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.
This document discusses menopause and the options for hormone replacement therapy (HRT). It covers the physiology of menopause, effects of declining estrogen levels, and risks like hot flashes, bone loss, and cardiovascular disease. It presents both benefits and risks of HRT, as well as non-hormonal options and lifestyle interventions like diet, exercise and supplements that can help manage menopause symptoms and health risks. The key decision is choosing treatments that improve quality of life based on each woman's individual symptoms, risk factors and medical history.
This document discusses menopause and management options. It begins by defining menopause as the permanent cessation of menstruation resulting from loss of ovarian activity, typically between ages 45-55. It then outlines some of the main consequences of menopause like vasomotor symptoms, sexual dysfunction, osteoporosis, and cardiovascular risks. The document discusses treatment options like lifestyle changes, hormone replacement therapy, and alternative therapies. It provides details on hormone replacement regimens and duration of treatment for various symptoms and conditions.
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.
Recent 2018 ESHRE & ASRM evidence based guidelines for PCOS assementAtef Darwish
This document discusses recommendations for assessing polycystic ovary syndrome (PCOS). It covers diagnostic criteria including irregular menstrual cycles, hyperandrogenism, polycystic ovarian morphology on ultrasound, and anti-Müllerian hormone levels. It also discusses assessing cardiovascular, metabolic, and reproductive health risks associated with PCOS, including insulin resistance, impaired glucose tolerance, diabetes, and obesity. Ethnic variations in PCOS presentation and long-term health risks are also addressed.
Menopause is defined as the permanent cessation of menstruation and fertility due to loss of ovarian activity, typically occurring between ages 45-55. It involves 3 phases: peri-menopause, menopausal transition, and post-menopausal. Physiological changes include increased risk of heart disease, osteoporosis, urinary issues, and vasomotor symptoms like hot flashes and night sweats. Hormone replacement therapy can help relieve symptoms but also carries risks like breast cancer if used long term. Lifestyle changes and alternative treatments provide relief for some women in menopause.
Newer concepts of managing PCOD With Myo-InositolLifecare Centre
Myo-inositol is an effective treatment for polycystic ovary syndrome (PCOS) that works by improving insulin sensitivity and reducing androgen levels. Clinical studies show that myo-inositol reduces testosterone and fasting insulin levels, improves menstrual regularity and ovulation rates, and can help induce pregnancy in women with PCOS. Myo-inositol is a safe and well-tolerated treatment for PCOS that provides metabolic, reproductive, and dermatological benefits without major side effects.
Thin Endometrium & Infertility(Part – I) , Dr. Sharda Jain , Life Care Centre Lifecare Centre
The document summarizes key aspects of the endometrium and its role in fertility. It discusses how the endometrium undergoes cycles of regeneration each month in preparation for implantation. A thin endometrium can impair implantation and cause infertility. Various factors like clomiphene citrate use, reduced blood flow, polycystic ovarian syndrome, and endometritis may contribute to a thin endometrium. Evaluating the endometrium through ultrasound and hysteroscopy is important for infertility workup and treatment. Managing a thin endometrium remains a challenge in treating infertility.
This document discusses osteoporosis and menopause. It defines osteoporosis as a skeletal disorder characterized by compromised bone strength, which increases the risk of fractures. Key risk factors for osteoporosis include being postmenopausal, having a family history, lack of exercise, low calcium intake, vitamin D deficiency, smoking, and certain medical conditions or medications. The document reviews guidelines for testing and treating osteoporosis, including using bone mineral density (BMD) tests and the FRAX score to determine treatment. Lifestyle changes like exercise, calcium/vitamin D intake, and avoiding smoking are recommended to improve bone health. The document also discusses medications used to treat osteoporosis such as
This document discusses menopause and the options for hormone replacement therapy (HRT). It covers the physiology of menopause, effects of declining estrogen levels, and risks like hot flashes, bone loss, and cardiovascular disease. It presents both benefits and risks of HRT, as well as non-hormonal options and lifestyle interventions like diet, exercise and supplements that can help manage menopause symptoms and health risks. The key decision is choosing treatments that improve quality of life based on each woman's individual symptoms, risk factors and medical history.
This document discusses menopause and management options. It begins by defining menopause as the permanent cessation of menstruation resulting from loss of ovarian activity, typically between ages 45-55. It then outlines some of the main consequences of menopause like vasomotor symptoms, sexual dysfunction, osteoporosis, and cardiovascular risks. The document discusses treatment options like lifestyle changes, hormone replacement therapy, and alternative therapies. It provides details on hormone replacement regimens and duration of treatment for various symptoms and conditions.
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.
Recent 2018 ESHRE & ASRM evidence based guidelines for PCOS assementAtef Darwish
This document discusses recommendations for assessing polycystic ovary syndrome (PCOS). It covers diagnostic criteria including irregular menstrual cycles, hyperandrogenism, polycystic ovarian morphology on ultrasound, and anti-Müllerian hormone levels. It also discusses assessing cardiovascular, metabolic, and reproductive health risks associated with PCOS, including insulin resistance, impaired glucose tolerance, diabetes, and obesity. Ethnic variations in PCOS presentation and long-term health risks are also addressed.
