This document provides guidelines for the diagnosis and management of menopause. It defines key terms like menopause, perimenopause, and postmenopause. It recommends an individualized approach and discusses diagnosis of menopause without routine tests. It provides guidance on information to give to menopausal women, managing short-term symptoms like hot flashes and long-term risks and benefits of hormone replacement therapy (HRT). The guidelines discuss treatment options for various menopausal symptoms and long-term effects of HRT on risks like cardiovascular disease, breast cancer, and osteoporosis.
in this slide physiological, psychological and social aspects of menopause, Hormonal replacement therapy, surgical menopause , guidance and counselling / role of midwifery nurse practitioner in menopause.
in this slide physiological, psychological and social aspects of menopause, Hormonal replacement therapy, surgical menopause , guidance and counselling / role of midwifery nurse practitioner in menopause.
Amenorrhea Presented By Muhammad Abdullah.pptxEmma269971
Amenorrhea is the absence of menstrual periods in women of reproductive age. It can be a sign of underlying health issues and can have significant impacts on a woman's fertility and overall health. In this PPT, you will learn about the definition, types, and causes of amenorrhea, including primary and secondary amenorrhea.
The presentation will cover the financial impact of amenorrhea on women's health, as well as the common symptoms and clinical findings associated with this condition. Additionally, the PPT will explore the differential diagnosis of amenorrhea, which involves ruling out other potential causes of menstrual irregularities, such as pregnancy, thyroid disorders, and polycystic ovary syndrome (PCOS).
The PPT will also delve into the treatment and management of amenorrhea, including lifestyle changes, hormone therapy, and surgical interventions. Furthermore, the presentation will discuss the crucial role of pharmacies in providing support and advice to women with amenorrhea, such as providing access to medications and monitoring treatment efficacy.
Overall, this PPT will provide a comprehensive overview of amenorrhea, from its definition and symptoms to its diagnosis, treatment, and management, highlighting the critical role of healthcare professionals, including pharmacists, in helping women with this condition.
Amenorrhea Presented By Muhammad Abdullah.pptxEmma269971
Amenorrhea is the absence of menstrual periods in women of reproductive age. It can be a sign of underlying health issues and can have significant impacts on a woman's fertility and overall health. In this PPT, you will learn about the definition, types, and causes of amenorrhea, including primary and secondary amenorrhea.
The presentation will cover the financial impact of amenorrhea on women's health, as well as the common symptoms and clinical findings associated with this condition. Additionally, the PPT will explore the differential diagnosis of amenorrhea, which involves ruling out other potential causes of menstrual irregularities, such as pregnancy, thyroid disorders, and polycystic ovary syndrome (PCOS).
The PPT will also delve into the treatment and management of amenorrhea, including lifestyle changes, hormone therapy, and surgical interventions. Furthermore, the presentation will discuss the crucial role of pharmacies in providing support and advice to women with amenorrhea, such as providing access to medications and monitoring treatment efficacy.
Overall, this PPT will provide a comprehensive overview of amenorrhea, from its definition and symptoms to its diagnosis, treatment, and management, highlighting the critical role of healthcare professionals, including pharmacists, in helping women with this condition.
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.
The uterine cycle, also known as the menstrual cycle, is a complex series of events that occurs in the female reproductive system, primarily involving the uterus and ovaries. The cycle is divided into three main phases: the menstrual phase, the proliferative phase, and the secretory phase. The uterine cycle is tightly regulated by hormonal changes, primarily those involving estrogen and progesterone. The uterine cycle is a dynamic and intricately regulated process essential for reproductive health. It plays a central role in the preparation of the uterus for potential pregnancy and is influenced by hormonal fluctuations throughout the menstrual cycle.
Absent or irregular periods??
