Q.1. Does all healthy (disease free)
& symptomless women mandate HRT as soon as she achieves menopause? In such
healthy women what will be ideal HRT (first choice) and what will be the time
of initiation of HRT? AT what time such healthy women (absence of DN, HTN, and
hyperlipidaemia) --- such HRT should be stopped. What will be rough annual cost
of such HRT in perfectly well woman excluding the cost of monitoring due to
drug?
What is your/Society’s view on routine calcium and
Vit. D suppl. to all Indian women after attaining the age of 35 yrs.
If you do approve such suppl at what age you propose to stop such nutritional
suppl. Any monitoring during such Ry or side effects.
Q.2. Do you routinely prescribe/inject some oestrogen if you
perform TAH and BSO before she leaves nursing home? On which postoperative day
you would be happy to initiate HRT if you perform oophorectomy concurrently /
do not sacrifice ovaries? What should be usual choice of HRT in medically fit
women after TAH & BSO?
Q.3. What HRT will
be ideal for women suffering from some medical diseases
like DM, HTN, IHD (CAD), Hyperlipidaemia, Chr. Joint disorders, Hyperuricaemia
etc. etc?
Q.4. what important prophylactic steps doctors/gynecologist
usually misses or usually does not advice in premenopausal years to prevent bone loss/ breast cancer?
What are the lapse on the part of doctors that cause much annoyance to people
like you who are more concerned about pre/postmenopausal wellbeing of Indian
women?What will be your message to people like us?
Q.5. what are the different pharmaco-prophylaxis of
osteopenia /osteoporosis in postmenopausal years excluding aerobic exercises.
From our experience we have learnt that they seldom undergo exercises as
prescribed. There is no point in denying this.
Q. 6. What are the usual prophylactic therapeutic measures
to protect Breast malignancy? Is any drug available to prevent Breast
malignancy? What will be HRT of choice in cases with family history of Breast
Cancer/personal history of having fibroadenosis of breast? What type of HRT
will be safe in a woman with mammographic evidence DENSE BREAST?
Q.7. the investigative process of mammography is
underutilized in India: what is your view on this personal feeling? To put in
other way what are the usually globally accepted indications/ recommendation of
mammography in otherwise asymptomatic women. Any
difference of timing in women who are on HRT and who are not on HRT.
What is the list of Pretests prior to initiation of HRT? Any
difference with hormonal/ nonhormonal HRT in this regard?
Q. 8. What is your
opinion on routine
evaluation of bone health by BMD?
/ T—Score?
Q.9. your views on multi-vitamin supplementation in
otherwise health asymptomatic women? There are several drugs / brands of such
nutritional supplements claimed as the ANTIOXIDANTS for post menopausal women?
Does your Society approve such supplementation?
Q.10 what is your
stand / stand of your Society on estimation of serum Vit D & Homocysteine
level on four yearly basis and then
supplementing such drugs as on demand basis or do you routinely prescribe such
drugs on empirical basis.
Q. 11. What type of HRT will be most suitable for women
whose father and mother has died in sixth decade of life due to M.I. and she
herself is suffering from hyperlipidaemia?
Q. 12.
Role of Biphosphonates in modern era: Postmenopausal osteoporosis is a nightmare
for orthopedic surgeons. Do all women who are on tibolone Ry / CEE& MPA
Ry mandate Anti-resoprtive therapy
concomitantly? Which HRT do not take care of bone health? It is our experience
that most Indian women would not exercise or take milk or other healthy foods
inspite of our advice. Such is the experience when we advocate attending Gym
for PCOS girls. Mm
If compliance is poor (which is true for most Indian women-
who are less aware of consequences of bone loss) - then question of antiresorptives
come in. Should you recommend routine calcium and vitamin D supplementation to
all women after the attaining age of 35 yrs? Or wait till Lab evidence of
osteoporosis is evident. What is the harm if we routinely prescribe Biphosphonates after
certain age say, 35yrs? We are aware of its toxicity and side effects. But what
else can be initiated to prevent bone loss if she is non compliant ion life
style. Do all HRT mandate co
prescription of Biphosphonates (Alendronate/residronate) to ensure good bone
health. Or else such antiresorptives are prescribed in documented cases of
osteopenia along with Tibolone/CEE/MPA Ry?
What is your recommendation? If so how long such Biphosphonates
(Alendronate/residronate) are to be continued. Any monitoring during such long
term Biphosphonates therapy?
What about calcitonin & Isoflavones
in routine clinical practice? Isoflavones have become popular in rural areas.
As it is like soft protocol of stimulation in subfertility practice. What is
your considered opinion on Isoflavones?
Q.13. Quite often elderly women suffer from Vulvar pain or vaginal soreness with no
clinically demonstrable lesion. Is there any HRT locally or injectable which
may benefit such women? What will be treatment of choice of Vulvar soreness in
postmenopausal women?
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