Menopause
Menopausal symptoms
Management
Benefits and risks of HRT
Other stuff including contraception
no need to use FSH to diagnose menapause unless its remenapuse in which have to use fsh
maybe to dx it with secondary amenorrhea
because of the changing andorgen to oestroge ratio sometimes menapusal women get hirtisum and virlism
E2 vs E1 where they are produced and differences. one is directly and one is aromatised.
menapausa symptoms vs post menapausal symptoms and problems
post menapausal bleeding must not be taken lightly because it can be indicative of endometrial hyperplasia and canver
ph of vagina before menarche and after menapuse is alkaline thats why before menarche the most common organism is tb and for menapusal the most common is ecoli.
in ocp the active ingreient is rogesterone mianly but oestrogen helps to prevent breakthough bleeding
but in hrt in menapause the active ingredient is oestrogen that helps alleviate symptoms
but we give orgesterone also because otherwise the endometrium will keep proliferating if not.
but oestorgen given in hrt is very very low dose...just enough to alleviate symptoms.
ocp the bleeding is less as oestrogen and progesterone both togteher and not oestrogen only
oestorgen to proliferate the endometrium and rogesterone to stabalise and maintain it
and bleeding is progesteron ewithdrawal
oestorgen builds, progesterone maintains
above is very important to understand different hormonal therapy that is being used,
prevention of oesteoprosis is by hrt
but if osteoporsis is already there then must use bisphonates.
other drigs are timlone which is no longer used
tsmosifence and relaoxifene SERMS
its called selective because it only acts on selected serotnin or oestrogen receptors not all serotnin or pestrogen receptors
So serms activates some oestrgen receptors and blocks the rest
activates endometrium so increases chances of endometrial ca but blocks in breast so reduces chance of breast ca
but both causes vte
the duration of hrt depends. must weight benefits and risks. If normal spontanoeus menapause then better to give for 2 to 5 years. The more older she gets the more harms outweight the beenfits.
But if its surgical or premature menapuse then can hive hrt for longer. even upto 10 years.
the more younger the more benefits outweight the risks and the more older the more harms outweight the benefits.
so the more earlier you start the more longer you can afford to continue it.