones like genistein are the most studied phytoestrogens and may help reduce menopausal symptoms and long-term conditions like osteoporosis and heart disease. The document reviews the sources, types, and pharmacology of various phytoestrogens.
This document provides information about an Indian physician named Dr. Laxmi Shrikhande, including her professional accomplishments and roles. It lists that she has served as Chairperson Elect of the Indian College of OB/GYN, National Corresponding Editor of the Journal of OB/GYN of India, Founder Patron and President of ISOPARB Vidarbha Chapter, and various other leadership positions in medical organizations. It also notes some of the awards and recognition she has received for her work in women's health and related fields.
1. The document summarizes two patient cases involving menopause and hormone replacement therapy (HRT). The first case is a 52-year-old woman experiencing menopausal symptoms who is continuing HRT. The second case is a 51-year-old woman with Sheehan's syndrome who is being weaned off HRT.
2. The document then reviews recommendations and guidelines for HRT use, including that it remains the most effective treatment for vasomotor symptoms. It discusses the immediate effects of HRT on various systems and considerations for progestogen use.
3. Alternative treatments to HRT are also mentioned, including SSRIs, venlafaxine, and phytoestrog
This document discusses hormone replacement therapy (HRT) and aims to break stigmas around its use. It summarizes recent research showing that for healthy women under 60, the benefits of HRT generally outweigh the risks when initiated soon after menopause. While some studies linked oral HRT to increased breast cancer and heart risks, newer options like transdermal estrogen and bioidentical micronized progesterone may not carry these risks. HRT can help reduce risks of conditions like dementia and osteoporosis linked to estrogen loss. However, risks likely outweigh benefits for some women with hormone-receptive cancer histories. Overall, the document advocates that HRT use should be considered on a case-by-case basis.
Bio-identical Hormone Optimization for Women, teacher presentationPaul Cox
This document discusses regenerative and integrative medicine, which aims to optimize the body's self-repair mechanisms through hormones, lifestyle changes, and supplements. It focuses on hormone optimization for women, explaining how hormone systems can fail and symptoms of menopause. Different hormone replacement options are described, including bioidentical hormones that have the same chemical structure as what the body produces, reducing risks. Safety studies on bioidentical progesterone are summarized, finding no increased breast cancer risk unlike synthetic progestins.
This document provides an overview of endometriosis from Dr. S.N. Sethi. Some key points:
- Endometriosis is often misdiagnosed, taking an average of 8 years to diagnose correctly.
- It is estrogen-dependent and invasive, with lesions found in various locations besides the uterus.
- Symptoms include pelvic pain and infertility. Dienogest is highlighted as an effective long-term medical treatment that provides pain relief and few side effects.
- Studies show Dienogest significantly reduces endometriosis lesions and symptoms compared to placebo and has similar efficacy to leuprolide with fewer side effects.
Hormone therapy in postmenopausal womenMayuriSimon
This document discusses hormone replacement therapy (HRT) for postmenopausal women. It defines menopause and describes the hormonal changes that occur. It explains that HRT can help relieve menopausal symptoms, prevent osteoporosis, and maintain quality of life. However, HRT also carries some risks like breast and endometrial cancer if not administered properly. The document discusses the various HRT preparations available, recommended durations of use, and the importance of monitoring women receiving HRT.
Presentation given in 2018 on Endometriosis - management in the infertility setting. When are assisted reproductive technologies used and what are the medications used for dealing with this condition?
Menopause is defined as the absence of menstrual periods for 12 months and marks the end of a woman's reproductive years. It is caused by a natural decline in ovarian function with age. The average age of menopause is 51 but it can occur earlier or later. Perimenopause is the transition period before menopause where estrogen levels fluctuate. Hormone replacement therapy can be used to treat menopause symptoms but requires evaluation for safety.
A slight description on contraception, its types along with a brief explanation on Oral Contraceptives. Types of oral contraceptives, it's types, mechanism of action, contraindications, dosing, advantages, disadvantages, risk, benefit amd recent research trends.
