Women'S Health: Prof. DR Syed Azhar Syed Sulaiman

WOMEN’S HEALTH
Prof. Dr Syed Azhar Syed Sulaiman

Introduction
 The postmenopausal vasomotor symptoms are the
result of estrogen withdrawal rather than declining
estrogen levels
 Women who are taking oral estrogen experience this

drop on a daily basis. If a woman takes oral estrogen
in the morning, she is more likely to experience night
sweats
Introduction
 Women tend to take some medications to
overcome few conditions existing in geriatric
era:
 Menopausal symptom
 Osteoporosis
 Joint pain
Prescription Medications
 Estrogen Replacement Therapy (ERT) Common
names include:
 Conjugated Equine Estrogens (Premarin, Premarin
Vaginal Cream)
 Synthetic Conjugated Estrogens (Cenestin)
 Esterified Estrogens (Estratab, Menest)
 Estropipate (Ortho-Est, Ogen, Ogen Vaginal Cream)
 Micronized 17-beta estradiol (Estrace, Matrix patch:
Alora, Climara, Esclim, Vivelle, Vivelle-Dot; Reservoir
Patch:Estraderm; Estrace Vaginal Cream, Estring
Vaginal Ring)
 Estradiol Hemihydrate (Vagifem Vaginal Tablet)
Estrogen Replacement Therapy
(ERT)
 Estrogen replacement therapy (ERT) provides you
with a fraction of the amount of estrogen that was
produced by your ovaries before menopause.
 It helps reduce hot flashes and vaginal dryness and

may reduce your risk of osteoporosis.
 Estrogen may be administered as an oral tablet, skin

patch, injection, pellet placed under the skin, or as a
vaginal cream, ring, or tablet
Estrogen Replacement Therapy
(ERT)
 Possible side effects include:
 Uterine bleeding
 Enlargement of benign uterine tumors
 Sore Breasts
 Abdominal bloating
 Nausea
 Fluid retention
 Headache, including migraine
 Dizziness
 Corneal changes in the eye
 Increased risk of breast, ovarian and endometrial cancers
 Increased risk of heart attacks and strokes
 Increased risk of blood clots
Progestogen
 the progesterone that your ovaries once produced must be
replaced to reduce the increased risk of uterine cancer from
taking ERT alone.
 Progesterone or progestin (synthetic progesterone) is available

as replacement therapy.
 If you have had your uterus removed (hysterectomy), you are

not at risk for uterine cancer and do not need to take
progesterone with ERT.
Progestogen
 Progestin Oral Tablet
 Medroxyprogesterone acetate (Amen, Cycrin,
Provera)
 Norethindrone (Micronor, Nor-QD)
 Norethindrone acetate (Aygestin)
 Norgestrel (Ovrette)
 Levonorgestrel (Norplant)
 Megestrol Acetate (Megace)
 Progestin Injectable
 Medroxyprogesterone acetate (Depro-Provera)
Progestogen
 Progestin IUD
 Levonorgestrel (Mirena)
 Progesterone Oral Capsule
 Progesterone USP (Prometrium)
 Progesterone: Vaginal Gel
 Progesterone (Crinone)
 Progesterone IUD
 Progesterone (Progestasert)
Progestogen
Possible side effects include:
 Fluid retention
 Weight gain
 Headache
 Mood changes
Estrogen Plus Progestogen (Hormone
Replacement Therapy – HRT) Oral,
Continuous Cycle:
 Available as:
 Conjugated Equine Estrogens and
Medroxyprogesterone Acetate (Premphase)
 Oral, Continuous-Combined:
 Conjugated Equine Estrogens and
Medroxyprogesterone Acetate (Prempro)
 Ethinyl Estradiol and Norethindrone Acetate
(Femhrt)
 17-Beta Estradiol and Norethindrone Acetate
(Activella)
Estrogen Plus Progestogen (Hormone
Replacement Therapy – HRT) Oral,
Continuous Cycle:
Oral, Intermittent-Combined:
 17-Beta Estradiol and Norgestimate
Skin Patch, Continuous Cycle

