The document provides guidelines for the management of menopause. It defines menopause and outlines the stages of menopause including perimenopause. It discusses various symptoms of menopause like vasomotor symptoms, genitourinary syndrome of menopause, and mood symptoms. It also covers the effects and complications of menopause including increased risk of cardiovascular disease, osteoporosis, and cognitive decline. The guidelines recommend menopausal hormonal therapy for treatment of symptoms in most women, and discuss various treatment options including different routes of administration and combinations of estrogen and progesterone. Risks and benefits of therapy are weighed based on factors like age and time since menopause.
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 Mirena, a levonorgestrel-releasing intrauterine system, as an alternative to hysterectomy for treating heavy menstrual bleeding. It provides evidence that Mirena is as effective as endometrial ablation and more effective than oral medications in reducing bleeding. Mirena has additional benefits of reversible contraception and poses fewer risks than hysterectomy. The document outlines counseling points for addressing common patient concerns with Mirena like initial irregular bleeding or amenorrhea. It promotes Mirena as a cost-effective first-line treatment that can prevent unnecessary hysterectomies in many cases.
This document discusses menopause and hormonal changes in menopausal women. It defines menopause as the permanent cessation of menstruation from loss of ovarian activity, determined after 12 months of amenorrhea. The document outlines the stages of menopause including perimenopause and climacteric, and discusses premature ovarian failure. It also discusses estrogen replacement therapy and management of menopausal symptoms like vasomotor symptoms, urogenital atrophy, and osteoporosis. The document lists contraindications to hormone replacement therapy and discusses alternative therapies.
medical management of infertility,think before surgery!!!!ShitalSavaliya1
Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
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.
Prof. Narendra Malhotra has had an extensive career in obstetrics and gynecology. He is the president of multiple organizations, has published and presented numerous papers, and has authored and edited several books. He specializes in high risk obstetrics, ultrasound, laparoscopy, infertility treatment and genetics. He currently practices in Agra, India and is the managing director of Global Rainbow Health Care.
This document discusses types of anovulation and treatments for infertility related to anovulation. It describes the main types of anovulation as hypogonadotropic hypoestrogenic, normogonadotrophic normoestrogenic (PCOS), and hypergonadotrophic hypoestrogenic. Investigations for determining the type include progesterone, FSH, LH, prolactin and thyroid tests. Treatments include lifestyle changes, oral contraceptives, metformin, gonadotropins, clomiphene citrate, and IVF depending on the type and severity of the case. The document also outlines types of ovarian stimulation and drugs commonly used for ovarian stimulation.
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 Mirena, a levonorgestrel-releasing intrauterine system, as an alternative to hysterectomy for treating heavy menstrual bleeding. It provides evidence that Mirena is as effective as endometrial ablation and more effective than oral medications in reducing bleeding. Mirena has additional benefits of reversible contraception and poses fewer risks than hysterectomy. The document outlines counseling points for addressing common patient concerns with Mirena like initial irregular bleeding or amenorrhea. It promotes Mirena as a cost-effective first-line treatment that can prevent unnecessary hysterectomies in many cases.
This document discusses menopause and hormonal changes in menopausal women. It defines menopause as the permanent cessation of menstruation from loss of ovarian activity, determined after 12 months of amenorrhea. The document outlines the stages of menopause including perimenopause and climacteric, and discusses premature ovarian failure. It also discusses estrogen replacement therapy and management of menopausal symptoms like vasomotor symptoms, urogenital atrophy, and osteoporosis. The document lists contraindications to hormone replacement therapy and discusses alternative therapies.
medical management of infertility,think before surgery!!!!ShitalSavaliya1
Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
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.
Prof. Narendra Malhotra has had an extensive career in obstetrics and gynecology. He is the president of multiple organizations, has published and presented numerous papers, and has authored and edited several books. He specializes in high risk obstetrics, ultrasound, laparoscopy, infertility treatment and genetics. He currently practices in Agra, India and is the managing director of Global Rainbow Health Care.
This document discusses types of anovulation and treatments for infertility related to anovulation. It describes the main types of anovulation as hypogonadotropic hypoestrogenic, normogonadotrophic normoestrogenic (PCOS), and hypergonadotrophic hypoestrogenic. Investigations for determining the type include progesterone, FSH, LH, prolactin and thyroid tests. Treatments include lifestyle changes, oral contraceptives, metformin, gonadotropins, clomiphene citrate, and IVF depending on the type and severity of the case. The document also outlines types of ovarian stimulation and drugs commonly used for ovarian stimulation.
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
This document discusses thyroid disorders in pregnancy. It notes that hypothyroidism affects 0.05% of pregnant women while hyperthyroidism, mainly Graves' disease, affects 0.05-0.2%. Postpartum thyroiditis occurs in 5-10% of women. The thyroid gland normally enlarges in pregnancy due to increased vascularity. HCG and estrogen levels rise, decreasing TSH and free T4 levels. Treatment aims to maintain euthyroidism. Hyperthyroidism is treated mainly with antithyroid drugs like PTU or carbimazole. Hypothyroidism is treated with levothyroxine. Postpartum thyroiditis can cause transient hyperthyroidism or hyp
The document discusses the post coital test (PCT), which examines cervical mucus after intercourse for the presence of sperm. While the value of the PCT is debated, it provides information on estrogen stimulation, adequacy of insemination, and how sperm interact with cervical secretions. The document reviews procedures for administering the PCT and interpreting results, noting disagreement around methods and criteria. Some studies found higher pregnancy rates with positive versus negative PCT results, suggesting a positive PCT may increase chances of spontaneous pregnancy.
This document discusses Mayer Rokitansky Kuster Hauser Syndrome (MRKH), a rare disorder characterized by the congenital absence of the uterus and vagina. It describes the signs and symptoms, including primary amenorrhea. Surgical techniques for creating a neovagina are discussed, including the McIndoe technique using a skin graft. Options for women with MRKH like surrogacy and adoption are mentioned. The document emphasizes that while women with MRKH cannot carry their own biological children, they should realize others experience pain and appreciate what they have.
The document discusses long-acting reversible contraceptives (LARCs) available in Malaysia, including intrauterine devices (IUDs) and implants. It notes that LARC usage in Malaysia is low compared to contraceptive pills. The main types of LARCs are described - copper IUDs, hormonal IUDs, and implants. Benefits include high effectiveness, reversibility, and not requiring daily adherence. Side effects like irregular bleeding are also discussed. Religious views on spotting are provided.
The document discusses menopause and hormone replacement therapy. It defines menopause and describes the hormonal changes that occur during the menopausal transition as ovarian follicles are depleted and estrogen levels decline. This leads to symptoms like hot flashes, mood changes, and effects on the brain, skin and bones. Diagnosis of menopause is confirmed after 12 months of amenorrhea when FSH and estradiol levels indicate ovarian failure. Management of menopausal symptoms includes lifestyle changes, medications like estrogen therapy, and alternative therapies.