Menopause is defined as the permanent cessation of menstruation and fertility due to loss of ovarian activity, typically occurring between ages 45-55. It involves 3 phases: peri-menopause, menopausal transition, and post-menopausal. Physiological changes include increased risk of heart disease, osteoporosis, urinary issues, and vasomotor symptoms like hot flashes and night sweats. Hormone replacement therapy can help relieve symptoms but also carries risks like breast cancer if used long term. Lifestyle changes and alternative treatments provide relief for some women in menopause.
Newer concepts of managing PCOD With Myo-InositolLifecare Centre
Myo-inositol is an effective treatment for polycystic ovary syndrome (PCOS) that works by improving insulin sensitivity and reducing androgen levels. Clinical studies show that myo-inositol reduces testosterone and fasting insulin levels, improves menstrual regularity and ovulation rates, and can help induce pregnancy in women with PCOS. Myo-inositol is a safe and well-tolerated treatment for PCOS that provides metabolic, reproductive, and dermatological benefits without major side effects.
Thin Endometrium & Infertility(Part – I) , Dr. Sharda Jain , Life Care Centre Lifecare Centre
The document summarizes key aspects of the endometrium and its role in fertility. It discusses how the endometrium undergoes cycles of regeneration each month in preparation for implantation. A thin endometrium can impair implantation and cause infertility. Various factors like clomiphene citrate use, reduced blood flow, polycystic ovarian syndrome, and endometritis may contribute to a thin endometrium. Evaluating the endometrium through ultrasound and hysteroscopy is important for infertility workup and treatment. Managing a thin endometrium remains a challenge in treating infertility.
This document discusses osteoporosis and menopause. It defines osteoporosis as a skeletal disorder characterized by compromised bone strength, which increases the risk of fractures. Key risk factors for osteoporosis include being postmenopausal, having a family history, lack of exercise, low calcium intake, vitamin D deficiency, smoking, and certain medical conditions or medications. The document reviews guidelines for testing and treating osteoporosis, including using bone mineral density (BMD) tests and the FRAX score to determine treatment. Lifestyle changes like exercise, calcium/vitamin D intake, and avoiding smoking are recommended to improve bone health. The document also discusses medications used to treat osteoporosis such as
This document provides information about menopause. It begins by defining menopause as the permanent cessation of menstruation and ovarian activity, typically occurring between ages 45-55. It then discusses various aspects of menopause like symptoms, causes, diagnosis, and management. Key points include that menopause marks the end of a woman's reproductive years; common symptoms are hot flashes, night sweats, and mood swings; and treatment options include lifestyle changes, supplements, medications, and hormone replacement therapy. The document also covers related topics like abnormal menopause, psychological impacts, and the role of midwives in menopause care.
The document provides information about the qualifications and achievements of Dr. Laxmi Shrikhande. It lists her positions including Chairperson Elect of ICOG, National Corresponding Editor of a journal, founder and president of various organizations. It also lists some of the awards she has received for her work in women's health and related fields. The document then provides her name and credentials as Medical Director of Shrikhande Fertility Clinic in Nagpur, Maharashtra.
The document discusses how menopause affects women's lives and relationships. It notes that divorce rates are higher when women are in their 40s-60s, which some attribute to lower oxytocin levels during menopause that change a woman's thinking from "we" to "me." It also discusses how menopause symptoms like hot flashes and mood swings can negatively impact work productivity. Finally, it provides testimonials from women who found relief from menopause symptoms like hot flashes and night sweats using the natural supplement Err 731.
This document discusses the management of poor or hyper ovarian response in IVF treatment. It covers topics such as predicting ovarian reserve, definitions of poor response, protocols for poor and hyper responders, and techniques like coasting to help prevent ovarian hyperstimulation syndrome. Coasting, where gonadotropin administration is stopped but down regulation continued, is an effective way to prevent OHSS while still allowing for embryo retrieval and transfer. GnRH antagonist protocols may also help lower the risk of OHSS compared to long agonist protocols. There is no single best protocol, and treatments should be individualized based on patient factors and expectations.
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
This document discusses ovarian reserve, which refers to a woman's reproductive potential and is a function of the number and quality of her remaining oocytes. It declines with age due to a reduction in both quantity and quality of oocytes. Several tests can assess ovarian reserve, including antral follicle count (AFC), anti-Müllerian hormone (AMH) levels, and follicle-stimulating hormone (FSH) levels. AFC and AMH are currently considered the best tests as they have less variability than FSH. These tests can help predict response to fertility treatments and live birth outcomes. While they provide useful information, age is still the strongest predictor of ovarian reserve and reproductive potential.
Empty follicle syndrome (EFS) is a condition where no oocytes can be retrieved despite adequate ovarian stimulation and follicle development. It can be classified as genuine EFS, where optimal triggering fails to release oocytes, or false EFS, where a suboptimal trigger is responsible. Risk factors include diminished ovarian reserve, advanced age, and previous EFS cycles. The etiology involves dysfunctional signaling between the oocyte and follicular cells that prevents oocyte maturation and rupture of follicles. Management may include a rescue trigger in false EFS or altering the trigger in subsequent cycles. EFS has a significant psychological impact and its treatment remains largely empirical due to limited data.