Nulife module 7 controversies and conclusions editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
Menopause is the permanent cessation of menstrual periods, occurring on average at age 51. Hormone therapy can relieve menopausal symptoms but carries risks like endometrial cancer and blood clots. Options include oral or transdermal estrogen with or without progestin. Non-hormonal treatments include black cohosh, exercise, and lifestyle changes. Hormone therapy is generally recommended for short-term use to treat moderate to severe symptoms.
In this presentation, I talk about a brief description of menopause, hormonal changes during menopause, symptoms, and how HRT can be helpful during menopause. The advantages, risk factors and its methods of function are also included in this presentation.
Learn about the connection between Polycystic Ovary Syndrome (PCOS) and Metabolic Syndrome. Discover symptoms, associated risks, and effective management strategies to improve your health and well-being.
Late onset menopause, or delayed menopause, refers to the cessation of menstrual periods and reproductive function occurring at an older age than the average onset of menopause, which is typically around 51 years old. When menopause occurs after the age of 55, it is considered late onset. This phenomenon is relatively rare, affecting a small percentage of women, and is influenced by various factors including genetics, lifestyle, and environmental factors.
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This document discusses the history and scientific evidence around hormone replacement therapy (HRT) and its relationship to breast cancer. It notes that while early studies found HRT improved quality of life and reduced fractures, the large Women's Health Initiative studies from the 1990s-2000s found HRT increased risks of breast cancer, heart disease, and blood clots. However, sub-analysis indicated lower risks for younger women using HRT short-term. Current recommendations are that HRT may be used at lowest effective dose for shortest time to treat menopausal symptoms.
This document summarizes hormone replacement therapy (HRT) options for post-menopausal women. It discusses the reasons for HRT, including relieving symptoms and improving quality of life. It then describes various estrogen and progestin drug regimens used in HRT. The benefits of HRT for vasomotor symptoms, sleep, mood, the genital tract and other areas are outlined. Risks including certain cancers are also reviewed. Different drug formulations and their advantages and disadvantages are compared. Special situations and contraindications are covered as well.
Menopausal Harmone Therapy & Indian Gynaecologists Dr Sharda Jain Lifecare Centre
This document discusses menopause and menopausal hormone therapy (MHT). It provides information on:
1) The average age of menopause for Indian women is 46.2 years. Premature menopause, which occurs before age 40, increases risks for cardiovascular disease, diabetes, and metabolic syndrome.
2) Lessons learned from the WHI study show that the risks of MHT depend on factors like age of starting treatment, type of estrogen and progestogen used, and whether the uterus is present. Not all progestogens have the same safety profile.
3) The choice of progestogen is important as some, like medroxyprogesterone acetate (MPA), may
This document discusses menopause and hormone therapy. It covers topics like the definition of menopause, common symptoms during menopause, medical intervention guidelines, and safety and benefits of hormone therapy. It provides information on different hormone therapy options, guidelines from medical societies on hormone therapy use, and the effects of hormone therapy on conditions like osteoporosis and cardiovascular disease.
The document discusses menopause management options, focusing on phytoestrogens as a natural alternative to hormone replacement therapy (HRT). It notes that phytoestrogens from soy and other plants can act as selective estrogen receptor modulators (SERMs) to provide estrogenic effects without the health risks of HRT. Isoflavones like genistein are the most studied phytoestrogens and may help reduce menopausal symptoms and long-term conditions like osteoporosis and heart disease. The document reviews the sources, types, and pharmacology of various phytoestrogens.
This document provides information about an Indian physician named Dr. Laxmi Shrikhande, including her professional accomplishments and roles. It lists that she has served as Chairperson Elect of the Indian College of OB/GYN, National Corresponding Editor of the Journal of OB/GYN of India, Founder Patron and President of ISOPARB Vidarbha Chapter, and various other leadership positions in medical organizations. It also notes some of the awards and recognition she has received for her work in women's health and related fields.
1. The document summarizes two patient cases involving menopause and hormone replacement therapy (HRT). The first case is a 52-year-old woman experiencing menopausal symptoms who is continuing HRT. The second case is a 51-year-old woman with Sheehan's syndrome who is being weaned off HRT.
2. The document then reviews recommendations and guidelines for HRT use, including that it remains the most effective treatment for vasomotor symptoms. It discusses the immediate effects of HRT on various systems and considerations for progestogen use.