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 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 defines abnormal uterine bleeding as any deviation from normal menstruation in terms of frequency, duration, or amount of bleeding. It describes different clinical types and potential causes, including endometrial conditions, tumors, infections, and systemic diseases. Evaluation involves history, examination, and investigations like endometrial biopsy. Treatment options include medical therapies like hormonal treatments, surgical procedures like endometrial ablation, and hysterectomy.
This document discusses the role of progesterone in pregnancy and preventing preterm birth. It begins by outlining the problem of preterm birth globally, noting that 15 million babies are born preterm each year. It then discusses various trials investigating the use of progesterone supplementation to prevent preterm birth, including the large NICHD/MFMU trial which found that weekly injections of 17α-hydroxyprogesterone caproate reduced preterm birth rates. The document also notes vaginal progesterone trials have shown benefits but results are more mixed in high-order multiples and women with a short cervix may benefit most.
Endometriosis – Changing Perspective - Case based approach Lifecare Centre
Endometriosis – Changing Perspective - Case based approach
MODERATOR : Dr Sharda Jain
Dr Meenakshi Sharma
PANELIST : Dr. Rupam Arora
Dr. Dipti Nabh
Dr. Renu Chawla
Dr. Vandana Gupta
Dr. Jyoti Agarwal
Dr. Poonam Goyal
On 31st Oct 2018
HORMONAL CONTRACEPTION & NEWER CONTRACEPTIVES BY DR SHASHWAT JANIDR SHASHWAT JANI
This document provides information on hormonal contraceptives. It discusses the world population growth and India's population statistics. It then focuses on oral contraceptives, describing the different types including combined, progestin-only, and extended/continuous use pills. The document outlines the mechanisms of action, administration, effectiveness, advantages, side effects, drug interactions, and follow-up for oral contraceptive use.
The document discusses intrauterine contraceptive devices (IUDs). It notes that two copper IUDs and one levonorgestrel-releasing IUD are currently available. IUDs are highly effective forms of reversible birth control, with failure rates of 1.26 and 0.09 per 100 women-years respectively for copper and levonorgestrel IUDs. Common side effects include irregular bleeding and cramping, which usually decrease over time. Risks include perforation, infection and expulsion.
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIDR SHASHWAT JANI
Dr. Shashwat Jani provides a summary of the optimal management of women who experience reduced fetal movements (RFM). The document discusses evaluating these women to exclude fetal death or compromise and identify pregnancies at risk. It recommends confirming fetal heart tone with Doppler, performing a cardiotocography if over 28 weeks, and considering ultrasound to check amniotic fluid and fetal growth if concerns remain. For persistent RFM, monitoring with biophysical profiles and ultrasounds twice weekly is suggested before 37 weeks, and labor induction after 37 weeks if the cervix is favorable.
This document discusses menopause, including its definition, phases, causes, physiological changes, and treatments. Menopause is defined as the permanent cessation of menstruation due to loss of ovarian activity, usually occurring between ages 45-55. It involves four phases: pre-menopause, peri-menopause, menopausal phase, and post-menopausal phase. Physiological changes include increased risk of heart disease and osteoporosis due to lowered estrogen levels, as well as hot flashes, night sweats, and vaginal dryness. Treatments include non-hormonal options like diet, exercise, and supplements, as well as hormone replacement therapy using estrogen and/or progesterone to
Thyroid Disorders in Obs & Gynae - Case based approach onHyperthyroidism & T...Lifecare Centre
Thyroid Disorders in Obs & Gynae - Case based approach onHyperthyroidism & Thyroid Cancer--- Part 2
Moderator - Dr Meenakshi Sharma
& Dr Puja Dewan
Panelist
Dr Dipti Nabh
Dr Richa Singhal
Dr Manju Sharma
Dr Deepa Gupta
Dr Renu Chawla
Dr Anita Agarwal
PREGNANCY IN UTERINE PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of uterine prolapse during pregnancy. It notes that uterine prolapse is more common in India due to high parity and lack of trained birth attendants. During pregnancy, a pessary can be used to support a prolapsed uterus. If the cervix remains outside the vagina, tightening surgery or bed rest may be used. During labor, manual techniques help with dilation and delivery. After birth, rest and antibiotics can help recovery. The management requires an individualized approach based on each woman's symptoms and condition.
This document describes the Fothergill's Operation procedure for uterine prolapse. The key steps are:
1. Amputating the elongated cervix while preserving menstrual function.
2. Approximating the cardinal ligaments in front of the cervical stump using a Fothergill stitch to support the uterus.
3. Repairing any enterocele or cystocele.
The operation is indicated for 2nd or 3rd degree prolapse with vaginal wall defects. Complications can include hemorrhage, cervical stenosis, recurrence of prolapse, and bladder or fistula injuries. A modification by Shirodkar involves cutting and crossing the uterosacral ligaments in
Menopause is defined as the final menstrual period and results from loss of ovarian function. It occurs on average between ages 50-51 and can be influenced by various factors like smoking or surgery. Symptoms include hot flashes, sleep changes, mood changes and vaginal dryness. Hormone levels fluctuate during the menopausal transition and estrogen levels dramatically decline after menopause. Diagnosis is made after 12 months of no periods and confirmed by elevated FSH levels. Treatment options aim to relieve symptoms and prevent bone loss and include hormone therapy and non-hormonal therapies like SSRIs. HRT carries some health risks but may help vasomotor symptoms and prevent osteoporosis when used at lowest effective
This document discusses menopause and related topics. It defines menopause as the permanent cessation of menstruation resulting from loss of ovarian activity. Natural menopause is recognized after 12 months of amenorrhea without other causes. Women in the UK typically experience menopause between ages 45-55. The document also discusses premenopause, perimenopause, postmenopause, premature ovarian insufficiency, symptoms, diagnosis, and management including hormone replacement therapy.
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
This document discusses thyroid disorders in pregnancy. It notes that hypothyroidism affects 0.05% of pregnant women while hyperthyroidism, mainly Graves' disease, affects 0.05-0.2%. Postpartum thyroiditis occurs in 5-10% of women. The thyroid gland normally enlarges in pregnancy due to increased vascularity. HCG and estrogen levels rise, decreasing TSH and free T4 levels. Treatment aims to maintain euthyroidism. Hyperthyroidism is treated mainly with antithyroid drugs like PTU or carbimazole. Hypothyroidism is treated with levothyroxine. Postpartum thyroiditis can cause transient hyperthyroidism or hyp
The document discusses the post coital test (PCT), which examines cervical mucus after intercourse for the presence of sperm. While the value of the PCT is debated, it provides information on estrogen stimulation, adequacy of insemination, and how sperm interact with cervical secretions. The document reviews procedures for administering the PCT and interpreting results, noting disagreement around methods and criteria. Some studies found higher pregnancy rates with positive versus negative PCT results, suggesting a positive PCT may increase chances of spontaneous pregnancy.