Menstrual cycle disorders can cause a woman’s periods to be absent or infrequent. Although some women do not mind missing their menstrual period, these changes should always be discussed with a healthcare provider because they can signal underlying medical conditions and potentially have long-term health consequences. A woman who misses more than three menstrual periods (either consecutively or over the course of a year) should see a healthcare provider.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. CONTENTS
I. Terms used in this guideline
II. Guidelines
1. Individualize care
2. Diagnosis of perimenopause and menopause
3. Information and advise
4. Managing short tem menopausal symptoms
5. Long-term benefits and risks of HRT
6. Diagnosing and managing premature ovarian
insufficiency
ABOUBAKR ELNASHAR
3. TERMS USED IN THIS GUIDELINE
Menopause
A biological stage in a woman's life that occurs
when she stops menstruating and reaches the end of
her natural reproductive life.
Defined when a woman has not had a period for 12
consecutive months (for women reaching menopause
naturally).
The changes associated with menopause occur
when the ovaries stop maturing eggs and secreting
oestrogen and progesterone.
ABOUBAKR ELNASHAR
4. Menopausal women
This includes women in perimenopause and
postmenopause.
Perimenopause
The time in which a woman has irregular cycles of
ovulation and menstruation: menopause and
continuing until 12 months after her final period.
The perimenopause is also known as the
menopausal transition or climacteric.
ABOUBAKR ELNASHAR
5. Postmenopause
The time after menopause has occurred
starting when a woman has not had a period for 12
consecutive months.
Premature ovarian insuffificiency
Menopause occurring before the age of 40 years
(also known as premature ovarian failure or
premature menopause).
It can occur naturally or as a result of medical or
surgical treatment
ABOUBAKR ELNASHAR
6. Vasomotor symptoms
such as
hot flushes and
night sweats
{constriction and dilatation of blood vessels in the
skin: sudden increase in blood flow to allow heat loss.
These symptoms can have a major impact on
activities of daily living.
ABOUBAKR ELNASHAR
7. Urogenital atrophy
Thinning and shrinking of the tissues of the vulva,
vagina, urethra and bladder {oestrogen deficiency}.
This results in multiple symptoms:
vaginal dryness
vaginal irritation
frequent need to urinate and
urinary tract infections.
Low mood
Mild depressive symptoms that impair quality of life
usually intermittent
often associated with hormonal fluctuations in
perimenopause
ABOUBAKR ELNASHAR
8. Fragility fracture
Fractures that result from mechanical forces that
would not ordinarily result in fracture
(such as a fall from a standing height or less).
Reduced bone density is a major risk factor
occur most commonly in the spine, hip and wrist.
ABOUBAKR ELNASHAR
9. Compounded bioidentical hormones
Unregulated plant-derived hormonal combinations
similar or identical to human hormones that are
compounded by pharmacies to the specification of
the prescriber.
ABOUBAKR ELNASHAR
11. 2. Diagnosis of perimenopause and menopause
1 Diagnose the following without laboratory tests in
otherwise healthy women aged over 45 years with
menopausal symptoms:
Perimenopause based on
vasomotor symptoms and
irregular periods
Menopause in women who have
not had a period for at least 12 months
not using hormonal contraception
Menopause based on
symptoms in women without a uterus.
ABOUBAKR ELNASHAR
12. 2 Take into account that it can be difficult to diagnose
menopause in women who are taking hormonal
treatments, for example for the treatment of heavy
periods.
3 Do not use the following laboratory and imaging tests
to diagnose perimenopause or menopause in women
aged over 45 years:
AMH
inhibin A
inhibin B
Oestradiol
AFC
ovarian volume.
ABOUBAKR ELNASHAR
13. 4 Do not use FSH test to diagnose menopause in
women using
combined oestrogen and progestogen contraception or
high-dose progestogen.
5 Consider using a FSH test to diagnose menopause
only:
in women aged 40 to 45 years with menopausal
symptoms, including a change in their
menstrual cycle
in women aged under 40 years in whom menopause
is suspected
ABOUBAKR ELNASHAR
14. 3 Information and advice
1 Give information to menopausal women that includes:
an explanation of the stages of menopause
common symptoms and diagnosis
lifestyle changes and interventions that could help
general health and wellbeing
benefits and risks of treatments for menopausal
symptoms
long-term health implications of menopause.