3. Alternative treatments to HRT are also mentioned, including SSRIs, venlafaxine, and phytoestrog
This document discusses hormone replacement therapy (HRT) and aims to break stigmas around its use. It summarizes recent research showing that for healthy women under 60, the benefits of HRT generally outweigh the risks when initiated soon after menopause. While some studies linked oral HRT to increased breast cancer and heart risks, newer options like transdermal estrogen and bioidentical micronized progesterone may not carry these risks. HRT can help reduce risks of conditions like dementia and osteoporosis linked to estrogen loss. However, risks likely outweigh benefits for some women with hormone-receptive cancer histories. Overall, the document advocates that HRT use should be considered on a case-by-case basis.
Bio-identical Hormone Optimization for Women, teacher presentationPaul Cox
This document discusses regenerative and integrative medicine, which aims to optimize the body's self-repair mechanisms through hormones, lifestyle changes, and supplements. It focuses on hormone optimization for women, explaining how hormone systems can fail and symptoms of menopause. Different hormone replacement options are described, including bioidentical hormones that have the same chemical structure as what the body produces, reducing risks. Safety studies on bioidentical progesterone are summarized, finding no increased breast cancer risk unlike synthetic progestins.
This document provides an overview of endometriosis from Dr. S.N. Sethi. Some key points:
- Endometriosis is often misdiagnosed, taking an average of 8 years to diagnose correctly.
- It is estrogen-dependent and invasive, with lesions found in various locations besides the uterus.
- Symptoms include pelvic pain and infertility. Dienogest is highlighted as an effective long-term medical treatment that provides pain relief and few side effects.
- Studies show Dienogest significantly reduces endometriosis lesions and symptoms compared to placebo and has similar efficacy to leuprolide with fewer side effects.
Hormone therapy in postmenopausal womenMayuriSimon
This document discusses hormone replacement therapy (HRT) for postmenopausal women. It defines menopause and describes the hormonal changes that occur. It explains that HRT can help relieve menopausal symptoms, prevent osteoporosis, and maintain quality of life. However, HRT also carries some risks like breast and endometrial cancer if not administered properly. The document discusses the various HRT preparations available, recommended durations of use, and the importance of monitoring women receiving HRT.
Presentation given in 2018 on Endometriosis - management in the infertility setting. When are assisted reproductive technologies used and what are the medications used for dealing with this condition?
Menopause is defined as the absence of menstrual periods for 12 months and marks the end of a woman's reproductive years. It is caused by a natural decline in ovarian function with age. The average age of menopause is 51 but it can occur earlier or later. Perimenopause is the transition period before menopause where estrogen levels fluctuate. Hormone replacement therapy can be used to treat menopause symptoms but requires evaluation for safety.
A slight description on contraception, its types along with a brief explanation on Oral Contraceptives. Types of oral contraceptives, it's types, mechanism of action, contraindications, dosing, advantages, disadvantages, risk, benefit amd recent research trends.
Nulife module 7 controversies and conclusions editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
Menopause is the permanent cessation of menstrual periods, occurring on average at age 51. Hormone therapy can relieve menopausal symptoms but carries risks like endometrial cancer and blood clots. Options include oral or transdermal estrogen with or without progestin. Non-hormonal treatments include black cohosh, exercise, and lifestyle changes. Hormone therapy is generally recommended for short-term use to treat moderate to severe symptoms.
In this presentation, I talk about a brief description of menopause, hormonal changes during menopause, symptoms, and how HRT can be helpful during menopause. The advantages, risk factors and its methods of function are also included in this presentation.
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A urinary tract infection (UTI) during pregnancy occurs when bacteria enter the urinary tract, leading to an infection. This condition is relatively common during pregnancy due to hormonal changes that can affect the urinary system, as well as the physical changes that occur as the uterus expands and puts pressure on the bladder. UTIs in pregnancy require prompt attention and treatment to prevent complications for both the mother and the baby
Discover the essential steps and expert advice for optimal pre-conception care. Learn how to enhance your fertility, ensure a healthy pregnancy, and lay the foundation for your baby's lifelong well-being
Explore the intricacies of ovulation induction in intrauterine insemination (IUI) with Dr Laxmi Shrikhande's informative slide share presentation. From understanding the hormonal mechanisms to the latest techniques, this presentation offers insights into optimizing fertility through IUI. Whether you're a clinician seeking to enhance patient outcomes or an individual navigating fertility treatments, this resource provides valuable knowledge for your journey towards conception.