This document discusses Mayer Rokitansky Kuster Hauser Syndrome (MRKH), a rare disorder characterized by the congenital absence of the uterus and vagina. It describes the signs and symptoms, including primary amenorrhea. Surgical techniques for creating a neovagina are discussed, including the McIndoe technique using a skin graft. Options for women with MRKH like surrogacy and adoption are mentioned. The document emphasizes that while women with MRKH cannot carry their own biological children, they should realize others experience pain and appreciate what they have.
The document discusses long-acting reversible contraceptives (LARCs) available in Malaysia, including intrauterine devices (IUDs) and implants. It notes that LARC usage in Malaysia is low compared to contraceptive pills. The main types of LARCs are described - copper IUDs, hormonal IUDs, and implants. Benefits include high effectiveness, reversibility, and not requiring daily adherence. Side effects like irregular bleeding are also discussed. Religious views on spotting are provided.
The document discusses menopause and hormone replacement therapy. It defines menopause and describes the hormonal changes that occur during the menopausal transition as ovarian follicles are depleted and estrogen levels decline. This leads to symptoms like hot flashes, mood changes, and effects on the brain, skin and bones. Diagnosis of menopause is confirmed after 12 months of amenorrhea when FSH and estradiol levels indicate ovarian failure. Management of menopausal symptoms includes lifestyle changes, medications like estrogen therapy, and alternative therapies.
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 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 defines abnormal uterine bleeding as any deviation from normal menstruation in terms of frequency, duration, or amount of bleeding. It describes different clinical types and potential causes, including endometrial conditions, tumors, infections, and systemic diseases. Evaluation involves history, examination, and investigations like endometrial biopsy. Treatment options include medical therapies like hormonal treatments, surgical procedures like endometrial ablation, and hysterectomy.
This document discusses the role of progesterone in pregnancy and preventing preterm birth. It begins by outlining the problem of preterm birth globally, noting that 15 million babies are born preterm each year. It then discusses various trials investigating the use of progesterone supplementation to prevent preterm birth, including the large NICHD/MFMU trial which found that weekly injections of 17α-hydroxyprogesterone caproate reduced preterm birth rates. The document also notes vaginal progesterone trials have shown benefits but results are more mixed in high-order multiples and women with a short cervix may benefit most.
Endometriosis – Changing Perspective - Case based approach Lifecare Centre
Endometriosis – Changing Perspective - Case based approach
MODERATOR : Dr Sharda Jain
Dr Meenakshi Sharma
PANELIST : Dr. Rupam Arora
Dr. Dipti Nabh
Dr. Renu Chawla
Dr. Vandana Gupta
Dr. Jyoti Agarwal
Dr. Poonam Goyal
On 31st Oct 2018
HORMONAL CONTRACEPTION & NEWER CONTRACEPTIVES BY DR SHASHWAT JANIDR SHASHWAT JANI
This document provides information on hormonal contraceptives. It discusses the world population growth and India's population statistics. It then focuses on oral contraceptives, describing the different types including combined, progestin-only, and extended/continuous use pills. The document outlines the mechanisms of action, administration, effectiveness, advantages, side effects, drug interactions, and follow-up for oral contraceptive use.
The document discusses intrauterine contraceptive devices (IUDs). It notes that two copper IUDs and one levonorgestrel-releasing IUD are currently available. IUDs are highly effective forms of reversible birth control, with failure rates of 1.26 and 0.09 per 100 women-years respectively for copper and levonorgestrel IUDs. Common side effects include irregular bleeding and cramping, which usually decrease over time. Risks include perforation, infection and expulsion.
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIDR SHASHWAT JANI
Dr. Shashwat Jani provides a summary of the optimal management of women who experience reduced fetal movements (RFM). The document discusses evaluating these women to exclude fetal death or compromise and identify pregnancies at risk. It recommends confirming fetal heart tone with Doppler, performing a cardiotocography if over 28 weeks, and considering ultrasound to check amniotic fluid and fetal growth if concerns remain. For persistent RFM, monitoring with biophysical profiles and ultrasounds twice weekly is suggested before 37 weeks, and labor induction after 37 weeks if the cervix is favorable.
This document discusses menopause, including its definition, phases, causes, physiological changes, and treatments. Menopause is defined as the permanent cessation of menstruation due to loss of ovarian activity, usually occurring between ages 45-55. It involves four phases: pre-menopause, peri-menopause, menopausal phase, and post-menopausal phase. Physiological changes include increased risk of heart disease and osteoporosis due to lowered estrogen levels, as well as hot flashes, night sweats, and vaginal dryness. Treatments include non-hormonal options like diet, exercise, and supplements, as well as hormone replacement therapy using estrogen and/or progesterone to
Thyroid Disorders in Obs & Gynae - Case based approach onHyperthyroidism & T...Lifecare Centre
Thyroid Disorders in Obs & Gynae - Case based approach onHyperthyroidism & Thyroid Cancer--- Part 2
Moderator - Dr Meenakshi Sharma
& Dr Puja Dewan
Panelist
Dr Dipti Nabh
Dr Richa Singhal
Dr Manju Sharma
Dr Deepa Gupta
Dr Renu Chawla
Dr Anita Agarwal
PREGNANCY IN UTERINE PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of uterine prolapse during pregnancy. It notes that uterine prolapse is more common in India due to high parity and lack of trained birth attendants. During pregnancy, a pessary can be used to support a prolapsed uterus. If the cervix remains outside the vagina, tightening surgery or bed rest may be used. During labor, manual techniques help with dilation and delivery. After birth, rest and antibiotics can help recovery. The management requires an individualized approach based on each woman's symptoms and condition.
This document describes the Fothergill's Operation procedure for uterine prolapse. The key steps are:
1. Amputating the elongated cervix while preserving menstrual function.
2. Approximating the cardinal ligaments in front of the cervical stump using a Fothergill stitch to support the uterus.
3. Repairing any enterocele or cystocele.
The operation is indicated for 2nd or 3rd degree prolapse with vaginal wall defects. Complications can include hemorrhage, cervical stenosis, recurrence of prolapse, and bladder or fistula injuries. A modification by Shirodkar involves cutting and crossing the uterosacral ligaments in
Menopause is defined as the final menstrual period and results from loss of ovarian function. It occurs on average between ages 50-51 and can be influenced by various factors like smoking or surgery. Symptoms include hot flashes, sleep changes, mood changes and vaginal dryness. Hormone levels fluctuate during the menopausal transition and estrogen levels dramatically decline after menopause. Diagnosis is made after 12 months of no periods and confirmed by elevated FSH levels. Treatment options aim to relieve symptoms and prevent bone loss and include hormone therapy and non-hormonal therapies like SSRIs. HRT carries some health risks but may help vasomotor symptoms and prevent osteoporosis when used at lowest effective
This document discusses menopause and related topics. It defines menopause as the permanent cessation of menstruation resulting from loss of ovarian activity. Natural menopause is recognized after 12 months of amenorrhea without other causes. Women in the UK typically experience menopause between ages 45-55. The document also discusses premenopause, perimenopause, postmenopause, premature ovarian insufficiency, symptoms, diagnosis, and management including hormone replacement therapy.