ABOUBAKR ELNASHAR
15. 2 Explain to women that they may experience a variety
of symptoms associated with menopause, including:
vasomotor symptoms: hot flushes and sweats
musculoskeletal symptoms: joint and muscle pain
effects on mood: low mood
urogenital symptoms: vaginal dryness
sexual difficulties: low sexual desire
ABOUBAKR ELNASHAR
16. 3 Give information to menopausal women about the
following types of treatment for menopausal symptoms:
hormonal, for example HRT
non-hormonal, for example clonidine
non-pharmaceutical, for example cognitive
behavioural therapy (CBT).
4 Give information on menopause in different ways to
help encourage women to discuss their symptoms and
needs.
ABOUBAKR ELNASHAR
17. 5 Give information about contraception to women who
are in the perimenopausal and postmenopausal phase.
6 Offer women who are likely to go through menopause
as a result of medical or surgical treatment (including
women with cancer, at high risk of hormone sensitive
cancer or having gynaecological surgery)
support and:
information about menopause and fertility before
they have their treatment referral to a healthcare
professional with expertise in menopause.
ABOUBAKR ELNASHAR
18. 4. Managing short-term menopausal symptoms
1 Adapt a woman's treatment as needed, based on her
changing symptoms.
Vasomotor symptoms
1. Offer women HRT for vasomotor symptoms after
discussing with them the
short-term (up to 5 years) and
longer-term benefits and risks.
2. Offer a choice of preparations as follows:
oestrogen and progestogen to women with a
uterus
oestrogen alone to women without a uterus.
ABOUBAKR ELNASHAR
19. .3 Do not routinely offer
selective serotonin reuptake inhibitors (SSRIs),
serotonin and norepinephrine reuptake inhibitors
(SNRIs) or
clonidine as first-line treatment for vasomotor
symptoms alone.
4 Explain to women that there is some evidence that
isoflavones or black cohosh may relieve vasomotor
symptoms. However, explain that:
multiple preparations are available and their safety is
uncertain
different preparations may vary
interactions with other medicines have been
reported.
ABOUBAKR ELNASHAR
20. Psychological symptoms
1. Consider HRT to alleviate low mood that arises as
a result of the menopause.
2. Consider CBT to alleviate low mood or anxiety that
arise as a result of the menopause.
3. understand that there is no clear evidence for
SSRIs or SNRIs to ease low mood in menopausal
women who have not been diagnosed with
depression
ABOUBAKR ELNASHAR
21. Altered sexual function
1.Consider testosterone supplementation for
menopausal women with
low sexual desire if HRT alone is not effective.
ABOUBAKR ELNASHAR
22. Urogenital atrophy
1.Offer vaginal oestrogen to women with urogenital
atrophy (including those on systemic HRT) and
continue treatment for as long as needed to relieve
symptoms.
2. Consider vaginal oestrogen for women with
urogenital atrophy in whom systemic HRT is
contraindicated
3. If vaginal oestrogen does not relieve symptoms of
urogenital atrophy, consider increasing the dose
ABOUBAKR ELNASHAR
23. 4.Explain to women with urogenital atrophy that:
symptoms often come back when treatment is
stopped
adverse effects from vaginal oestrogen are very
rare, they should report unscheduled vaginal
bleeding
5. Advise women with vaginal dryness that
moisturisers and lubricants can be used alone or in
addition to vaginal oestrogen.
6. Do not offer routine monitoring of endometrial
thickness during treatment for urogenital atrophy
ABOUBAKR ELNASHAR
24. Complementary therapies and unregulated
preparations
1.Explain to women that the efficacy and safety of
unregulated compounded bioidentical hormones are
unknown.