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Overview of the presentation's objectives and key topics to be covered
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Prevalence varies among studies and countries (4.5-68.6%)
Nearly 20-30% Indian women in reproductive age group have fibroid uterus
At any given time, nearly 15-25 million Indian women have fibroid uterus
Understand fibroids in a better way
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This presentation covers the
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3) Causes
4) Symptoms
You can get the awareness that you were looking for Non Specific Musculoskeletal Pain details
Non-Specific Musculoskeletal Pain presented by Dr.Laxmi Shrikhande Consultant –Shrikhande Hospital & Research Centre Pvt Ltd
Nagpur. The leading hospital in Nagpur
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Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
The document discusses oral health challenges during pregnancy. It notes increased risks of gingivitis, dental caries, and pregnancy tumors due to hormonal changes. Proper oral hygiene and dental care during pregnancy is important for maternal and infant health and can help prevent complications like preterm births. The roles of obstetricians and dentists in educating pregnant women and providing treatment are discussed. Guidelines indicate dental care is safe during pregnancy with precautions.
Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male foetus.
In women,AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation
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Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
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Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
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Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
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As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
1. Immediate Past Chairperson –Indian College of
OB/GY-ICOG
National Corresponding Editor-Journal of
OB/GY of India JOGI
National Corresponding Secretary- Association
of Medical Women, India
Joint Secretary-Indian Menopause Society
President –ISOPARB Vidarbha Chapter 2019-21
Chairperson-IMS Education Committee 2021-23
Chairperson-fertility enhancement Committee-
ISOPARB
Member-SAFOG Education Committee
President-Association of Medical Women,
Nagpur AMWN 2021-24
Senior Vice President FOGSI 2012
President Menopause Society, Nagpur 2016-18
President Nagpur OB/GY Society 2005-06
Dr. Laxmi
Shrikhande
MBBS; MD(OB/GY);
FICOG; FICMU; FICMCH
Medical Director-
Shrikhande Fertility Clinic
Nagpur, Maharashtra
Nagpur Ratan Award @hands
of Union Minister Shri Nitinji
Gadkari
Received Bharat excellence
Award for women’s health
Received Mehroo Dara
Hansotia Best Committee
Award for her work as
Chairperson HIV/AIDS
Committee, FOGSI 2007-2009
Received appreciation letter
from Maharashtra
Government for her work in
the field of SAVE THE GIRL
CHILD
Delivered 22 orations and
450 guest lectures
Publications- 42 National
& 21 International
Sensitized 2 lakh boys and
girls on adolescent health
issues
Awards
Positions
2. 5 steps for
Menopausal Hormone Therapy
Dr Laxmi Shrikhande
Consultant-Shrikhande Hospital & Research Centre
NAGPUR
3. U turn in Menopausal Hormone Therapy
Widespread use of hormone therapy in the 1980s and
1990s came to an abrupt halt in the early 2000s after
initial findings of the Women’s Health Initiative trial
were published and the study was terminated
Over the next several years, extensive re-analysis and
assessment of the WHI data cast doubt about the
validity of the original conclusions
N Engl J Med 2016; 374(9): 803–806
4. U turn in Menopausal Hormone Therapy
● In 2016, to atone for the turmoil caused by the
inappropriately communicated findings of the WHI
trials, two WHI investigators published a request for
forgiveness
N Engl J Med 2016; 374(9): 803–806
5. U turn in Menopausal Hormone Therapy
There is general agreement among guideline groups that HT
has a favorable risk–benefit ratio in women who initiate
treatment between 50 and 59 years of age or within 10 years
of menopause onset
In this population, HT is highly effective for relief of
vasomotor and urogenital symptoms, and can prevent bone
loss and fracture
Symptom relief provides additional benefits such as
improved sexual function and overall quality of life (QoL)
Climacteric 2016; 19(2): 109–150
Menopause 2017; 24(7): 728–753
Minerva Ginecol 2018; 70(1): 27–34.
