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INDICATIONS

This document discusses hormone replacement therapy (HRT) for menopausal symptoms. It outlines both the physical and psychological symptoms of menopause that HRT can help with, as well as contraindications. It describes different HRT drug options including estrogen, progesterone, tibolone, raloxifene, soy isoflavones, and bisphosphonates. Risks of unopposed estrogen therapy are addressed. Guidelines are provided for HRT treatment of hot flashes, night sweats, and vaginal atrophy. The conclusion recommends that HRT only be used for as short a time as possible at the lowest effective dose.

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Sivasubramanian Balasubramanian
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19 views26 pages

INDICATIONS

This document discusses hormone replacement therapy (HRT) for menopausal symptoms. It outlines both the physical and psychological symptoms of menopause that HRT can help with, as well as contraindications. It describes different HRT drug options including estrogen, progesterone, tibolone, raloxifene, soy isoflavones, and bisphosphonates. Risks of unopposed estrogen therapy are addressed. Guidelines are provided for HRT treatment of hot flashes, night sweats, and vaginal atrophy. The conclusion recommends that HRT only be used for as short a time as possible at the lowest effective dose.

Uploaded by

Sivasubramanian Balasubramanian
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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HORMONE

REPLACEMENT
THERAPY

BY

B.SIVASUBRAMANIAN
Introduction
 HRT does not suit everyone.
 Each woman needs to be aware of the
benefits and potential risks of HRT
(pros and cons) so that she can make
an informed decision.
PHYSICAL SYMPTOMS
 IRREGULAR PERIODS
 HOT FLUSHES
 NIGHT SWEATS
 PALPITATIONS
 SEXUAL CHANGES
 SKIN & HAIR
 JOINT PAINS
 URINARY SYMPTOMS
 WEIGHT GAIN
 HEADACHE
PSYCHOLOGICAL
SYMPTOMS
 DEPRESSION
 IRRITABILITY
 TIREDNESS /
POOR SLEEP
 ANXIETY
 LOSS OF LIBIDO
 WEEPINESS
 FORGETFULNESS
&
 LOSS OF
CONCENTRATION
INDICATIONS:
1.Symptomatic
2.High risk cases-
cvs,osteoporosis,alzheimer,
ca colon
3.Post oopherectomy in
premenopausal women and
premature menopause
4.Who demand HRT
CONTRAINDICATIONS
OF HRT
 PREVIOUSTHROMBOEMBOLIC
DISEASE
 IMPAIRED LFT/ LIVER DISEASE
 Ca BREAST
 Ca ENDOMETRIUM
 FIBROIDS &ENDOMETRIOSIS
(relative)
HYPERTENTION,DIABETES,CARDIO-
VASCULAR DISEASE ARE NOT C/I
DRUGS IN HRT
 ESTROGEN
 PROGESTOGEN
 TIBOLONE
 RALOXIFENE
 ISOFLAVONE
 BISPHOSPHONATES
 CLONDINE
 ANDROGENS
STRATEGIES OF T/M
PO ST M ENO PAUSAL

IN T A C T U T E R U S ABSEN T UTER U S

B L E E D IN G N O N B L E E D IN G UNO PPO SED


R E G IM E N R E G IM E N ESTRO G ENS

C Y C L IC A L T IB O L O N E
E & P C O N T IN O U S
E & P
T/M OF PRE-
MENOPAUSAL WOMEN
T P R E M E N O P A U S A L W IT H
C L IM A C T E R IC S Y M P T O M S