2. Explain to women who wish to try complementary
therapies that the quality, purity and constituents of
products may be unknown.
ABOUBAKR ELNASHAR
25. 3. Advise women with a history of, or at high risk of,
breast cancer that,
although there is some evidence that St John's
wort may be of benefit in the relief of
vasomotor symptoms, there is uncertainty about:
appropriate doses
persistence of effect
variation in the nature and potency of
preparations
potential serious interactions with other drugs
(including tamoxifen, anticoagulants and
anticonvulsants).
ABOUBAKR ELNASHAR
26. Review and referral
1.Discuss with women the importance of keeping up
to date with nationally recommended health
screening.
2. Review each treatment for short-term menopausal
symptoms:
at 3 months to assess efficacy and tolerability
annually thereafter unless there are clinical
indications for an earlier review
treatment ineffectiveness
side effects or adverse events
ABOUBAKR ELNASHAR
27. 3. Refer women to a healthcare professional with
expertise in menopause if
treatments do not improve their menopausal
symptoms or
they have ongoing troublesome side effects.
4. Consider referring women to a healthcare
professional with expertise in menopause if:
they have menopausal symptoms and
contraindications to HRT or
there is uncertainty about the most suitable
treatment options for their menopausal symptoms.
ABOUBAKR ELNASHAR
28. Starting and stopping HRT
1.Explain to women with a uterus that unscheduled
vaginal bleeding
a common side effect of HRT within the first 3
months of treatment
should be reported at the 3-month review
appointment, or
promptly if it occurs after the first 3 months
2. Offer women who are stopping HRT a choice of
gradually reducing or immediately stopping treatment.
ABOUBAKR ELNASHAR
29. 3. Explain to women that:
gradually reducing HRT may limit recurrence of
symptoms in the short term
gradually reducing or immediately stopping HRT
makes no difference to their symptoms in the
longer term.
ABOUBAKR ELNASHAR
30. Women with, or at high risk of, breast cancer
1. Offer menopausal women with, or at high risk of,
breast cancer:
information on all available treatment options
information that the SSRIs paroxetine and
fluoxetine should not be offered to women with
breast cancer who are taking tamoxifen
referral to a healthcare professional with expertise
in menopause.
ABOUBAKR ELNASHAR
31. 5. Long-term benefits and risks of hormone
replacement therapy
Venous thromboembolism
1 Explain to women that:
the risk of VTE is increased by oral HRT
compared with
baseline population risk
the risk of VTE associated with HRT is greater for
oral than transdermal preparations
the risk associated with transdermal HRT given at
standard therapeutic doses is no greater than
baseline population risk.
ABOUBAKR ELNASHAR
32. 2 Consider transdermal rather than oral HRT for
menopausal women who are at increased risk of
VTE, including those with a BMI over 30 kg/m2.
3 Consider referring menopausal women at high risk
of VTE
those with a strong family history of VTE or
a hereditary thrombophilia
to a haematologist for assessment before
considering HRT.
ABOUBAKR ELNASHAR
33. Cardiovascular disease
1. Ensure that menopausal women and healthcare
professionals involved in their care understand that
HRT:
does not increase cardiovascular disease risk
when started in women aged under 60 years
does not affect the risk of dying from
cardiovascular disease.
2. Be aware that the presence of cardiovascular risk
factors is
not a contraindication to HRT as long as they are
optimally managed.
ABOUBAKR ELNASHAR
34. 3. Using tables 1 and 2, explain to women that:
the baseline risk of coronary heart disease and
stroke for women around menopausal age varies
from one woman to another according to the
presence of cardiovascular risk factors
HRT with oestrogen alone is associated with no, or
reduced, risk of coronary heart disease
HRT with oestrogen and progestogen is associated
with little or no increase in the risk of coronary heart
disease.
ABOUBAKR ELNASHAR
36. 4. Explain to women that taking oral (but not
transdermal) oestrogen
is associated with a small increase in the risk of
stroke.
