Professional Documents
Culture Documents
AND HRT
THE MENOPAUSE – WHAT IS IT?
Yunani Men (month) dan pausis (berhenti)
From the British Menopause Society:
• Permanent cessation of menstruation
• Only diagnosed after 12 months spontaneous amenorrhoea – a
retrospective diagnosis
• Climacteric/perimenopause – period of change leading up to the
menopause
THE MENOPAUSE – WHY
DOES IT HAPPEN?
• Women are born with around 1.5m oocytes
• 1/3 are lost by the time of menarche.
• Most women menstruate about 400 times, and 20-
30 follicles start to develop each time.
• Eventually the supply of responsive oocytes in the
ovaries runs out
STAGES OF REPRODUCTIVE AGING WORKSHOP
(STRAW)
HOW COMMON ARE SYMPTOMS?
• 80% of women experience menopausal symptoms1
• 45% of these find the symptoms distressing1
• Most women manage the symptoms themselves – 10% seek
medical advice for their symptoms2
1) RCPE, 2003
• HRT
• Alternatives
LIFESTYLE CHANGES
• Hot flushes and night sweats
• Regular exercise, lighter clothing, sleep in a cooler room,
stress management
• Avoid triggers
• Sleep disturbances
• Avoid exercise late in the day
• Maintain regular routine
• Mood and anxiety
• Adequate sleep, regular exercise, relaxation exercises
• Cognitive symptoms
• Adequate sleep, regular exercise
TREATMENT - HRT
HRT
• Effective treatment for menopausal symptoms
• Previously used widely and for prolonged periods
• However:
Women’s health initiative (2002) – increased risk of
coronary heart disease, stroke, breast cancer, PE
Million women study (2003) – increased risk breast and
ovarian cancer
BAKOUR, SH; WILIAMSON J. LATEST EVIDENCE ON USING
HORMONE REPLACEMENT THERAPY IN THE MENOPAUSE. 2015.
INDICATIONS FOR HRT1
• Treatment of menopausal symptoms where the risk
benefit ratio is favourable, in fully informed
women, in the lowest possible dose needed to
control symptoms and for the shortest possible time
• In women with premature menopause until the age
of natural menopause (50)
• For prevention of osteoporosis in women unable to
use other medications
• 1) “Menopause” Clinical Knowledge Summaries
CHOICE
• Estrogen + progestogen
• estrogen alone
• Tibolone
ROUTES OF DELIVERY
• Oral tablets
• Patches
• Creams/gels
• Nasal sprays
• IUS
• Oestrogen releasing vaginal ring
• S/C implants
WHICH PREPARATION?
Questions:
1. Does the women have an intact uterus?
2. Are symptoms primarily vaso-motor or
urogenital?
3. Systemic or local treatment?
4. Combined or oestrogen only?
5. Cyclical or continuous?
WHICH TYPE OF HRT??
HRT
Postmenopausa
al