This document discusses adolescent polycystic ovary syndrome (PCOS). It defines adolescent PCOS and notes its prevalence ranges from 1.8-15% depending on diagnostic criteria, ethnicity, and increasing prevalence of childhood obesity. The presentation, diagnosis, evaluation, and treatment of adolescent PCOS are discussed in detail. Key treatment approaches include lifestyle modifications focused on weight loss through diet and exercise, hormonal contraceptives to manage menstrual irregularities and hirsutism/acne, and metformin to treat insulin resistance and restore ovulation.
This document discusses menopause and hormonal replacement therapy. It begins by defining menopause and describing the stages and symptoms. It then discusses the diagnosis of menopause and various treatment options for managing symptoms, including lifestyle changes, supplements, medications, and hormone replacement therapy. HRT can help relieve symptoms but also carries some health risks, so the document outlines the appropriate usage and monitoring of HRT.
This document discusses the management of postmenopausal osteoporosis. It defines osteoporosis as a disease characterized by low bone density and deterioration of bone tissue, causing increased fragility and risk of fractures from low-impact falls. Several treatments for osteoporosis are discussed, including hormone therapy, SERMs like raloxifene, bisphosphonates like alendronate, and PTH analogs like teriparatide. These treatments have been shown to increase bone mineral density at the lumbar spine and hip and reduce the risk of fractures to varying degrees. Lifestyle modifications including adequate calcium and vitamin D intake, exercise, smoking cessation, and fall prevention are also recommended to help manage oste
This document discusses polycystic ovary syndrome (PCOS), including its definition, diagnostic criteria, pathophysiology, clinical features, evaluation, and management. PCOS is the most common endocrine disorder in women of reproductive age, affecting 5-10% of women. It is characterized by ovarian dysfunction, hyperandrogenism, and polycystic ovaries. Treatment focuses on managing symptoms and preventing long-term complications through lifestyle modifications, medications, and fertility treatments.
Key points in prescription writing in menopause, Dr. Sharda Jain, Dr. Jyoti A...Lifecare Centre
1. Menopause is caused by the depletion of ovarian follicles leading to a decline in estrogen levels, and can also result from surgical removal of the ovaries and uterus.
2. Estrogen plays an important role in many bodily functions beyond reproduction, including brain and psychological health, temperature regulation, bone and heart health, and more.
3. Hormone replacement therapy is often used to treat discomforting menopause symptoms, but its use requires consideration of risks like increased chances of blood clots, stroke, and certain cancers. Alternative treatments include progesterone, gabapentin, SSRIs, and herbal remedies.
This document provides guidelines for the diagnosis and management of premature ovarian insufficiency (POI). It defines POI as depletion of follicular activity before age 40, characterized by menstrual disturbances, raised gonadotropins, and low estrogen. The prevalence is approximately 1% in the general population. Causes include genetic factors, autoimmune disorders, infections, chemotherapy and radiation. Management focuses on hormone replacement therapy (HRT) to reduce long-term health risks, fertility options, and treatment of symptoms like reduced bone mineral density and increased cardiovascular risk.
IUI remains an effective treatment option for certain fertility issues like unexplained infertility, mild male factor infertility, and infertility due to cervical factors. Stimulated IUI cycles have higher success rates than natural cycles. Optimal timing of IUI is 36-40 hours after hCG administration. IUI can be considered for poor responders to IVF as an alternative to cancellation. Success rates of IUI decline significantly after age 40. IUI may not be as effective as IVF for cases involving distal unilateral tubal blockage or hydrosalpinx. Strict protocols should be followed when performing IUI for HIV discordant couples.
This document discusses polycystic ovarian syndrome (PCOS) and its impact on fertility. It notes that PCOS is the most common cause of infertility in women. The document covers the etiology, signs and symptoms, diagnostic criteria and tests, and treatment options for PCOS. It emphasizes that PCOS is associated with insulin resistance and an increased risk of conditions like diabetes and heart disease. Lifestyle changes including diet and exercise are recommended as first-line treatment, especially for overweight patients. Medications like metformin can also help address insulin resistance and related issues.
Serum anti-Mullerian hormone (AMH) levels were measured in 14080 human samples over 6 months using an ELISA method. AMH levels declined with increasing age and varied individually. AMH strongly correlates with antral follicle count and predicts ovarian response to fertility treatments. AMH assessment is valuable for evaluating ovarian reserve, infertility, polycystic ovary syndrome, and menopausal status. While age impacts ovarian reserve, AMH is a better marker as levels decline earlier than other indicators.
Hormone replacement therapy (HRT) involves prescribing estrogen, often along with progesterone, to treat symptoms of menopause. It helps relieve hot flashes and vaginal dryness, prevents osteoporosis, and maintains quality of life. HRT is generally safe for most women, especially when taken for short durations at low doses, but does increase risks of blood clots, breast cancer, stroke and heart disease for some. Proper screening and monitoring is important for safe administration of HRT.