6. Menopausal Hormone Therapy-The timing hypothesis
Timing of initiation of hormone therapy affects the
relation with coronary risk
Estrogen may provide coronary benefit in early
menopause but harm if started later
Absolute risks of hormone therapy are lower in early
than late menopause
Hormone therapy is appropriate for vasomotor
symptom relief in early menopause
Hormone therapy is not recommended for chronic
disease prevention
Metabolism. 2016 May ; 65(5): 794–803
7. A Step by Step Guide to MHT = HRT
Steps
Step 1 - Assess if MHT is right for the patient
Step 2 – Hormonal therapy options
Step 3 – Starting MHT treatment
Step 4 – Follow-up
Step 5 – Stopping treatment
9. MHT indications
Vasomotor symptoms
− Hormone therapy has been shown in double-
blind RCTs to relieve hot flashes and is
approved as first-line therapy for relief of
menopause symptoms in appropriate
candidates
Prevention of bone loss
− Hormone therapy has been shown in double-
blind RCTs to prevent bone loss, and in the
WHI, to reduce fractures in postmenopausal
women
9
The Journal of The North American Menopause Society 2017
10. MHT indications
10
The Journal of The North American Menopause Society 2017
Premature hypoestrogenism
HT is approved for women with hypogonadism, POI,
or premature surgical menopause without
contraindications, with health benefits for
menopause symptoms, prevention of bone loss,
cognition and mood issues, and in observational
studies, heart disease
Genitourinary symptoms
Hormone therapy has been shown in RCTs to
effectively treat symptoms of vulvovaginal atrophy
11. MHT contraindications
Current, past or suspected breast cancer,
Known or suspected estrogen-dependent malignant tumors (e.g. endometrial
cancer),
Undiagnosed genital bleeding,
Untreated endometrial hyperplasia,
Previous idiopathic or current venous thromboembolism (deep venous
thrombosis, pulmonary embolism),
Active or recent arterial thromboembolic disease (e.g. angina, myocardial
infarction),
Untreated hypertension,
Active liver disease,
Known hypersensitivity to the active substances or to any of the excipients,
Porphyria cutanea tarda (an absolute contraindication).
The Journal of The North American Menopause Society 2017
12. Main risk factors for MHT use
Older age (>60 years)
Obesity (BMI > 30 kg/m2),
Insulin resistance
Increase cardiovascular risk (dyslipidaemia,
hypertension, diabetes mellitus, smoking)
Personal or family history of venous
thromboembolism (VTE)
The presence of risk factors does not necessarily preclude use of MHT
Women’s Health 2019
13. Recommendations for use of hormone
therapy in symptomatic menopausal
women with risk factors*
*Note: Based on international guidelines, clinical literature and expert opinion (clinical experience and
expertise) of the authors
Minerva Ginecol 2018; 70(1): 27–34
Diabetes Res 2015; 2015: 916585
Endocr Pract 2017; 23(7): 869–880
14. Age >60 years or more than 10 years since onset of menopause
For current users of MHT it can be continued at an appropriate dose (lowest
effective dose) for an appropriate time if no new contraindications emerge
For new users in whom MHT is indicated, and in the absence of major
contraindications, treatment with transdermal oestradiol (either 25 mcg patch
or gel, 1 puff per day) and vaginal progesterone (either 100 mg in the evening
continuously or 200 mg in the evening for 14 days a month) is preferred. If
other risk factors are present, vaginal treatment with oestradiol or oestriol is
preferred
15. Obesity (BMI > 30 mg/m2)
As elevated oestrone production from adipose tissue increases the risk of
proliferative endometrial lesions, protecting the endometrium with
progesterone or progestogens (e.g. levonorgestrel or dienogest intrauterine
system) is a priority.
The woman’s willingness to make lifestyle improvements should be
empowered.
