H0RMONE REPLACEMENT THERAPY IN POSTMENOPAUSAL STAGE

Q] Hormone replacement therapy ( HRT) in a post menopausal women is not indicated for……[AIIMS MAY 2013]
[A] Osteoporosis
[B] Cardiovascular manifestation
[C] Urogenital atrophy
[D] Flushing

H0RMONE REPLACEMENT THERAPY IN POSTMENOPAUSAL STAGE

Perimenopausal and menopausal women present with wide spectrum and variable intensity of symptoms resulting from decreased circulating levels of estrogens.

The most common presentation of menopause is  vasomotor instability leading to hot flashes (hot flushes), sweating, and palpitations.

Presenting symptoms include the following :-

[1] Vasomotor system: Vasomotor instability hot flashes (hot flushes), sweating, and palpitations.

[2] Urogenital system: Atrophy and thinning of the mucosal lining of the urogenital system( loss of vaginal elasticity and distensibility)

[3] Bone : progressive osteoporosis

[4] Cardiovascular system : Increased susceptibility to heart disease

[5] Neurologic symptoms: Mood changes, insomnia, depression, anxiety

How is HRT given?

HRT CONSISTS OF :-

[1]Estrogen alone

[2]Combined estrogen and progestogen

[3]Selective estrogen receptor modulator (SERM)

[4]Gonadomimetics, such as tibolone

Schedules of HRT :-

[1]Estrogen( daily)

[2]Cyclic or sequential regimens: Progestogen is added for 10-14 days every 4 weeks

[3]Continuous combined regimens: Estrogen + progestogen (taken daily)

INDICATIONS OF HRT

[1] To relieve vasomotor symptoms

[2] To improve urogenital symptoms

[3] To prevent osteoporosis

NOTE : Current clinical guidelines do not recommend routine hormone therapy for cvs problems in postmenopausal women.

So the ans to the asked mcq is [B] Cardiovascular manisfestation.

CONTRAINDICATIONS TO HRT  : Relative contraindications are as a history of breast cancer/endometrial cancer , Porphyria, Severe active liver disease, Hypertriglyceridemia, Thromboembolic disorders, Undiagnosed vaginal bleeding, Endometriosis, Fibroids.

POTENTIAL RISKS OF HRT :

  • Breast cancer (slightly increased risk after at least 5 years of continuous use )
  • Endometrial cancerand uterine hyperplasia
  • Thromboembolism
Advertisements