Hormone replacement therapy (HRT) can help relieve menopausal symptoms, prevent osteoporosis, and maintain quality of life during menopause. It is recommended for women experiencing premature menopause or those who had surgical menopause. HRT improves hot flashes, urogenital atrophy, and bone mineral density while reducing risks of fractures, colorectal cancer, and possibly heart disease. However, HRT may increase risks of blood clots, breast cancer, gallbladder disease, and dementia. The benefits and risks depend on dosage and treatment duration, so the lowest effective dose is recommended for short periods of time.
This document provides information about menopause. It begins by defining menopause as the permanent cessation of menstruation and ovarian activity, typically occurring between ages 45-55. It then discusses various aspects of menopause like symptoms, causes, diagnosis, and management. Key points include that menopause marks the end of a woman's reproductive years; common symptoms are hot flashes, night sweats, and mood swings; and treatment options include lifestyle changes, supplements, medications, and hormone replacement therapy. The document also covers related topics like abnormal menopause, psychological impacts, and the role of midwives in menopause care.
The document provides information about the qualifications and achievements of Dr. Laxmi Shrikhande. It lists her positions including Chairperson Elect of ICOG, National Corresponding Editor of a journal, founder and president of various organizations. It also lists some of the awards she has received for her work in women's health and related fields. The document then provides her name and credentials as Medical Director of Shrikhande Fertility Clinic in Nagpur, Maharashtra.
The document discusses how menopause affects women's lives and relationships. It notes that divorce rates are higher when women are in their 40s-60s, which some attribute to lower oxytocin levels during menopause that change a woman's thinking from "we" to "me." It also discusses how menopause symptoms like hot flashes and mood swings can negatively impact work productivity. Finally, it provides testimonials from women who found relief from menopause symptoms like hot flashes and night sweats using the natural supplement Err 731.
This document discusses the management of poor or hyper ovarian response in IVF treatment. It covers topics such as predicting ovarian reserve, definitions of poor response, protocols for poor and hyper responders, and techniques like coasting to help prevent ovarian hyperstimulation syndrome. Coasting, where gonadotropin administration is stopped but down regulation continued, is an effective way to prevent OHSS while still allowing for embryo retrieval and transfer. GnRH antagonist protocols may also help lower the risk of OHSS compared to long agonist protocols. There is no single best protocol, and treatments should be individualized based on patient factors and expectations.
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
This document discusses ovarian reserve, which refers to a woman's reproductive potential and is a function of the number and quality of her remaining oocytes. It declines with age due to a reduction in both quantity and quality of oocytes. Several tests can assess ovarian reserve, including antral follicle count (AFC), anti-Müllerian hormone (AMH) levels, and follicle-stimulating hormone (FSH) levels. AFC and AMH are currently considered the best tests as they have less variability than FSH. These tests can help predict response to fertility treatments and live birth outcomes. While they provide useful information, age is still the strongest predictor of ovarian reserve and reproductive potential.
Empty follicle syndrome (EFS) is a condition where no oocytes can be retrieved despite adequate ovarian stimulation and follicle development. It can be classified as genuine EFS, where optimal triggering fails to release oocytes, or false EFS, where a suboptimal trigger is responsible. Risk factors include diminished ovarian reserve, advanced age, and previous EFS cycles. The etiology involves dysfunctional signaling between the oocyte and follicular cells that prevents oocyte maturation and rupture of follicles. Management may include a rescue trigger in false EFS or altering the trigger in subsequent cycles. EFS has a significant psychological impact and its treatment remains largely empirical due to limited data.
This document discusses adolescent polycystic ovary syndrome (PCOS). It defines adolescent PCOS and notes its prevalence ranges from 1.8-15% depending on diagnostic criteria, ethnicity, and increasing prevalence of childhood obesity. The presentation, diagnosis, evaluation, and treatment of adolescent PCOS are discussed in detail. Key treatment approaches include lifestyle modifications focused on weight loss through diet and exercise, hormonal contraceptives to manage menstrual irregularities and hirsutism/acne, and metformin to treat insulin resistance and restore ovulation.
This document discusses menopause and hormonal replacement therapy. It begins by defining menopause and describing the stages and symptoms. It then discusses the diagnosis of menopause and various treatment options for managing symptoms, including lifestyle changes, supplements, medications, and hormone replacement therapy. HRT can help relieve symptoms but also carries some health risks, so the document outlines the appropriate usage and monitoring of HRT.
This document discusses the management of postmenopausal osteoporosis. It defines osteoporosis as a disease characterized by low bone density and deterioration of bone tissue, causing increased fragility and risk of fractures from low-impact falls. Several treatments for osteoporosis are discussed, including hormone therapy, SERMs like raloxifene, bisphosphonates like alendronate, and PTH analogs like teriparatide. These treatments have been shown to increase bone mineral density at the lumbar spine and hip and reduce the risk of fractures to varying degrees. Lifestyle modifications including adequate calcium and vitamin D intake, exercise, smoking cessation, and fall prevention are also recommended to help manage oste
This document discusses polycystic ovary syndrome (PCOS), including its definition, diagnostic criteria, pathophysiology, clinical features, evaluation, and management. PCOS is the most common endocrine disorder in women of reproductive age, affecting 5-10% of women. It is characterized by ovarian dysfunction, hyperandrogenism, and polycystic ovaries. Treatment focuses on managing symptoms and preventing long-term complications through lifestyle modifications, medications, and fertility treatments.