J Steroid Biochem Mol Biol 2007; 106(1–5): 81–96
16. Insulin resistance
Menopausal HT should be recommended to
women with type 2 diabetes, or a family history
of diabetes, as it reduces progression
Diabetes Res 2015; 2015: 916585
Climacteric 2014; 17(5): 540–556
17. Hypertension
Menopausal HT can improve recent-onset
hypertension, with enhanced response to
antihypertensive drugs
the option to start transdermal HT should
be discussed with a cardiologist
18. Smoking
Women who smoke should be counselled to
quit while also increasing daily aerobic exercise
in order to improve endothelial function, reduce
hypertension and, if relevant, reduce the risk of
weight gain
For women who choose not to quit, vaginal HT
is preferred. In selected cases, systemic HT
may be considered, but only if the woman is
fully aware of the higher independent
cardiovascular risk due to smoking
22. Basics of MHT
● Estrogen replacement therapy: for
women without a uterus
● Estrogen–progestogen therapy: For
women with intact uterus
23. Oestrogen
● Oestrogen is the primary active component of HT and is the recognized ‘gold
standard’ for treating menopausal symptoms, especially vasomotor
symptoms
● Systemic oestrogens used for MHT in India are conjugated equine estrogens
(CEEs) and oestradiol valerate
24. Estradiol valerate:
● Natural estrogen
● Safer than its synthetic counterpart
● Micronized form: Increased dissolution and bioavailability
● Esterified preventing extensive first pass metabolism in liver and GIT
● Convenient oral administration
● Is safe even for long-term use (adherence is good even after 7 yrs. of
therapy)*
*Peter HM. Long term adherence to continuous combined HRT. Seven-year update on the Heikkinen
study. Menopause international. 2003;9:8-9
25. Parameters Estradiol Valerate Conjugated Estrogens (CE) Comments
Source Natural Pregnant mare’s urine
product
Estrogenic activity Estradiol valerate
contains the most active
estrogen i.e 17-
estradiol.
CE contains 52 –61% of
estrone that is 1/3 of Estradiol
activity.
CE also contains unknown
ingredients.
Ten hormones present in CE are chemically
different from female hormones.
Unknown ingredients may cause any
possible adverse effect.
Mammographic
density
No significant effect1 Significant increase in
mammographic density 2
Increase in mammographic density may be
a concern as it is a predictor of cancerous
growth in the breasts.
Blood Pressure
(BP)
No effect on renin-
aldosterone system.
Stimulates the liver
production angiotensinogen,
therofore increases BP
CE by stimulating renin-angiotensin
system is associated with the risk of
hypertension.
Coagulation Factor No effect on factor VII factor VII CE ( by factor VII) may cause abnormal
increase in clotting of blood.
Medscape Womens Health. 2002 Jul-Aug;7(4):1; Ginecol Obstet Mex. 2000 Nov;68:442-7.
E2V vs Conjugated Equine Estrogens
26. Parameters Estradiol valerate Conjugated estrogen (CE) Comments
Vasomotor
symptoms
Hot flushes, severe throbs, and
breast tenderness is lower 3
Presence of vasomotor
symptoms are higher with CE
EV could be an option that is
better accepted by
postmenopausal women. It is the
drug approved by US FDA for such
condition.
Lipid profile and
cardioprotective
effect
Offers favorable lipid profile4 Lesser favorable lipid profile. EV has better bioavailability and
therefore, is a better option in
dealing with concerns of
postmenopausal cardiovascular
protection
Endothelial function EV improves endothelial
function and reduces plasma
levels of endothelin-15
Vasoprotective effect not
reported
EV has fast effects on endothelial
function thus acutely
vasoprotective
Plasma
homocysteine level
EV has no effect on plasma
homocysteine level6
Effect on homocysteine level
not reported
Homocysteine is a risk factor for
CHD. EV reduces the risk of CHD
3Maturitas. 1997 Jul;27(3):275-84.
4Maturitas. 2001 Dec 14;40(3):239-45; 5Acta Obstet Gynecol Scand. 2006;85(11):1304-6.