Based on the information provided:
- The woman is 40 years old, which is below the typical age of menopause (around 50 years).
- She has not had any periods for 1 year.
To diagnose menopause in this woman:
1. I would do a beta human chorionic gonadotropin (hCG) test to rule out pregnancy.
2. I would check a follicle stimulating hormone (FSH) level. An FSH level over 35 mIU/ml would support the diagnosis of menopause.
3. I would do an ultrasound of the pelvis to examine the ovaries and rule out other potential causes of amenorrhea like polycystic
This document discusses male and female climacteric changes. It describes andropause or male menopause as age-related changes in men over 50 that involve a drop in testosterone levels and similar symptoms to hypogonadism. Common symptoms include low energy, depression, erectile dysfunction and reduced muscle mass. Diagnosis is based on history, exam and testosterone blood levels. Lifestyle changes and testosterone therapy are management options. Menopause in women occurs between 45-55 and involves stopping periods due to declining estrogen levels. Symptoms last 4 years and are managed with hormone replacement therapy, lifestyle changes or mindfulness.
This document provides information about menopause including:
- Defining menopause as the permanent cessation of menstruation due to ovarian failure typically occurring between ages 40-55.
- Detailing the stages of menopause including the transitional perimenopause stage and changes in hormone levels.
- Identifying common signs and symptoms like hot flashes, changes to the reproductive system, increased risk for certain diseases.
- Outlining treatments and management strategies for menopause including hormone therapy, lifestyle changes, exercise, and health education about nutrition and preventing osteoporosis and heart disease.
The document summarizes the peri-menopausal period and peri-menopausal syndrome. It describes peri-menopause as the transitional phase before and after menopause, encompassing the 2-8 years leading up to the final period and the first years after. Common symptoms during this time include hot flashes, night sweats, mood changes, sleep disturbances, and vaginal dryness due to declining estrogen levels. Treatment options discussed include hormone replacement therapy using estrogen and progestogen to relieve symptoms, as well as traditional Chinese medicine therapies.
This document discusses hormonal replacement therapy (HRT). It begins by defining HRT as any medical treatment that replaces hormones the body can no longer produce on its own due to age or organ damage/failure. The main types of HRT are then listed, including various sex hormones. Effects of HRT for transgender individuals and testosterone replacement therapy are also outlined. The document concludes by discussing menopause, including its phases, causes, and physiological changes like hormonal and ovarian changes.
This document discusses menopause and hormone replacement therapy (HRT). It defines different types of menopause and explains the role of estrogen and progesterone in the body. Symptoms of estrogen and progesterone deficiency are outlined. The document discusses the indications, benefits, and risks of HRT for osteoporosis and cardiovascular health. Contraindications to HRT include a history of certain cancers, liver disease, or blood clots. Proper counseling, screening, and the shortest effective treatment duration are recommended for HRT.
The document discusses menopause, defining it as the permanent cessation of menstruation due to loss of ovarian activity, typically occurring between ages 45-55. It describes changes in hormone levels surrounding menopause, including decreases in estrogens, increases in FSH and LH, and organ system effects like increased risk of osteoporosis and cardiovascular disease due to estrogen deficiency. Symptoms of menopause include hot flashes, night sweats, and urogenital atrophy. Diagnosis involves cessation of periods for 12 months and low estrogen levels. Management focuses on lifestyle changes, calcium/vitamin D supplementation, and sometimes hormone replacement therapy.
This document discusses menopause and postmenopause. It defines menopause as the permanent cessation of menstruation due to loss of ovarian activity, usually occurring between ages 45-50. The document describes the hormonal changes, symptoms, risks, diagnosis, and treatment options associated with menopause including hormone replacement therapy and lifestyle modifications.
This document provides an overview of controversies surrounding hormonal replacement therapy (HRT) and menopausal hormone therapy (MHT). It discusses the history of HRT, how the paradigm has shifted from viewing it as a preventative treatment to one focused on symptom relief. Key topics covered include the indications, contraindications and effects of HRT on breast cancer, endometrial cancer, osteoporosis and fractures. Routes of administration and precautions for prescribing HRT are also summarized.
Menopause typically occurs between ages 50-52 as ovaries stop producing eggs and estrogen levels decline. Symptoms include hot flashes, night sweats, and vaginal dryness. Management includes lifestyle changes and various hormonal and non-hormonal treatments to relieve symptoms and prevent long-term issues like osteoporosis and heart disease. Hormone replacement therapy (HRT) effectively treats short-term menopausal issues but carries risks if used long-term like an increased risk of breast cancer. Careful screening and use of the lowest effective dose for the shortest time is recommended for HRT.
Menopause is defined as the permanent cessation of menstruation due to loss of ovarian activity, occurring typically between ages 45-55. It marks the end of a woman's reproductive life and is a natural part of aging. Common symptoms include hot flashes, night sweats, sleep problems, mood changes, and vaginal dryness due to declining estrogen levels. Hormone replacement therapy can help treat short-term symptoms but carries some health risks with long-term use. Lifestyle changes and supplements are generally recommended first before considering hormone therapy.
Menopause is the time in a woman's life when her period stops. It usually occurs naturally, most often after age 45. Menopause happens because the woman's ovaries stop producing the hormones estrogen and progesterone. A woman has reached menopause when she has not had a period for one year.
menopause.pptxfor bscnursing students pdf.MANJUPAUL7
This document discusses menopause and provides definitions and details related to the cessation of menstruation and ovarian function. It defines natural menopause as occurring after 12 consecutive months of amenorrhea for women around 47 years old on average. Premature menopause is defined as occurring before age 40. The document also discusses the hormonal changes, symptoms, risks, diagnosis, and treatment options associated with menopause such as hormone replacement therapy.
This document discusses menopause and physical therapy approaches for related disorders. It begins by defining menopause and related terms. It then describes the endocrinological changes associated with menopause and how this impacts various body systems. Common clinical features of menopause are outlined including vasomotor symptoms, neurological/psychological symptoms, and increased risk of osteoporosis and cardiovascular disease due to estrogen deficiency. The document concludes by describing various physical therapy approaches that can be used to treat postural problems, osteoporosis, pelvic floor dysfunction, and other menopause-related conditions. Modalities discussed include resistance training, aerobic exercise, pulsed electromagnetic field therapy, and low-level laser therapy
This document discusses the management of menopause. It begins with a case study of a 51-year-old woman experiencing less frequent periods, hot flashes, and vaginal dryness. It then covers how to diagnose menopause, differential diagnoses, common menopause problems like hot flashes and sleep issues, and treatment approaches. Non-hormonal treatments discussed include lifestyle changes, but evidence for supplements is inconsistent. Hormonal therapy is recommended for relieving menopausal symptoms in most women, though risks must be considered.