Key points in prescription writing in menopause, Dr. Sharda Jain, Dr. Jyoti A...Lifecare Centre
1. Menopause is caused by the depletion of ovarian follicles leading to a decline in estrogen levels, and can also result from surgical removal of the ovaries and uterus.
2. Estrogen plays an important role in many bodily functions beyond reproduction, including brain and psychological health, temperature regulation, bone and heart health, and more.
3. Hormone replacement therapy is often used to treat discomforting menopause symptoms, but its use requires consideration of risks like increased chances of blood clots, stroke, and certain cancers. Alternative treatments include progesterone, gabapentin, SSRIs, and herbal remedies.
This document provides guidelines for the diagnosis and management of premature ovarian insufficiency (POI). It defines POI as depletion of follicular activity before age 40, characterized by menstrual disturbances, raised gonadotropins, and low estrogen. The prevalence is approximately 1% in the general population. Causes include genetic factors, autoimmune disorders, infections, chemotherapy and radiation. Management focuses on hormone replacement therapy (HRT) to reduce long-term health risks, fertility options, and treatment of symptoms like reduced bone mineral density and increased cardiovascular risk.
IUI remains an effective treatment option for certain fertility issues like unexplained infertility, mild male factor infertility, and infertility due to cervical factors. Stimulated IUI cycles have higher success rates than natural cycles. Optimal timing of IUI is 36-40 hours after hCG administration. IUI can be considered for poor responders to IVF as an alternative to cancellation. Success rates of IUI decline significantly after age 40. IUI may not be as effective as IVF for cases involving distal unilateral tubal blockage or hydrosalpinx. Strict protocols should be followed when performing IUI for HIV discordant couples.
This document discusses polycystic ovarian syndrome (PCOS) and its impact on fertility. It notes that PCOS is the most common cause of infertility in women. The document covers the etiology, signs and symptoms, diagnostic criteria and tests, and treatment options for PCOS. It emphasizes that PCOS is associated with insulin resistance and an increased risk of conditions like diabetes and heart disease. Lifestyle changes including diet and exercise are recommended as first-line treatment, especially for overweight patients. Medications like metformin can also help address insulin resistance and related issues.
Serum anti-Mullerian hormone (AMH) levels were measured in 14080 human samples over 6 months using an ELISA method. AMH levels declined with increasing age and varied individually. AMH strongly correlates with antral follicle count and predicts ovarian response to fertility treatments. AMH assessment is valuable for evaluating ovarian reserve, infertility, polycystic ovary syndrome, and menopausal status. While age impacts ovarian reserve, AMH is a better marker as levels decline earlier than other indicators.
Hormone replacement therapy (HRT) involves prescribing estrogen, often along with progesterone, to treat symptoms of menopause. It helps relieve hot flashes and vaginal dryness, prevents osteoporosis, and maintains quality of life. HRT is generally safe for most women, especially when taken for short durations at low doses, but does increase risks of blood clots, breast cancer, stroke and heart disease for some. Proper screening and monitoring is important for safe administration of HRT.
Hormone replacement therapy (HRT) can help relieve menopausal symptoms, prevent osteoporosis, and maintain quality of life during menopause. It is recommended for women experiencing premature menopause or those who had surgical menopause. HRT improves hot flashes, urogenital atrophy, and bone mineral density while reducing risks of fractures, colorectal cancer, and possibly heart disease. However, HRT may increase risks of blood clots, breast cancer, gallbladder disease, and dementia. The benefits and risks depend on dosage and treatment duration, so the lowest effective dose is recommended for short periods of time.
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.
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.
Tamoxifen is used for prophylaxis of breast cancer in high-risk women. It works by competing with estrogen for binding to estrogen receptors in breast tissue, thereby blocking the normal stimulatory effects of estrogen on breast growth. Some breast tumors may regress with tamoxifen treatment due to this antagonism of estrogen receptors in breast cells. The drug is administered orally where it undergoes extensive metabolism by the CYP450 system.
This document discusses various estrogens and estrogen-modulating drugs. It begins by describing natural estrogens like estrone, estradiol, and estriol. It then discusses synthetic estrogens and how estrogens are regulated in the body. The document outlines estrogens' mechanisms of action, pharmacokinetics, therapeutic uses including hormone replacement therapy, and potential adverse drug reactions. Specific drugs discussed include clomiphene citrate, tamoxifen, raloxifene, and aromatase inhibitors.
The document discusses the hypothalamic-pituitary-gonadal axis and its role in regulating the female reproductive cycle and secretion of sex hormones including estrogens and progesterone. It provides details on the types of estrogens and progestins, their mechanisms of action, therapeutic uses in hormone replacement therapy, contraception, and management of menopausal symptoms. Adverse effects and drug interactions are also summarized.