E2V vs Conjugated Equine Estrogens
27. Vaginal Estrogen: Treatment of GSM*
Estrogen Preparation (FDA Approved)
Vaginal creams: 17-beta estradiol, conjugated estrogens
Vaginal ring: 17-beta estradiol, estradiol acetate
Vaginal tablet inserts: Estradiol hemihydrate
CLEVELAND CLINIC JOURNAL OF MEDICINE 2018
*Genitourinary Syndrome of Menopause
28. Vaginal Estrogen: Treatment of GSM*
Local Estrogen & Endometrial Impact
● Endometrial surveillance with either transvaginal ultrasonography or
endometrial sampling is not required, even with long-term use, but it should
be considered with higher doses or more frequent applications
● Progestogen therapy is not recommended with low-dose vaginal ET, but
appropriate evaluation of the endometrium should be performed if vaginal
bleeding occurs, given the limitations of safety data
CLEVELAND CLINIC JOURNAL OF MEDICINE 2018
*Genitourinary Syndrome of Menopause
29. Rationale of Progestogen in MHT
● Since chronic unopposed exposure of the endometrium to oestrogen
increases the risk of endometrial hyperplasia and cancer, progestogens are a
part of systemic HT in menopausal women with an intact uterus
30. Selecting the ‘Best’ Progestogen
● Although selecting the ‘best’ progestogen for use in an individual patient
requires further clarification, there is evidence to suggest that micronized
progesterone have better risk profiles than medroxyprogesterone acetate
(MPA), and is associated with a lower risk of breast cancer compared with
other progestogens
Maturitas 2014; 77(4): 311–317
31. Progestogens available for MHT
Characteristic Androgenic Non-androgenic
Norethisterone acetate Levonorgestrel MPA Dydrogesterone
Micronised progesterone
Route of administration
Oral
Transdermal
Oral
Transdermal
Intrauterine
Oral
Oral
Oral
32. An international expert panel’s recommendations on MHT containing micronized
progesterone are as follows
○ Oral micronized progesterone provides endometrial protection if applied
sequentially for 12–14 days/month at 200mg/day for up to 5 years
○ Vaginal micronized progesterone may provide endometrial protection if applied
sequentially for at least 10 days/month at 4% (45 mg/day) or every other day at
100mg/day for up to 3–5 years (off-label use)
○ Transdermal micronized progesterone does not provide
endometrial protection
32
CLIMACTERIC, 2016
Selecting the ‘Best’ Progestogen
33. Dydrogesterone
● According to the Women's Health Initiative (WHI) study, the most important
risks during combined hormone replacement therapy (HRT) are breast
cancer, stroke and venous thromboembolism.
● To date, combinations of estradiol with natural progesterone or its
retroisomer dydrogesterone are the only combined HRT regimens for which
large case–control or cohort studies show no increase in any of these three
risks.
● Moreover, due to the neutral effect of dydrogesterone on the vascular and
metabolic systems, the preventive effect of the estradiol component with
respect to myocardial infarction and metabolic syndrome can be maintained if
HRT is started early after the menopause.
Alfred O. Mueck, Harald Seeger, Kai-J. Bühling,Use of dydrogesterone in hormone replacement therapy, Maturitas,
Volume 65, Supplement 1,2009,Pages S51-S60,ISSN 0378-5122,https://doi.org/10.1016/j.maturitas.2009.09.013.
34. Dydrogesterone
● Although a study with the same design as the WHI has not been performed,
these results appear to be plausible considering the positive experimental
evidence, particularly in the context of breast cancer and cardiovascular
risks/benefits.
● Combination with dydrogesterone avoids endometrial hyperproliferation,
maintains the beneficial effects of estradiol (i.e. efficacy against climacteric
symptoms and prevention of osteoporotic fractures) and minimizes the most
important risks known to be associated with the progestogen components of
HRT regimens.
● More studies needed to know the safety of this drug in MHT.
Alfred O. Mueck, Harald Seeger, Kai-J. Bühling,Use of dydrogesterone in hormone replacement therapy, Maturitas,
Volume 65, Supplement 1,2009,Pages S51-S60,ISSN 0378-5122,https://doi.org/10.1016/j.maturitas.2009.09.013.
