Transcript Menopause and hormone replacement therapy

((Menopause))
And
((Hormone replacement therapy))
Objective: Climacteric and menopause is one phase
in woman”s life
 It is associated with health changes and
diseases
 Hormone replacement therapy needed to
improve quality of life and prevent medical
complications which follow menopause
 Menopause is the last menstrual period
the average age is 51 years.
 Climacteric is transition from fertility to
infertility from 45-55 years.
 Women live 40% of her life in menopause.
 The first endocrine change in menopause
is fall in inhibin(glycoprotein) from ovaries
which inhibit the release of FSH and LH
from pituitary,so FSH and LH rise.
Causes of menopause
A)Premature ovarian failure
Menopause occuring before 45 years,low
oestrogen,high FSH&L
May be associated with autoimmune
pathology.
B) Surgical menopause
Menopause after oophorectomy,after
hysterectomy menopause occurs about 3
years earlier the natural menopause.
C) After chemotherapy or radiotherapy as
breast cancer or lymphoma.
Diagnosis of menopause
 History(age,disease,surgery,treatment)
 Clinical examination
 Investigations
Low oestrogen(E2 10-50pg/ml)
High FSH&LH >10IU/L
Total cholesterol increase
HDL cholesterol decrease
LDL cholesterol increase
D.Diagnosis: PMS
 Depression
 Thyroid disease
 Phaeochromocytoma,carcinoid syndrome.
Clinical features
1.Early changes:
Vsomotor symptoms(disturbance in the
thermoregulator in the hypothalamus) occur in
70% of women.
Frequency – few to several times per day.
Duration –weeks to years.
Hot flushes followed by sweating.
 Psychological symptoms
Insomnia,poor concentration,irritability,
anxiety and lethergy.
2. Intermediate changes(2-4 years,collagen )
Wrinkled skin,small breasts.
Genital tract,thin and dry vagina,acidity
reduced
infection,dysparunia and
genital prolapse.
Urinary symptoms,frequency,dysuria,urgency,
and stress incontnence.
3.Late changes(>10 years)
Bones,osteoporosis(colle’s fracture,fracture
of neck femur and vertebral crush fracture)
CVS,stroke and heart attacks.
Treatment:Hormone Replacement Therapy
Principles
 Depend on the presence and severity of
symptons.
 Patient decision.
 Careful counselling before treatment.
Examination: BP,breast examination(mammogram)
 Pelvic examination,look for oestrogen
sensitive tumours(fibroid,endometriosis,
endometrial carcinoma)
Benefits of HRT
 Cure early symptons of menopause.
 Prevent fractures in about 50%.
 Reduce heart attacks in about 40%.
 Reduce bladder dysfunction.
 May prevent against bowel carcinoma and
Alzheimer’ disease.
Contraindications of HRT
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Absolute:-
Present or suspected pregnancy
Suspicion of breast cancer
Suspicion of endometrial cancer
Active liver disease
Uncontrolled hypertension
Cofirmed VTE
Relative:
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Presence of fibroid
Past history of benign breast disease
Uconfirmed VTE
Chronic liver disease
Migraine
Preparations of HRT
Natural oestrogens(from plants or animal)
 Oestradiol valerate 1-2mg
 Congugated equine oestrogens
 Oestrone 1.25mg
Progestogens
 Medroxyprogesterone acetate 10mg
 Dydrogesterone 10mg
 Norethisterone 1mg
 Norgesterel
0.15mg
Post-hysterectomy : use only oestrogens
Add progestogens at least for 12 days of
28 days for non-hysterectomized patient.
 Combined oral oes. And prog. (pills 28
days)
 Combined oes. And prog. In patch(weekly)
 Oestrogen patch
 Oestrogen gel rubbed into the skin daily
 Inplant s\c for one year
 Vaginal(cream,pessary,tablet for local
symptoms)
Tibolone: Synthetic steroid
 Has oestrogenic,progestogenic and
androgenic effect
 Used 1year after menopause 2.5mg daily
Raloxifene SERM: Selective oestrogen receptor modulator
 Prevent osteoporosis
 Does not stimulate breast and endometrial
receptors
 May worsen vasomotor symptons
Side effcts of HRT(first 12 weeks)
 Breast tenderness and nipple sensitivity
 Appetite rise and weight gain
 Calf cramps
Patient must reviewed 6 months then
annually(BP,breast,pelvic examination)