Hormone Replacement Therapy(HRT) is indicated in menopausal women to overcome the short-term and long- term consequences of estrogen deficiency.HRT can be administered orally( in pill form),vaginally( as a cream),or transdermally ( in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. It can be used before, during and after menopause
Hormone replacement therapy (HRT) provides relief from post-menopausal symptoms and long-term health benefits by replacing hormones lost during menopause. It is commonly used to treat hot flashes, night sweats, and risks of osteoporosis and heart disease. Estrogen is the primary hormone replaced through various oral pills, patches, implants, or creams. Progestin is often added for women with a uterus to prevent potential health risks. HRT regimens aim to mimic the body's natural hormone levels and cycles. While generally effective and beneficial, HRT also carries some health risks if used long-term such as potential increased risks of blood clots, breast cancer, or endometrial
This document provides an overview of pharmacotherapy for menopause. It discusses the pathophysiology of menopause and outlines natural, medical, and hormonal treatment options. The main hormonal treatments discussed are estrogen therapy, progesterone, tibolone, bisphosphonates, and treatments for hot flashes. It provides details on specific drugs, their indications, advantages, and disadvantages. It also briefly discusses andropause (male menopause) and testosterone replacement therapy options.
This document provides an overview of pharmacotherapy for menopause. It discusses the pathophysiology and diagnosis of menopause, as well as natural treatment options and medical treatments like hormone replacement therapy. Hormonal treatments include various forms of estrogen and progesterone administration to treat symptoms. Non-hormonal options for hot flashes and osteoporosis are also reviewed. Guidelines for hormone replacement therapy emphasize using the lowest effective dose for shortest duration to manage menopausal symptoms. The document concludes with a brief section on andropause or "male menopause" and testosterone replacement therapy options.
This document discusses female sex hormones and the female reproductive system. It covers the internal and external sex organs, the menstrual cycle, and the main female sex hormones - estrogens and progestins. It describes the regulation and mechanisms of action of estrogens, as well as their therapeutic uses in menopausal hormone therapy, delayed puberty, and more. Adverse effects and pharmacokinetics are also discussed. Selective estrogen receptor modulators (SERMs) and aromatase inhibitors are introduced as well.
The document summarizes dysfunctional uterine bleeding (DUB), abnormal bleeding caused by hormonal abnormalities without pregnancy, tumor, or coagulopathy. DUB is often associated with anovulation and a nonsecretory endometrium. It may result from disorders of the central nervous system, pituitary, ovaries, or effects of steroids. Signs include amenorrhea, continuous bleeding, and anemia. Treatment depends on age, fertility desires, and involves hormonal therapy, NSAIDs, endometrial ablation, or hysterectomy for severe cases.
This document discusses menstrual syndrome and hormonal replacement treatment. It begins by defining menopause and the phases of menopause, including pre-menopause, peri-menopause, menopausal phase, and post-menopausal phase. It then describes the physiological changes during menopause, including effects on the bones, cardiovascular system, endocrine system, genitals, breasts, and sexual characteristics. The document outlines diagnostic evaluation and management of menopause, including patient education, medication for anxiety and sleep, and hormonal replacement therapy for both short-term and long-term treatment. It concludes by listing contraindications related to hormonal replacement therapy.
CLINICAL USE OF HORMONES IN BITCHES.pptxRameshjoshi66
This document provides information on the clinical uses of hormones in bitches, including estrus induction, persistent estrus, irregular estrus, silent heat, anestrus, estrus suppression, mismating, hormonal infertility, cystic endometrial hyperplasia, pyometra, vaginal prolapse, and mammary neoplasia. Various hormone protocols and treatments are described for each condition. The potential adverse effects of hormonal therapies are also reviewed, including those of estrogens, progestogens, androgens, prostaglandins, and bromocriptine.
This document provides information about estrogens including their biosynthesis, mechanisms of action, pharmacological actions, therapeutic uses, and adverse effects. It discusses natural and synthetic estrogens as well as selective estrogen receptor modulators. Key points include that estradiol is mainly produced in the ovaries and adrenals and acts by binding to nuclear estrogen receptors. Estrogens have various effects in the female reproductive system as well as secondary sex characteristics, bone, brain, liver, and cardiovascular system. Therapeutic uses include hormone replacement therapy and contraception, while adverse effects include an increased risk of certain cancers.
This document discusses oral hormonal contraceptives, including combined oral contraceptive pills and progestogen-only pills. Combined pills contain estrogen and progestogen and work primarily by suppressing ovulation. They are highly effective at preventing pregnancy but must be taken correctly every day. Progestogen-only pills contain only progestogen and work mainly by thickening cervical mucus; they are less effective than combined pills. Both have benefits but also require strict use and have potential side effects. The document seeks to address common myths about contraceptive pills.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
2. Contents
Menopause – endocrinology, symptoms
Hormone replacement therapy (HRT) – indications, benefits,
risks, contraindications
Preparations for HRT
Duration of HRT
Progress in HRT
3. What is Menopause?
Definition - Menopause means permanent cessation of menstruation at the end of reproductive life
due to loss of ovarian follicular activity. It is the point of time when last and final menstruation occurs.