5. explain that the baseline population risk of stroke in
women aged under 60 years
is very low (see table 2).
ABOUBAKR ELNASHAR
38. Type 2 diabetes
1.Explain to women that taking HRT (either orally or
transdermally) is
not associated with an increased risk of developing
type 2 diabetes.
2. Ensure that women with type 2 diabetes and all
healthcare professionals involved in their care are aware
that HRT
is not generally associated with an adverse effect on
blood glucose control.
3. Consider HRT for menopausal symptoms in women
with type 2 diabetes after
taking comorbidities into account and
seeking specialist advice if needed.
ABOUBAKR ELNASHAR
39. Breast cancer
1.Using table 3, explain to women around the age of
natural menopause that:
the baseline risk of breast cancer for women around
menopausal age varies from one woman to another
according to the presence of underlying risk factors
HRT with oestrogen alone is associated with little or
no change in the risk of breast cancer
HRT with oestrogen and progestogen can be
associated with an increase in the risk of breast
cancer
any increase in the risk of breast cancer is
related to treatment duration and
reduces after stopping HRT.
ABOUBAKR ELNASHAR
41. Osteoporosis
1.Give women advice on bone health and discuss
these issues at review appointments
2. Using table 4, explain to women that the baseline
population risk of fragility fracture for women around
menopausal age in the UK is
low and
varies from one woman to another.
3. Using table 4, explain to women that their risk of
fragility fracture is decreased while taking HRT and
that this benefit:
is maintained during treatment but decreases
once treatment stops
may continue for longer in women who take HRT
for longer. ABOUBAKR ELNASHAR
43. Loss of muscle mass and strength
1.Explain to women that:
there is limited evidence suggesting that
HRT may improve muscle mass and strength
muscle mass and
strength is maintained through, and is important
for, activities of daily living.
ABOUBAKR ELNASHAR
44. 6. Diagnosing and managing premature ovarian
insufficiency
Diagnosing premature ovarian insufficiency
1.Take into account the
woman's clinical history (for example, previous
medical or surgical treatment) and
family history
2 Diagnose premature ovarian insufficiency in women
aged under 40 years based on:
menopausal symptoms, including no or infrequent
periods (taking into account whether the woman
has a uterus) and
elevated FSH levels on 2 blood samples taken 4–
6 weeks apart.
ABOUBAKR ELNASHAR
45. 3 Do not diagnose premature ovarian insufficiency on
the basis of a single blood test.
4 Do not routinely use AMH to diagnose premature
ovarian insufficiency.
5 If there is doubt about the diagnosis of premature
ovarian insufficiency, refer the woman
ABOUBAKR ELNASHAR
46. Managing premature ovarian insufficiency
1. Offer sex steroid replacement with a choice of
1. HRT or
2. combined hormonal contraceptive
to women with premature ovarian insufficiency,
unless contraindicated (for example, in women
with hormone-sensitive cancer).
ABOUBAKR ELNASHAR
47. 2. Explain to women with premature ovarian
insufficiency:
the importance of starting hormonal treatment either with
HRT or a combined hormonal contraceptive and continuing
treatment until at least the age of natural menopause
(unless contraindicated)
that the baseline population risk of diseases such as
breast cancer and cardiovascular disease increases with
age and is very low in women aged under 40
that HRT may have a beneficial effect on blood pressure
when compared with a combined oral contraceptive
that both HRT and combined oral contraceptives offer
bone protection
that HRT is not a contraceptive.
ABOUBAKR ELNASHAR
48. 3. Give women with premature ovarian insufficiency
and contraindications to hormonal treatments advice,
including on bone and cardiovascular health, and
symptom management.
4. Consider referring women with premature ovarian
insufficiency to healthcare professionals who have
the relevant experience to help them manage all
aspects of physical and psychosocial health related to
their condition.
ABOUBAKR ELNASHAR