36. Dose and route of administration
Most appropriate dose of HT depends on the woman’s
phase of life, age and general health status
Useful approach may be to start HT at a low dose, then
titrate upwards to the lowest effective dose that is
consistent with the woman’s treatment goals
Women’s Health 2019
38. Starting MHT
International guidelines recommend that HT be
started as soon as menopausal signs or symptoms
appear which, in most women, is between 45 and
55 years of age
Women with primary ovarian insufficiency require
earlier and continued use of HT (at least until the
normal age of menopause) to protect against
associated postmenopausal chronic diseases
Women’s Health 2019;15:1-8
39. Starting MHT
Evaluating risk factors for MHT in candidate patients
Questions to ask
Age
Menstruation status
Menopausal symptoms
Past and current medical history
Family history
Lifestyle factors (e.g. smoking, alcohol use, exercise)
Concurrent medications
Women’s Health 2019;15:1-8
40. Evaluating risk factors for MHT in candidate patients
Examinations/investigations to perform:
Body weight
Waist circumference
Blood pressure
Blood tests if indicated by responses to questioning
Imaging (e.g. ultrasound, bone density) if indicated by responses to
questioning
Mammography if not performed within previous year
Bone densitometry (dual-energy x-ray absorptiometry)
if patient at risk for osteoporosis
Women’s Health 2019;15:1-8
Starting MHT
41. A Practical Approach
Uterus intact Post hysterectomy
First line
management
A. Oral E
B. Transdermal E patch or gel
A. Oral E plus oral P
B. Combined transdermal (E+P) patch
Jane and Davis; A practitioner’s Toolkit for the Menopause; Jean Hailes for Women’s Health | jeanhailes.org.au
42. Cyclical/sequential HT
Cyclical or sequential HT involves daily administration of oestrogen, with the
addition of progestogen for 10– 14 days a month (monthly bleeds) or for 10–
14 days every 13 weeks (bleeds every 3 months)
Any irregular bleeding and/ or spotting that occurs in addition to regular
progestogen withdrawal bleeds can be managed by increasing the oestrogen
dose as this stabilizes the endometrium
Climacteric 2016; 19(4): 316–328
43. Continuous HT
this regimen eliminates withdrawal bleeding and promotes amenorrhea
Should be used only in women who are at least 2 years past their last
menstrual period as it can cause irregular bleeding in perimenopausal women
due to the unpredictable residual production of oestradiol by remaining
primordial ovarian follicles
Climacteric 2016; 19(4): 316–328
45. Follow-up of patients prescribed MHT
Schedule a follow-up appointment after
initiation of a MHT regimen in one month, to
assess treatment effect
Adverse effects of MHT include bloating,
breast tenderness, increased blood pressure,
headaches, fluid retention and urinary
incontinence
www.bpac.org.nz
46. Follow-up of patients prescribed MHT
What to do if there is persistent vasomotor
symptoms?
Increase MHT doses or try another
formulation
www.bpac.org.nz
47. Follow-up of patients prescribed MHT
What to do if there is breast tenderness ?
Reduce the dose of oestrogen or switch to
another progestogen
www.bpac.org.nz
48. Follow-up of patients prescribed MHT
What to do if there is unscheduled bleeding within the first three months ?
Consider continuing treatment unless there is a high suspicion of endometrial
cancer as bleeding may settle with time
Other options include:
o Switching to cyclical progestogen for patients taking continuous progestogen
o Increasing the dose of progestogen
o Switching from oral progestogen to a levonorgestrel IUD
www.bpac.org.nz
49. Follow-up of patients prescribed MHT
What to do if there is unscheduled bleeding
after the first three to six months of MHT?
Organise further investigations for
endometrial cancer
If no endometrial pathology is detected,
consider increasing oestrogen dose
www.bpac.org.nz
51. Stopping HT
Current users of HT can remain on treatment
indefinitely (lifelong if indicated), or at least until
such time as the patient asks to stop
Regular monitoring of HT is advised, with
adjustments made to type, dosage and/ or route of
administration according to a patient’s changing
circumstances and treatment goals
Women’s Health 2019;15:1-8
52. Key Take Aways
● MHT is a dominant therapeutic modality in Menopausal medicine
● The skill lies in the ability to choose the optimal MHT preparation for the
given patient
● Follow the steps when it is decided to start MHT.
● The key is individualization, minimum possible effective dose, early start of
therapy, adequate follow up
53. My World of sharing happiness!
Shrikhande Fertility Clinic
Ph- 91 8805577600
shrikhandedrlaxmi@gmail.com
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The Art of Living
Anything that
helps you to
become
unconditionally
happy and loving
is what is called
spirituality.
H. H. Sri Sri Ravishakar