Age – between 45-55 years.
The clinical diagnosis is confirmed following stoppage of menstruation (amenorrhea) for 12
consecutive months without any other pathology.
4. Endocrinology of Menopause
Depletion of Ovarian follicles and its resistance to FSH, LH.
Impaired folliculogenesis
Decreased Estradiol
production
Decreased negative feedback
effect on HPA axis
Increased FSH levels
Decreased Inhibin
release
6. ORGANS CHANGES
Ovaries Shrink, wrinkled, white
Fallopian tubes Thinned, no cilia
Uterus Smaller, thin and atrophied endometrium
Vagina Narrow, loss of elasticity, alkaline pH
Vulva Atrophied, flat labia, scanty pubic hair
Breasts Fat reabsorbed, flat, pedunculous, small nipples
Bladder and urethra Prone to damage and infection, dysuria, stress
incontinence
Pelvic floor muscles Muscle tone lost – uterine descent
7. The important symptoms and the health
concerns of menopause are:
1. Vasomotor symptoms – hot flushes, palpitations, fatigue, weakness, perspiration
2. Urogenital symptoms – atrophic changes, dyspareunia, dysuria, UTI, stress incontinence
3. Osteoporosis and fracture – bone mass loss, microarchitectural deterioration of bone tissue,
back pain, loss of height, kyphosis, fractures of the vertebral body, femoral neck and Colle’s
fracture.
4. Cardiovascular and Cerebrovascular effects – atherosclerotic changes, vasoconstriction,
thrombus formation, IHD, stroke.
5. Psychological changes – anxiety, depression, insomnia, irritability, inability to concentrate,
mood disorders
6. Skin and Hair - “Purse string” wrinkling around the mouth and “crow feet” around the eyes,
thinning, loss of elasticity, wrinkling, loss of pubic and axillary hair, slight balding.
7. Sexual dysfunction – due to depression, anxiety
8. Dementia and cognitive decline – Alzheimer’s disease
8.
9. Diagnosis of Menopause
• Cessation of menstruation for consecutive 12 months during climacteric.
• Appearance of menopausal symptoms ‘hot flush’ and ‘night sweats’.
• Vaginal cytology – showing maturation index of at least 10/85/5 (Features of low
estrogen).
• Serum estradiol : < 20 pg/mL.
• Serum FSH and LH: >40 mlU/mL (three values at weeks interval required).
11. Hormone Replacement Therapy (HRT)
The HRT is indicated in menopausal women to overcome the short-term and long-
term consequences of estrogen deficiency.
Indications of Hormone Replacement Therapy:
i. Relief of menopausal symptoms
ii. Prevention of osteoporosis
iii. To maintain the quality of life in menopausal years.
Special group of women to whom HRT should be prescribed:
i. Premature ovarian failure
ii. Gonadal dysgenesis
iii. Surgical or radiation menopause
12. Benefits of hormone replacement therapy
(HRT)
• Improvement of vasomotor symptoms (70– 80%)
• Improvement urogenital atrophy
• Increase in bone mineral density (2–5%)
• Decreased risk in vertebral and hip fractures (25–50%)
• Reduction in colorectal cancer (20%)
• possibly cardioprotection
13. HRT and Osteoporosis:
• HRT prevents bone loss and stimulate new bone formation. HRT
increases BMD by 2–5% and reduces the risk of vertebral and hip
fracture (25–50%).
• Estrogen is found to play a direct role, as receptors have been found in
the osteoblasts.
• Women receiving HRT should supplement their diet with an extra 500
mg of calcium daily. Total daily requirement of calcium in
postmenopausal women is 1.5 g.
14. HRT and Cardiovascular system:
HRT is thought to be cardiovascular protective.
LDL on oxidation produces vascular endothelial injury and foam cell
(macrophage) formation. These endothelial changes ultimately lead to
intimal smooth muscle proliferation and atherosclerosis. Estrogen
prevents oxidation of LDL, as it has got antioxidant properties.
15. Risk factors for osteoporosis in a woman:
• Family history
• Age—elderly
• Race—asian, White race
• Lack of estrogen
• Body weight—low bMI
• Early menopause—surgical, radiation
• Dietary—↓ calcium and ↓ Vitamin D, ↑ caffeine, ↑ smoking
• Sedentary lifestyle
• Drugs—Heparin, corticosteroids, GnRH analogue
• Diseases—Thyroid disorders, hyperparathyroidism malabsorption, multiple
myeloma.
16. Risk factors for cardiovascular disease in
postmenopause:
• Hypertension
• Smoking habit
• Familial hyperlipidemia
• Impaired glucose tolerance
17. Risks of hormone replacement therapy:
a. Endometrial cancer: When estrogen is given alone to a woman with intact uterus, it
causes endometrial proliferation, hyperplasia and carcinoma. It is advised that a
progestogen should be added to ERT to prevent such risks.
b. Breast cancer: Combined estrogen and progestin replacement therapy, increases the
risk of breast cancer slightly, depending upon the dose and duration of therapy.
c. Venous thromboembolic (VTE) disease has been found to be increased with the use
of combined oral estrogen and progestin. Transdermal estrogen use does not have the
same risk compared to oral estrogen.
d. Coronary heart disease (CHD): Combined HRT therapy shows a relative hazard of
CHD.
e. Lipid metabolism: An increased incidence of gallbladder disease has been observed
following ERT due to rise in cholesterol (in bile).
f. Dementia, Alzheimer disease are increased.
