((Hormone replacement therapy))
Climacteric and menopause is one phase
in woman”s life
It is associated with health changes and
Hormone replacement therapy needed to
improve quality of life and prevent medical
complications which follow menopause
Menopause is the last menstrual period
the average age is 51 years.
Climacteric is transition from fertility to
infertility from 45-55 years.
Women live 40% of her life in menopause.
The first endocrine change in menopause
is fall in inhibin(glycoprotein) from ovaries
which inhibit the release of FSH and LH
from pituitary,so FSH and LH rise.
Causes of menopause
A)Premature ovarian failure
Menopause occuring before 45 years,low
May be associated with autoimmune
B) Surgical menopause
Menopause after oophorectomy,after
hysterectomy menopause occurs about 3
years earlier the natural menopause.
C) After chemotherapy or radiotherapy as
breast cancer or lymphoma.
Diagnosis of menopause
Low oestrogen(E2 10-50pg/ml)
High FSH&LH >10IU/L
Total cholesterol increase
HDL cholesterol decrease
LDL cholesterol increase
Vsomotor symptoms(disturbance in the
thermoregulator in the hypothalamus) occur in
70% of women.
Frequency – few to several times per day.
Duration –weeks to years.
Hot flushes followed by sweating.
anxiety and lethergy.
2. Intermediate changes(2-4 years,collagen )
Wrinkled skin,small breasts.
Genital tract,thin and dry vagina,acidity
reduced infection,dysparunia and
and stress incontnence.
3.Late changes(>10 years)
of neck femur and vertebral crush fracture)
CVS,stroke and heart attacks.
Treatment:Hormone Replacement Therapy
Depend on the presence and severity of
Careful counselling before treatment.
Pelvic examination,look for oestrogen
Benefits of HRT
Cure early symptons of menopause.
Prevent fractures in about 50%.
Reduce heart attacks in about 40%.
Reduce bladder dysfunction.
May prevent against bowel carcinoma and
Contraindications of HRT
Present or suspected pregnancy
Suspicion of breast cancer
Suspicion of endometrial cancer
Active liver disease
Presence of fibroid
Past history of benign breast disease
Chronic liver disease
Preparations of HRT
Natural oestrogens(from plants or animal)
Oestradiol valerate 1-2mg
Congugated equine oestrogens
Medroxyprogesterone acetate 10mg
Post-hysterectomy : use only oestrogens
Add progestogens at least for 12 days of
28 days for non-hysterectomized patient.
Combined oral oes. And prog. (pills 28
Combined oes. And prog. In patch(weekly)
Oestrogen gel rubbed into the skin daily
Inplant s\c for one year
Vaginal(cream,pessary,tablet for local
Has oestrogenic,progestogenic and
Used 1year after menopause 2.5mg daily
Selective oestrogen receptor modulator
Does not stimulate breast and endometrial
May worsen vasomotor symptons
Side effcts of HRT(first 12 weeks)
Breast tenderness and nipple sensitivity
Appetite rise and weight gain
Patient must reviewed 6 months then