Here are the key considerations for this patient:
- She is postmenopausal based on her age
- With an intact uterus, estrogen-only hormone therapy would put her at increased risk for endometrial cancer
- As she is asymptomatic, hormone therapy may not be needed
- Screening for osteoporosis, cardiovascular risk, and breast cancer should be discussed based on risk factors
- Lifestyle modifications like calcium/vitamin D, exercise, not smoking can help prevent diseases of menopause
- Close monitoring without hormone therapy is a reasonable option given her age and lack of bothersome symptoms
The priorities would be assessing risk factors, discussing screening recommendations, and supporting lifestyle changes to promote health during men
This document discusses menopause and hormone replacement therapy (HRT). It defines menopause and the stages surrounding it, including peri-menopause and post-menopause. It describes the pathophysiology of menopause and associated symptoms in the acute, medium-term, and long-term periods. These include hot flashes, vaginal dryness, urinary problems, and increased risk of osteoporosis and cardiovascular disease. The document outlines recommendations for diagnosing menopause and managing related symptoms through lifestyle changes, counseling, and HRT or alternatives when symptoms are severe. HRT is noted as the most effective treatment for estrogen deficiency symptoms.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
2. MENOPAUSE
• Definition: permanent cessation of menstruation resulting from loss of
ovarian follicular activity.
• It marks the end of women fertility.
• A retrospective diagnosis: when no menses for 12 months after the last
menstruation period (LMP) once physiological and pathological causes has
been ruled out
• Menopause subject women to various health problem and morbidity as
estrogen carry protective effect on women organ eg heart, brain, bone, skin
etc.
• Average malaysian women life expectancy in 2021 was 78.3 years old
• Average age of menopause 50.7 years
• 1/3rd or more of women life will be spent in the post menopause, a state of
estrogen deficiency.
3. TERMINOLOGY OF MENOPAUSE
TERMINOLOGY
Perimenopause period immediately before menopause when endocrinological, biological
and clinical features of menopause begin till 1year after LMP.
Natural menopause permanent cessation of menses resulting loss of follicular activity for 12
months after LMP once pathological or physiological causes has been rule out
Menopause
transition
start when there is variability menstrual cycle and last till the LMP
Premenopause refer to 1 or 2 years before menopause. This terminology not encourage.
5. PERIMENOPAUSE
• fluctuation estrogen level-->
perimenopause symptom
• Diagnosis: based on clinical sign and
symptom.
• measurement of FSH and estradiol
not necessary at this stage
• ovulation is unpredictable in
perimenopause--> contraception
needed until 1 year after LMP
6. ABNORMAL UTERINE BLEED (AUB)
IN PERIMENOPAUSE
• Abnormal uterine bleeding in perimenopause -->investigated uring FIGO classification system
PALM-COEIN
(polyps, adenomyosis, leiomyoma, malignancy, coagulation disorder, ovulatory disorder,
endometrial causes, iatrogenic causes and not otherwise classified)
• sexually active women with AUB--> VE, pap smear and transvaginal ultrasound TRO cervix,
uterus and ovaries pathology
• Also need to exclude pregnancy
• If VE cannot be done--> pelvic ultrasound on full bladder is sufficient
• Blood ix: FBC, TFT, COAG if necessary
• Other invasive IX eg EUA, endometrial biopsy or hysteroscopy based on above finding
• Treatment AUB: NSAID (eg Ponstan) and antifibrinolytic (eg Tanexamic acid), COCP or
menopause hormonal therapy(estrogen) + levonorgestrel intrauterine system (LNG-IUS) for
endometrial protection
7. PREMATURE OVARIAN INSUFFICIENCY (POI)
• Premature ovarian insufficiency (POI) is
the cessation of ovarian function below
age 40 years old
• Clinical presentation commonly primary
amenorrhea and 10% with secondary
amenorrhea.
• Primary amenorrhea--> no menopausal
symptom
• Secondary amenorrhea--> more severe
menopausal symtom
• women with POI is at higher risk of long
term consequences of estrogen deficiency
--> osteoporosis, premature coronary
artery disease, CVD and dementia.
8. PREMATURE OVARIAN INSUFFICIENCY
• Due to long term complication of POI, hormonal treatment with estrogen and
progestogen (in absence of contraindication required)
• Women with POI would require higher dose of estrogen than dose available in MHT
• Women with POI still have 5-15% chance of pregnancy due to intermittent ovarian
activity.
combine oral contraceptive pill (COCP)
*recommended
Menopausal Hormonal Therapy (MHT)
*alternative
act as hormonal therapy + additional
contraceptive effect
act as hormonal therapy + no additional
contraceptive effect
higher estrogen dose lower estrogen dose
not require additional contraception require additional contraceptive method eg
barrier method
given until natural age of menopause (50years
old) and change to MHT if hormonal therapy still
required
given until natural age of menopause (50years
old) and continued if hormonal therapy still
required
9. SYMPTOMS OF MENOPAUSE
Vasomotor symptoms
(VMS)
• Hot flushes(>50% women) -sudden waves of heat over upper body and
face lasting for 1-2 mins followed by sweating.
• Women with hot flushes has 2 fold risk of CVD in next 14 years.
• Night sweat - leads to poor sleep
• women with hot flushes +night sweat had 2 fold increase risk hip
fracture in the following years
Genitourinary
syndrome of
menopause symptom
(GSM)
• replaces term Vulvovaginal atrophy or atrophic vaginitis
• symptom: vaginal dryness, painful sex, sexual dysfunction, bladder and
urethral symptoms, frequent UTI, vaginal itchiness, burning and
irritation
Mood symptoms • Can range from irritability, palpitations, poor sleep, crying spells,
anxiety and feelings of low mood.
• The intensity of these symptoms may lessen well into post menopause.
Other symptoms • fatigue, lethargy, joint pain, etc.