18. Contraindications to HRT:
• Undiagnosed genital tract bleeding
• Estrogen dependent neoplasm in the body
• History of venous thromboembolism
• Active liver disease
• Gallbladder disease
19. Available preparations for hormone
replacement therapy:
Estrogens used are: Conjugated estrogen (0.625–1.25 mg/day) or
Micronized estradiol (1–2 mg/day).
Progestins used are: Medroxyprogesterone acetate (2.5–5 mg/ day),
Micronized progesterone (100–300 mg/day) or Dydrogesterone (5–10
mg/day).
Considering the risks, hormone therapy should be used with the lowest
effective dose and for a short period of time.
20. Low dose oral conjugated estrogen 0.3 mg daily is effective and has got
minimal side effects.
Dose interval:
Oral estrogen regime:
• Estrogen—conjugated estrogen 0.3 mg or 0.625 mg is given daily for woman who
had hysterectomy.
• Estrogen and cyclic progestin: For a woman with intact uterus estrogen is given
continuously for 25 days and progestin is added for last 12–14 days.
Daily (initial 2-3
months)
Every other
day (next 2-3
months)
Every 3rd day
(nesxt 2-3
months)
21. Continuous estrogen and progestin therapy:
To prevent endometrial hyperplasia. There may be irregular bleeding with this regimen.
1. Subdermal implants: inserted subcutaneously over the anterior abdominal wall. 17 β
estradiol implants 25 mg, 50 mg or 100 mg are available and can be kept for 6 months. This
method is suitable in patients after hysterectomy.
2. Percutaneous estrogen gel: 1 g applicator of gel, delivering 1 mg of estradiol daily, is to
be applied onto the skin over the anterior abdominal wall or thighs. Effective blood level of
oestradiol (90–120 pg/mL) can be maintained.
3. Transdermal patch: It contains 3.2 mg of 17 β estradiol, releasing about 50 µg of estradiol
in 24 hours. Physiological level of E2 to E1 is maintained. It should be applied below the
waist line and changed twice a week.
4. Vaginal cream: Conjugated equine vaginal estrogen cream 1.25 mg daily is very
effective specially when associated with atrophic vaginitis; reduces urinary frequency,
urgency and recurrent infection. Women with symptoms of urogenital atrophy and urinary
symptoms and who do not like to have systemic HRT, are suitable for such treatment.
5. Progestins: In patients with history of breast carcinoma, or endometrial carcinoma,
progestins may be used. It may be effective in suppressing hot flushes and it prevents
osteoporosis. Medroxyprogesterone acetate 2.5–5 mg/day can be used.
22. • Levonorgestrel intrauterine delivery system (LNG-IUS) with daily
release of 10 microgram of levonorgestrel per 24 hours, it protects
the endometrium from hyperplasia and cancer. At the same time it
has got no systemic progestin side effects.
• Estrogen can be given by any route.
• Tibolone: Tibolone is a steroid (19-nortestosterone derivative)
having weakly estrogenic, progestogenic and androgenic properties.
It prevents osteoporosis, atrophic changes of vagina and hot flushes.
It increases libido. A dose of 2.5 mg per day is given.
23. Monitoring Prior to and During HRT:
• physical examination including pelvic examination.
• blood pressure recording.
• breast examination and Mammography
• cervical cytology
• pelvic ultrasonography (TVs) to measure endometrial thickness (normal <
5 mm)
Any irregular bleeding should be investigated thoroughly (endometrial
biopsy, hysteroscopy).
Ideal serum level of estradiol should be 100 pg/ml during HRT therapy.
Serum level of estradiol is useful to monitor the HRT therapy rather than that
of serum FSH.
24. • Duration of HRT use: Generally, use of HRT for a short period of
3–5 years have been advised. Reduction of dosage should be
done as soon as possible.
• Menopausal women should maintain optimum nutrition, ideal
body weight and perform regular exercise.
25. Progress in hormone replacement therapy:
• Low Dose HRT—Women with intact uterus with 0.3 mg Conjugated equine estrogen
(CEE) and Medroxy Progesterone acetate (MPA) 1.5 mg is found effective to control
the vasomotor symptoms. Similarly 1 mg of estradiol and norethisterone acetate 0.5 mg
orally, are also effective and have significant bone sparing effect. Progestogen is added in
the HRT to minimize the adverse effects of estrogen.
• Dose interval may be modified (as explained earlier) before stopping the therapy.
• To minimize the systemic adverse effects of progestogen, LNG-IUS is being used.
• Estrogen component is delivered by oral or by transdermal route or as an implant. A
small size LNG-IUS has been developed that releases 10 µg LNG per day. This
reduced size LNG-IUS is suitable for the postmenopausal women as the size of the
uterus is also small.