 17-Beta-Estradiol and Norethindrone Acetate
Skin Patch, Continuous Combined

 17-Beta-Estradiol and Norethindrone Acetate
What information need to be told for
geriatric
 When progesterone is taken with estrogen, it is called
Hormone Replacement Therapy (HRT).
 Options for HRT include cyclic, continuous-cyclic,

continuous-combined, and intermittent-combined.
 Long-term HRT increases the risk of strokes, blood

clots, heart attacks, ovarian, endometrial, and
invasive breast cancers.
Possible side effects include:
 Uterine bleeding or “spotting”

 Fluid retention
 Sore breasts
 Headache
 Mood changes
 Increased risk of endometrial, breast and ovarian
cancers
 Increased risk of heart attacks and strokes
 Increased risk of blood clots
Bisphosphonates
 Common names include:
 Alendronate (Fosamax)
 Risedronate (Actonel)
 These agents effectively reduce both bone

loss and your risk of fractures.
 Alendronate may cause gastrointestinal

problems and irritation of your esophagus.
Selective Estrogen Receptor
Modulators (SERMs)
 Common names include:
 Raloxifene (Evista)
 SERMs have some of the beneficial effects of
estrogen, especially improved bone strength, but no
increased risk of breast cancer or uterine bleeding.
 However, these medications tend to cause, rather

than relieve, hot flashes and increase risk of blood
clots and gallstones.
Special Considerations
 Take them as directed, not more, not less, not at a
different time.
 Do not stop taking them without consulting your
health care provider.
 Don’t share them with anyone else.
 Know what effects and side effects to expect, and
report them to your health care provider.
 If you are taking more than one drug, even if it is
over-the-counter, be sure to check with a physician or
pharmacist about drug interactions.
 Plan ahead for refills so you don’t run out.
Traditional herbs
 Need to evaluate properly the usage clinically
 Some may cause harmful effects, example:

 Ephedra -- banned in 2004 by the FDA;
 Comfrey -- may induce liver toxicity;
 Sassafras -- linked to liver cancer in animals;
 Pennyroyal, rue -- abortifacients; and
 Kava -- can cause hepatotoxicity.
 Soya bean, yam and many other local herbs can be

used for controlling menopausal symptoms
Joint pain
 Many women tend to suffer from athritis and
joint pain
 Available medications:
 Paracetamol
 Nsaids
 Capcaisin
 Traditional herbs
Medication for joint pain
 Need to be aware if patients having organ
dysfunctions when on Nsaids
 Worsen renal situation and contribute to

complications
 Avoid oxicam groups – bleeding in the gut
 Advise on foods choice – avoid too much protein if

having gout

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WOMEN’S HEALTH

Prof. Dr Syed Azhar Syed Sulaiman

 Women who are taking oral estrogen experience this

 It helps reduce hot flashes and vaginal dryness and

 Estrogen may be administered as an oral tablet, skin

 Progesterone or progestin (synthetic progesterone) is available

 If you have had your uterus removed (hysterectomy), you are

Skin Patch, Continuous Cycle

Skin Patch, Continuous Combined

 Options for HRT include cyclic, continuous-cyclic,

 Long-term HRT increases the risk of strokes, blood

 Uterine bleeding or “spotting”

 These agents effectively reduce both bone

 Alendronate may cause gastrointestinal

 However, these medications tend to cause, rather

 Some may cause harmful effects, example:

 Comfrey -- may induce liver toxicity;

 Sassafras -- linked to liver cancer in animals;

 Pennyroyal, rue -- abortifacients; and

 Kava -- can cause hepatotoxicity.

 Soya bean, yam and many other local herbs can be

 Worsen renal situation and contribute to

 Avoid oxicam groups – bleeding in the gut

 Advise on foods choice – avoid too much protein if

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