10. EFFECT AND COMPLICATION OF MENOPAUSE
Cardiovascular
disease
• risk of cardiovascular disease due to increase age, loss of estrogen, changes of
fat distribution, decrease physical activity and increase in BP, lipid and
glucose level
• incidence of CVD 2-3 times more in post menopause compared to
premenopause
• reduction of modifiable risk factor such as DM, HTN, abdominal obesity,
smoking, psychosocial stress is the most effective strategy
Stroke • more stroke event occur in women due to longer life expectancy
• risk of stroke doubles in women after 10years of menopause
• estradiol shown to have protective effect in premenopausal women
• Other risk factor: DM,HTN,dyslpidemia, obesity, smoking
Venous
thromboembolism
(VTE)
• incidence of VTE is 1 in 1000 among post menopausal women with fatality
rate 10%
• women with early menopause have lesser risk of VTE compared to women
menopause late (each delay year of menopause increase risk of VTE by 7%)
• combination late menopause with high parity (>2child) confers 3fold risk of
VTE
11. EFFECT AND COMPLICATION OF MENOPAUSE
Osteoporosis • women loss 50% their trabecular bone and 30% cortical bone during the
course of their lifetime, about half of which is lost during first 10 years of
menopause
• Estimated 7-10% decline in spine bone mineral density (BMD) and 5-7% in the
hip BMD after 5 years menopause then increase risk of fracture by 50-100%
Sarcopenia • age-related involuntary loss of skeletal muscle mass and strength
• up to 50% muscle mass can be lost by 80 years of age
• causes: age related hormonal changes, low level physical activity, reduce
protein and calorie intake
• with aging, loss of type 2 muscle causes disability and problems with certain
movement such as regain posture after diturbed balance, rising from chair
Metabolic
syndrome
• consist of abdominal obesity, insulin resistance/glucose dysregulation,
dyslipidemia and hypertension
• average weight gain 2.0-2.5kg over 3years after menopause
• increase visceral fat especially around abdomen as early 3-4 years before
menopause
12. EFFECT AND COMPLICATION OF MENOPAUSE
Cognition • estrogen has positive effect on long term cognition
• women who menopause early/ POI has poor long term effect of congintive
function compared to women who menopause late
Skin • 30% skin collagen lost withing first 5 years menopause
• skin changes associated with loss estrogen are:
• Oily skin due to increase sebum production
• sagging skin and wrinkles due to change in fat distribution
• elastrosis due to lesser collagen and elastion
• thinning of epidermis lead to skin dryness and itchiness
• hyperpigmentation due to increase melanin result from hormonal imbalance
Hair • lesser and thinner scalp hair, male pattern baldness along with darker hair over
chin, upper lip and chest
• due to change in androgen:estrogen ratio (high androgen, low estrogen)
Taste • change of taste and neural function
• caused by reduction in saliva production, dysesthesia and atrophic gingivitis
13. EFFECT AND COMPLICATION OF MENOPAUSE
Dentition • increase risk of gum disease
• bone loss at the jaw lead to loosening of teeth and mandibular dysfunction
• mouth dryness due to lesser saliva secretion
• others: gingival atrophy, oral ulcer, oral candidiasis, sensation of painful mouth
and burning mouth syndrome
Vision • dry eyes (common) due to inflammatory process within lacrimal gland
• cataract more prevalent post menopause (estrogen confers an anti-oxidative
protection against cataractogenesis)
Voice • more throat clearing episode and mouth dryness
• hoarseness of voice due to higher androgen level (androgen:estrogen
imbalance)
Hearing • estrogen have positive influence on hearing
• higher decline of hearing occur during menopause
Smells • ageing is accompanied by olfactory loss and hyposmia or anosmia
• women affected strongly than man
14. HISTORY AND PHYSICAL EXAMINATION
*Vaginal examination only carried out in women
who sexually active.
15.
16. INVESTIGATION
• *pap smears are carried out
only in women who are
have been sexually active.
• Blood tests for FSH
(Follicular Stimulating
Hormone) should not be
routinely considered when
diagnosing menopause in
women aged over 45 years.
18. MENOPAUSAL HORMONAL THERAPHY (MHT)
• Replaces old term “ Hormonal Replacement Theraphy (MHT)”
• Effective for GSM, VSM and prevent bone loss and reduces fracture.
• Benefit outweight risk when given to healthy symptoms who are less
than 60 years or within 10 years of onset of menopause.
• MHT should be individualized taking into account:
womans personal health risk and preferences
signs and symptoms and its effect on her quality of life
age and duration of menopause in relation to initiation or continuation of MHT
balance of potential benefit and risk of MHT versus Non hormonal therapies or
other option.
19. INDICATION OF MHT
1. Vasomotor symptom(VMS):
reduces hot flushes and night sweat.
MHT recommended as first line therapy for moderate and severe
VMS
2. Genitourinary syndrome of menopause (GSM):
Low dose vaginal ET (estrogen therapy) recommended over
systemic therapy as first line therapy.
MHT has been shown to effectively restore genitourinary tract
anatomy, increase superficial vaginal cells, reduces vaginal PH and
treat symptoms of Vulvovaginal atrophy (VVA).
20. INDICATION OF MHT
3. Prevention of bone loss:
MHT reduce bone loss and reduces fractures (include hip/vertebra)
in post menopause women.
4. Hypoestrogenism:
caused by hypogonadism, POI, premature surgical menopause.
Hormonal therapy such as low dose COC or MHT recommended at
least until median age of menopause (50years ) and can be
continued after 50years with annual benefit and risk assessment.
Hormonal therapy relieves VMS, prevent bone loss, improve
cognition, mood and improve lipid profile.
21. CONTRAINDICATION OF MHT
• women with past or present history of following:
Hormonal related
cancer such as
breast or
endometrial cancer
Blood clots
particularly in the
lungs, eyes or deep
vein
Heart attack, stroke
or transient
ischemic attac (TIA)
liver disease or liver
problem
Inadequately
controlled arterial
hypertension
Pregnancy
Undiagnosed uterine
or vaginal bleeed
Hypertriglyceridemia Porphyria
22. TYPES OF MHT
Hysterectomised women
• Estrogen therapy only (ET)
Non-hysterectomised women (intact uterus)
• Estrogen and progesterone therapy(EPT)
• Can be given as cyclical therapy or continuos
combined therapy
23. Estrogen and Progesterone Therapy (EPT)
Cyclical Therapy
• Estrogen taken daily while progestrone taken at least for 12-14 days of cycle to provide endometrial
protection.
• women would experience regular monthly bleeds.
• For women in the perimenopause and up to 1 year from LMP.
Continuous combined therapy
• Estrogen and progesterone taken daily without break
• Called “non bleed therapy”
• Initial spotting or staining (breakthrough bleeding) is common up to 6 month.
• For women 1 year or more from LMP.
• Not recommended for perimenopause due to increase risk of irregular bleeding.
• Unscheduled bleeding > 6months should be investigated after rule out missing pills or non compliance.
33. BENEFIT AND RISK OF MHT
• In healthy symptomatic women who are less than 60years old or
within 10 years of menopause and with no contraindication, the
benefit risk rato is favourable towards VMS, GSM and bone health.
• For maximum cardio protective efficacy, a women should initiate
MHT as soon as VMS symptoms occur, preferebly within 10years of
menopause
• For women who initiate MHT after 60years old of age or 10years
after menopause, the benefit risk ratio may associate with greater
absolute risk toward CHD, stroke, VTE and dementia.
