HORMONE REPLACEMENT THERAPY.pptx

PURPOSE, MEDICAL AND SURGICAL MANAGEMENT

1. HORMONE REPLACEMENT THERAPY PRESENTED BY: LAMNUNNEM HAOKIP MSC (N) 1 ST YEAR UNDER THE SUPERVISION OF SHILPY MA’AM

2. DEFINITION MENOPAUSE Permanent cessation of menstruation at the end of reproductive life of a woman. HORMONES They are special chemicals that our body makes.

3. CHANGES IN THE BODY AFTER MENOPAUSE CHART

4. Estrogens There is a sharp fall in estrogen and also the trophic hormones. The woman is said to be in s state of true menopause. Progesterone: Due to loss of ovarian reserve, the progesterone levels are decreased markedly also known as Anti- Mullerian Hormone.

5. Organ changes Ovaries: Shrink in size, become wrinkled and white. Fallopian tubes: Show feature of atropy . The uterus: Become smaller, the endometrium become thinner and atrophiv . Vagina: becomes narrower due to gradual loss of elasticity.The vaginal pH become alkaline.

6. Vulva : Shows feature of atropy , labia becomes flattened and pubic hair becomes scantier. Breast fat: fats reabsorbed and glands atrophy, nipples decrease in size. The breast becomes flat and pendulous. Bladder and urethra: thin and more prone to damage and infection. Loss of muscle tone : uterine descend, pelvic relaxation.

7. SYMPTOMS OF MENOPAUSAL TRANSITION FLASH CARDS

8. Menstrual changes Short cycles Irregular bleeding. Vasomotor Symptoms Hot flushes Night sweats Sleep disturbance Psychological Irritability Mood swings Poor memory Depression

9. Sexual dysfunction Vaginal dryness Dyspareunia Urinary Incontinence Urgency Dysuria Others Backaches Joint aches

10. HORMONE REPLACEMENT THERAPY HRT is indicated in menopausal women to overcome the short term and long term consequences of estrogen and progesterone deficiency. HRT is a treatment for women who have low hormone levels.

11. INDICATIONS OF HRT PAMPHLETS

12. Relief of menopausal symptoms. Relief of vasomotor symptoms. Prevention of osteoporosis To maintain the quality of life in menopausal years. Premature ovarian failure Gonadal dysgenesis Surgical or radiation menopause.

13. CONTRAINDICATIONS OF HRT History of breast cancer Undiagnosed genital tract bleeding History of DVT Acute liver disease Gall bladder disease. Prior endometriosis

14. HORMONES USED IN HRT It can be given in wide range of modalities. Cream / gel Skin patch Tablet Vaginal ring Pallet

15. ESTROGEN THERAPY Estrogen Pill : CEE 0.3 mg or 0.625 mg, 0.9 mg is given daily for a woman ho had hysterectomy for 2-3 months. Estrace , Femtrace .

16. Patch: 3.2 mg of 17 β estradiol , releasing 50 μ g of estradiol in 24 hours.

17. Gel: Is to be applied on to skin over the anterior abdominal wall of thighs. 1.53 mg of evamist spray.

18. Implant: 25-50 mg or 100 mg and can be kept for 6 months. In the anterior abdominal wall.

19. Vaginal cream: 1.25 mg daily. Effective specially in atrophic vaginitis .

20. PROGESTERONE THERAPY Oral Progestin: Provera , Norgestrel 150 mg/ day.

21. Intrauterine progestin: Levenorgestrel like Kyleena , Mirena 20mcg/ day is given.

22. Testosterone: Pallets of 100 mg testosterone. It improves mood, bone, muscle mass and quality of life. Tibolone : Prevent osteoporosis, atrophic changes of vagina and hot flushes. Parathyroid Hormone(PTH): Teriparatide is given SC injection of 20 μ g/day, to prevent osteoporosis and fracture.

23. BENEFITS OF HRT Improvement of vasomotor symptoms. 70-80% Improvement of urogenital atrophy. Increase in bone mineral density 2-5% Decreased risk in vertebral and hip fractures 25-50% Reduction in colorectal cancer 20%.

24. SUMMARY & CONCLUSION

25. BIBLIOGRAPHY REFERENCE Hiralal Konar , DC Dutta’s Textbook of Gynaecology. 7 th Edition. Jaypee Health Science Publisher. pp 46 -52. Annamma Jacob. A textbook of Midwifery and Gynaecological Nursing. 4 th Edition. Jaypee Brothers Medical Publisher. pp 904 – 908. Lily Podder . Fundamentals of Midwifery Obstetrical Nursing. ELSEVIER. pp 354 – 358. https://www.thenovuscenter.com/resources-los-angeles/hormone-replacement-therapy/ Hormone Replacement Therapy : JAAOS - Journal of the American Academy of Orthopaedic Surgeons (lww.com)