IN T A C T ABSENT UTERUS
U TER U S

C Y C L IC A L E /P U N O PPO SED ESTRO G EN S


ESTROGEN
 Useful in hot flushes,night
sweats,palpitation,disturbed sleep
 Oral premarin-0.625mg
 E.estradiol-0.01mg
 Micronized estrogen-1 to 2 mg
 Give medroxy 10 mg 10 to 12 days a month along
with it to prevent Endometrial hyperplasia
 Local estrogen creams-for dyspareunia,urethral
syndrome,senile vaginitis-1/2 g daily for 10 to 12
days each month
LONGTERM THERAPY
 ORAL-High first pass metabolism
 Cardioprotective
 Decreases triglycerides
 TRANSDERMAL PATCH-avoids first pass
metabolism
 GEL-100mg contains 60 mg beta estradiol
 VAGINAL CREAM-For urethral syndrome and dry
vagina
 IMPLANT-25 to 50 mg estradiol for 6 months each
RISKS OF UNOPPOSED
ESTROGENS
ENDOMETRIAL HYPER PLASIA

ADENOCARCINOMA

INCREASED RISK OF Ca BREAST

2-4FOLD INCREASED RISK OF


DEVELOPING
THROMBOLIC DISEASE
CONTRAINDICATIONS FOR E-
THERAPY:
 CA BREAST,CA UTERUS/FAMILY H/O
OF CANCER
 H/O THROMBOEMBOLIC EPISODE
 LIVER AND GB DISEASE
 HYPERTENSIVE,DIABETIC
PROGESTOGENS

TYPES:
 PREGNANE-LYNESTEROL
 ESTRANE-NORETHISTERONE
 GONANE-LEVONORGESTREL
 3rd GENERATION-DESOGESTREL
ROUTES OF ADMINISTARTION
 ORAL
 IM
 IMPLANTS
 IMPREGNATED IUCD
 VAGINAL TABLET AND RINGS
 SKIN PATCHES
SIDE EFFECTS
 NAUSEA VOMITING
 WEIGHT GAIN,WATER
RETENTION,LEG CRAMPS
 DEPRESSION
 INCREASED LDL,CVS PROBLEMS
 DVT,P.EMBOLISM
 CA BREAST
TIBOLONE

 Synthetic dvt of 19nortestosterone


 Actions-
estrogenic,progestogenic,androgenic
 Use-cardioprotective,improves sex
drive
 Start only after 1 year to avoid vaginal
bleeding
RALOXIFENE

 60mg daily with calcium and vitamin D


 USES:
 Cardioprotective
 Reduces risk of fractures
 CONTRAINDICATIONS
 Venous thrombosis
 Don’t give with estrogen,NSAIDs,Diazepam
 Hepatic dysfunction
SOYA
 ISOFLAVONE-45 to 60 mg daily
 Advantages:
 Decreases cholesterol,LDL
 Anti viral anti fungal anti cancerous
properties
BISPHOSPHONATES
 Etidronate-10mg/kg wt for 2 weeks with
a gap of 2 to 3 months for 10 cycles
 Ibadronate once a month 150 mg
 Alendronate-5,10,35,70 mg
 Action by reduction of osteoclastic
activity
 CALCITONIN,VITAMIN D ARE BONE
PROTECTIVE
 CLONIDINE IS USED FOR HOT
FLUSHES
 ANDROGENS IMPROVE LIBIDO
 DAILY WEIGHT BEARING EXERCISE
FOR HALF AN HOUR DELAYS
OSTEOPOROSIS
VASOMOTOR HOT FLUSHES
includes night sweats
Grade A
 HRT is an effective treatment for hot
flushes

 Tibolone is effective for alleviating the


severity and reducing the frequency of
hot flushes
VASOMOTOR HOT FLUSHES
(includes night sweats)
Grade B
 Unopposed estrogen may be effective
for reducing the waking episodes that
are associated with sleep disruption.
 There is no evidence that HRT is
effective for vasomotor symptoms
such as headaches and dizziness.
Vaginal atrophy
Grade A
 Low dose topical estrogen is an
effective treatment
 E3 (estriol) therapy is also effective but
requires either the addition of
progestogen or close monitoring of the
endometrium
 Tibolone has been shown to be effective
for vaginal atrophy
Conclusion
1-HRT is not recommended for
routine use in the menopause.

2-HRT must be used for as short a


time as possible with lowest
effective dose .

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