• Younger women who undergo surgical menopause are advised ET (in
absence of contraindication), to prevent immediate and long term
problems of menopause especially to bone, brain and heart.
35. DURATION OF MHT
• There is no mandatory limitation to duration of MHT use
• Post menopausal women can continue MHT as long as annual review which
includes a benefit-risk assessment and relevant investigation are carried out.
• When long term MHT (beyond 10 years) is considered, a low dose hormonal
regime is advised.
• Stopping MHT may cause recurrence in VSM (50%), GSM and further bone loss
with increase risk of fracture.
• Continue use of MHT (beyond 10 years) recommended in post-menopausal
women with persistent VSM, to improve GSM, to increase bone density and to
reduce fracture at all sites.
• women with POI or early menopause (natural, induced, surgical), early
initiation of COC or MHT till natural age of menopause (50years old) is
recommended and MHT can be continued after age 50 years if benefit
outweight risk.
36. SIDE EFFECT OF MHT
• Side effect--> usually transient and may resolve spontaneously with
continue used.
• encouraged to continue particular hormone for at least 3months
before swithching or stopping as to allow the initial side effect to
settle
• Side effect likely to occur or be problematic when women further into
their menopause (further away from LMP)
37. • Estrogen is taken daily. Its side
effect likely to occur randomly
or continuously throughout the
cycle.
• Progesterone related side effect
are more problematic and
usually depend on the type,
duration and dose of estrogen
• In cyclic theraphy,progesterone
side effect present during
progestogenic phase of the
cycle
• In continuous combined
theraphy, progesterone side
effect can occur randomly
through the cycle.
38. MANAGEMENT OF MHT SIDE EFFECT
SIDE EFFECT EXPLAINATION AND MANAGEMENT
Breast Pain -due to stimulation of breast gland and discomfort may be settle within 4-6weeks
-Mx: reduce MHT dose and with time, increase to normal dose.
-Alternative: change of progestogen or complete switch to tibolone
Irregular
bleeding
-Cyclical preparation may produces regular and predictable bleeding pattern.
-Non compliance to meds or GI upset (reduce absorption) may alter the pattern.
-Continues combine preparation may cause breakthrough bleeding (BTB) up to 6 months.
- BTB more than 6 months (despite good compliance) should be investigated TRO pelvic
pathology
Abdominal
bloating
-progestrogen inhibit smooth muscle peristalsis resulting in bloating and distension
-symptoms may settle with time.
39. MANAGEMENT OF MHT SIDE EFFECT
SIDE EFFECT EXPLAINATION AND MANAGEMENT
Weight gain -Weight gain in menopause are due to low estrogen level, lifestyle changes and lack of
exercise.
-MHT not associated with weight gain and has been shown to redistribute the fat away
from abdominal area
-MX: appropriate dietary and lifestyle measures.
Leg Cramps not common. Exercise and stretching movement may help reduce the incidence
Nausea and
dyspepsia
-MX: altering the time of intake oral MHT --> taken at night, nausea may not be
experienced.
-or oral MHT taken with food to reduce gastric issue
Alternative: switch oral to transdermal MHT
Headaches -MX : change oral MHT to transdermal MHT in women with persistent headache.
Tansdermal estrogen produces stable estradiol which may cut down frequency of headache
Mood swing
and
Depression
-women with combined theraphy may experience mood changes
-symptoms usually disappear with prolong used.
40. MANAGEMENT OF BREAKTHROUGH BLEEDING
(BTB)
• BTB is common in the first 6
month of continous combine
MHT.
• Noncompliance / GI disturbance
(reduce absorption) also lead to
BTB.
• persistent bleed (6months) or
new onset of bleed need furter
investigation using the FIGO
classification using PALM-COEIN
polyps, adenomyosis, leiomyoma,
malignancy, coagulation disorder,
ovulatory disorder, endometrial
causes, iatrogenic cause and not
otherwise classified
41. CYCLICAL THERAPY WITH ABSENCE SCHEDULED
BLEEDING
• women on cyclical therapy usually may experience regular monthly
bleeding
• 5% of women who compliant on cyclical therapy may not experience
any bleeding due to presence of atrophic endometrium.
• Pregnancy should be ruled out !
42. FOLLOW UP MHT
• TCA 3 month after start
MHT to review side
effect and
effectiveness.
• Upon satisfactory
evaluation, annual
consultation is advised
.
43.
44. STOPPING MHT
• if stopping MHT --> risk of recurrent
VSM (rebound VSM is more severe),
recurrent GSM, risk of fracture.
• Gradual taper down MHT dose over 3-6
months to minimize rebound
symptoms.
• In severe rebound symptoms, continue
low dose MHT for longer time
(preferably 3-6months) prior trying to
stop again.
• succesful stopping MHT --> if women
had none or minimal symptoms after 2-
3 month of hormone cessation
45. MHT IN PERIMENOPAUSE
• fluctuation in estrogen level during perimenopause --> irregular bleeding,
perimenopause symptoms eg hot flushes, night sweat, mood swing,
disturbed sleep pattern, anxiety, depression, myalgia.
• Estrogen is the most effective treatment for perimenopausal symptoms.
• contraception is important in perimenopause as risk of pregnancy 2-3%
between ages 45-50years and 1% after 50years if still not menopause.
• MHT--> only adequate to treat perimenopause symptom, but inadequate as
contraceptive (estrogen and dose in MHT less than in the low dose COCP)
• Low dose COCP (in women without contraindication) can be used until
50years old and change to MHT (if menopause and if hormonal therapy still
required).
• LNG-IUS can be used to control irregular bleeds and as contraception with
added oral/transdermal estrogen to treat perimenopause symptoms
46. EFFECT OF MHT
Vasomotor symptoms -MHT is first line theraphy for VMS
-low dose MHT can be taken 6-8weeks to relieve vasomotor symptoms
-micronised progestrogen when taken at night was effective in treating VSM and improving
sleeps
Mood disorder -MHT not act as antidepressant but augment the effect of SSRI-->improve mood
-oral estrogen improve mood significantly compared to transdermal preparation
Genitourinary syndrome
of menopause (GSM)
-topical vaginal estrogen --> effective to treat GSM +minimal side effect (added
progesterone not required for endometrial protection)
-regular topical vagina estrogen for 2 years not associated with endometrial hypertrophy
-non ablative laser theraphy may be used to treat vulvovaginal symptoms (eg vaginal
dryness, burning, itching, dysparenuia, dysuria) and as short term basis (need to be
repeated at regular interval)
Cardiovascular disease -estrogen improve lipid profile (primarily oral estrogen), improve insulin sensitivity
-estrogen increase serum triglyceride (oral estrogen), increase risk of blood clot
-MHT not recommend for primary and secondary prevention CHD in menopause women
- risk of CVD is higher when starting MHT in women age >60years and >10years from
menopause
-Transdermal estrogen has low risk to CVD, less thrombotic and low risk VTE compared to
oral
47. Stroke -MHT in women <60years old or <10 years of menopause --> minimal risk of stroke
-MHT in women >60years old or > 10 years of menopause --> high risk of stroke
-cardiovascular risk factor: DM/HTN/Dyslipidemia --> increase risk of stroke (oral
therapy)
Venous
thromboembolism
(VTE)
-MHT in women <60years old or <10 years of menopause --> minimal risk of VTE
-Transdermal preparation has lower risk of VTE compared to oral
-obesity increase risk of VTE in MHT
-transdermal estrogen not increase risk of VTE in obese women
Osteoporosis -MHT is first line treatment for osteoporosis prevention for women below 60years
-MHT slows bone turnover, increase bone mineral density (BMD) and decrease
fracture
-in women >60 years old and >10years menopause--> other non hormonal bone-
active therapy require to prevent osteoporosis/fracture.
