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Did9z3ct0k0krfmeql0m Signature Poli 180218060814
Did9z3ct0k0krfmeql0m Signature Poli 180218060814
THERAPY
• Initially, Every menopausal woman
was advised to go on HRT as soon as
menopause sets in.
• Preparations of oestrogen:
– Oral Premarin(E1 natural equine-conjugated oestrogen)
0.625mg OD upto 1.25mg
– Ethinyl oestradiol 0.01mg
– Micronized oestrogen 1-2mg
– Evalon 1-2mg
ORAL THERAPY
• Long term therapy:
– In delaying osteoporosis & reducing cardiovascular diseases.
– Beyond 8-10 years is not beneficial.
ADVANTAGES DISADVANTAGES
Cheap & easy to take High doses are required(oestrone in
intestine & liver 10% reaches systemic
circulation)
Good for lipid profile & cardiovascular Daily intake
protection
High incidence of side effects.
Increase chances of HTN,
thromboembolism
TRANSDERMAL PATCH
• Estraderm patch: 3-4 mg oestradiol & releases 50 mcg each
day.
• VAGINAL RING:
– Estring releases 5-10mcg oestrogen for 90 days.
• IMPLANT:
– Containing 25-50mg oestradiol is effective for 6 months each.
– Maintains E2 level at 50-60pg/ml.
– Suitable in hysterectomised patients.
PROGESTINS
• Used to avoid the risk of endometrial hyperplasia & cancer of non-
hystrectomised patients.
• Given 12 days in each cycle reduces risk to less than 2%.
• Enzyme: 17β-hydroxydehydrogenase inactivates E2 controls mitotic
activity in endometrial cells.
• Drugs :
– Duphaston/medroxyprogesterone 10mg
– Primolut-N 2.5mg OD for 10-12 days each month (prevent
endometrial hyperplasia)
PROGESTINS
• Side effects:
– Bloated feel
– wt. gain
– Depression
– Adversely alter lipid profile
– poor compliance
• Mirena IUCD (levonorgestrel) for 5 years.
• Drospirenone: no androgenic & adverse lipid effect.
– 3mg combined 30mcg estradiol is been tried.
• Testosterone implant & combined tablet with oestrogen- to improve
libido
OTHER DRUG
• Tibolone: synthetic derivative of 19-nortestoterone
– Weak oestrogenic, progestrogenic & androgenic action.
– Elevates mood, relieves vasomotor symptoms, improves sex drive &
reduces bone resorption
– Cardioprotective decreases TG
– S/E: wt. gain, edema, tenderness in breast, vaginal bleed, greasy skin.
HRT & BREAST CANCER
• Risk does not increase upto 3yrs of HRT & 5yrs of oestrogen alone
replacement therapy.
• Can cause recurrence of breast cancer.
• Increases density of breast tissue & impede screening programme
of mammogram subsequently.
• Breast cancer following HRT – low grade with good prognosis
HRT & ENDOMETRIAL CARCINOMA
• ERT can cause well differentiated carcinoma.
• Minimum of 12 days of progesterone added to ERT reduces
risk to 2%
• Combined HRT – better protection
• Tibolene – safe drug which does not cause endometerial
hyperplasia.
MONITORING BEFORE & DURING HRT
Baseline parameters and their subsequent check-ups necessary:
• Physical examination including pelvic examination
• Blood pressure recording
• Breast examination & mammography
• Cervical cytology
• Pelvic ultrasonography: to measure endometrial thickness
• Endometrial biopsy, hysteroscopy- any irregular bleeding
• Serum estradiol levels (100pg/ml)
THANK YOU