Hormonal Replacement Therapy Menopause

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Hormone replacement therapy (HRT) is done when there is a lack of naturally produced hormones in the body. Due to this, the body has to face many types of problems. For example, the stage of menopause in women is one such condition when the main hormones of women are deficient.

It is defined as when there have been no menstrual periods for 12 consecutive months, and no other biological cause can be identified.

It is described as a physiological cessation of menses and the end of fertility.

 

Perimenopause is when there is a decline in ovarian function, and the woman experiences estrogen deficiency symptoms and possibly; irregular cycle.

 

Hormonal Replacement Therapy Menopause
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Table of Contents

Causes of hormonal replacement therapy

 

  • Cessation of ovarian function
  •  Age
  •  Surgical intervention
  •  Chemotherapeutic agents

 

Symptoms of hormonal replacement therapy

Genitalia

  •  Atrophy of vulva, vagina, urethra results in dryness
  •  Loss of labia minora
  •  Thinning of pubic hair
  •  Decreased secretion during intercourse
  •  Bleeding and Itching
  •  Burning and Dysuria

Sexual function

  •  Vaginal dryness
  •  Dyspareunia
  •  Discomfort
  •  Decreased intensity and duration of sexual response

Psychological

  • Insomnia, Depression             
  •  Irritability
  •  Anxiety, Fear 
  •  Memory loss

Vasomotor

  • Hot flashes
  •  Anxious feeling
  •  Sweating
  •  Night sweats 

 

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Diagnostic Evalution

  • History collection
  • Physical examination
  • Based on the symptoms
  •  Lab investigations 
  • FSH more significant than 30-40 U/L indicated menopause; greater than 100 IU/L indicates complete ovarian failure

Management

Menopausal hormone therapy / Estrogen replacement therapy 

  • Indicated at the smallest possible dose for the shortest period by the oral and transdermal route to reduce vasomotor symptoms.

Progesterone co-therapy preparation 

  •  In cyclical dosage pattern if the uterus is intact to prevent endometrial hyperplasia and possible cancer.
  •  No longer recommended because of association with adverse breast outcomes. 
  •  Vaginal preparation is most useful for atrophic vaginitis.

Menopausal Hormonal Therapy is Contraindicated with the following Conditions

  •  Increased risk of thromboembolic disease, previous or current idiopathic deep vein thrombosis or pulmonary embolism.
  •  Past, current, or suspected breast cancer.
  •  Estrogen sensitive cancer ( uterine, ovarian), untreated endometrial hyperplasia, undiagnosed genital bleeding.                       
  • Active or recent angina or myocardial infection.
  •  Untreated hypertension. 
  • Active liver disease.
  •  Hypersensitivity to the active substance in menopausal hormonal therapy.
  •  porphyria cutanea ( absolute contraindication )

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Other measures:

  • Vaginal lubricants    
  • SSRIs for depressive symptoms                 
  • Clonidine (central alpha-blockers ) for vasomotor symptom
  • Gabapentin  for hot flash
  • Dietary supplementation ( soy products, vitamin E 400 IU daily )

Complication

  • Osteoporosis
  • Coronary artery disease
  • Vaginal atrophy
  • Psychosocial issues of menopause: risk of depression increase

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