Sarcopenia -no recommendation use of MHT for prevention or treatment of sarcopenia
Cognition -MHT should not be used solely for cognition or for reduction of alzheimer disease
Skin -collagen loss within 5years of menopause
-estrogen may reverse collagen loss, elastin content, skin moisture and wrinkle
-MHT not advised as first line treatment for aging skin
Hair -MHT not decrease menopause related hair loss or improve hair density
48. Metabolic
disease,
weight & DM
-MHT has beneficial effect on metabolic system but not
recommend as first line to prevent metabolic disease
-in women without DM: increase lean body mass, reduce waist
circumference, reduce abdominal fat, reduction fasting glucose
level, reduction insulin resistance, 30-40% reduction new onset
DM
-in women with DM: reduction insulin resistance, fasting glucose
and fasting insulin
-MHT increase HDL, reduce LDL and mean BP
-oral estrogen increase TG level
Dentition,
vision, voice
changes,
hearing, smell
&taste
-MHT decrease gum disease and tooth loss, improve eyesight,
hearing, smell, taste, decrease hoarseness of voice
-However MHT is not recommend as first line to treat this
problem
49. MHT AND CANCER
Type of cancer Effect of MHT use
Cervical cancer -MHT not increase risk of cervical ca recurrence post hysterectomy
-post hysterectomy cervical ca women--> can use MHT (estrogen therapy) to treat
menopausal symptom
Endometrial cancer -MHT not recommend even after surgery due to fears of stimulating remnant
cancer cells
Lung cancer -MHT not increase risk of lung cancer
-MHT can be use to treat menopause symptom in women completed lung cancer
treatment
Ovarian cancer - risk of ovarian ca with long term MHT use has remained inconclusive
-MHT can be used for treatment of menopause symptom in women completed
ovarian ca treatment
50. MHT IN WOMEN WITH SPECIAL PROBLEM
• endometriosis is an estrogen dependant disease
• MHT should be used with caution -> fear of reactivation endometriotic foci
• women who had surgical menopause due to endometriosis-->estrogen
progesterone treatment is preferred over estrogen therapy only
ENDOMETRIOSIS
• MHT is not contraindicated in fibroids, but volume and size of fibroid may
increase
• Tibolone may be used as alternative to MHT
UTERINE FIBROID
• MHT not contraindicated in women with well controlled BP
HYPERTENSION
51. TIBOLONE (STEAR)
1. Selective estrogenic activity regulator (STEAR) - activates hormonal receptor in a tissue specific manner.
estrogenic effect- relieve vasomotor symptom
progestrogenic effect- prevent endometrial activity and hyperplasia
androgenic effect- increase libido and sexual activity
Decrease bone turnover, increase BMD
2. Tibolone used as follows:
women with intact uterus with no period for 1 year (started early may cause unscheduled bleeding)
transition from continuous combine MHT to tibolone
hysterectomised women if various estrogen preparation not suites them
women with special problem eg endometriosis, fibroid
3. tibolone above women >60years old --> risk of stroke
4. Not recommend in breast ca --> increase risk of recurrence
52. Selective Estrogen Receptor Modulator (SERMs)
• compound that exhibit tissue specific estrogen receptor (ER) agonist or antagonist
• works either stimulate or negate the effect of estrogen
• Usage: treat post menopausal osteoporosis, adjunct therapy by estrogen positive breast
ca due antagonistic action
• Side effect: exacerbate vasomotor symptoms
Tamoxifen -taken in breast cancer survivor to reduce recurrence (estrogen antagonist
activity)
-improve bone mineral density in post menopause women
-may stimulate endometrium (estrogen agonist activity)--> risk of
endometrial hyperplasia
Raloxifen
hydrochloride
- 2nd generation SERMs , alternative to tamoxifen for treatment and
prevention breast ca
-recommended in post menopausal osteoporosis women with higher risk of
breast ca
-cause 55% reduction vertebral fracture
53. NON HORMONAL MANAGEMENT OF MENOPAUSE
(PHARMACOTHERAPHY)
• used as alternative to MHT eg women with breast ca, other medical disorder such as CAD, liver
disease, previous VTE
• Data is limited and inconclusive in treating post menopause symptoms
(a2 adrenergic agonist)
Clonidine
- an antihypertensive and the only licensed non hormonal therapy in UK
-use for vasomotor symptoms
SNRI
(venlafaxine,desvenlafaxine)
-use for vasomotor symptoms
SSRIs
(paroxetine,fluoxetine,citalopram,
escitalopram
-use for vasomotor symptoms
Antiepileptic
(Gabapentin, pregabalin)
-use for vasomotor symptoms
Breakthrough bleeding more than 6 month should be investigated after rule out missing pills or non compliance
17 estradiol is associated with lesser risk of VTE compared to conjugated equine estrogen (CEE) and may be offered to women with higher risk of CHD and VTE.
Non oral routes (eg transdermal) offer potential on the clotting profile as it bypass the liver (first pass hepatic effect) thus no increased risk of stroke or VTE.
Transdermal estrogen preferred over oral estrogen in women who obese, women with hypertriglyceridemia, active gallbladder disease and known thrombophilia such as factor V Leiden
17 estradiol is associated with lesser risk of VTE compared to conjugated equine estrogen (CEE) and may be offered to women with higher risk of CHD and VTE.
low dose vaginal estrogen used for GSM and addition of progesterone not required.
micronized progesterone does not affect blood pressure or cardiovascular system, does not increase risk of VTE and stroke and minimal effect on breast
dydrogesterone does not increase endometrial hyperproliferation, maintain beneficial effect of estradiol and minimum of side effect and risk to breast, stroke and VTE
Intrauterine levonorgestrel system (LNG-IUS) is used as contraceptive and endometrium protection and can be combine with estrogen orally or transdermally.
usually transient
patient fears of side effect or contraindicated in MHT