What are the available
options before us if we decide for & woman concerned agrees to accept for hormonal
tr for certain specified period?? The followings are the drug options
for women with intact uterus? 1) Cyclical basis, not continuous:-Conj.
Oestrogen alone for 3 weeks—gap for 7 days --- cyclical. 2) Continuous combined :-Conj. Oestrogen
& MPA (0.625 & MPA 2.5 mg as daily basis 3) Sequential but combined
i.e. same formulation for 3 weeks and 1
week off. 4) Same formulations: Monday
to Friday. 3) Low dose daily Oestrogen only i..e. Premarin 0.3mg.
4) Continuous combined:
oestrogen and cyclical progesterone 5) Tibolone 6) Progesterone alone (Norethindrone alone Noreta HRT 1 mg-
but what about ? breast Ca if she don’t report for regular check up
à say lost to follow up ??
The other
options:-. What are hormonal
options available as HRT for a woman who had hysterectomy & BSO? 1) Conj. Oestrogen alone for 3 weeks-
cyclical 2) Continuous combined
Conj. Oestrogen & MPA 3) Tibolone.
Q. 4:-Any scope of Inj.
Androgens./ Tab form in menopause??
Ans: Not very much. ---> Only in selected cases where there is poor sex
drive !! May be!! . Drug are 1) Restore Tab?
ESTRATEST TAB( E 2 & Methyl Testosterone tab/ Mesterolone/ provironum )
Q. 5:-Is it true that Prog Challenge test should be always employed
before initiation of HRT. If she bleeds HRT should be avoided. What
about Tibolone? Should we do such PCT ??
. Q 6:-. Is there any chance of systemic absorption if someone
uses EVALON CREAM for years together? Q. 7: Someone
is having bleeding after Tibolone Ry.--What should be done? What are the possible causes in such
situation? Hysteroscopy after USG. Or wait & watch.
Q. 8. Any member prescribes alpha Calcidol? Is there any clinical
situation where one has to estimate ration of E2/E1 (menopause = 0.23)
Q, 9:--What about
Transdermal oestrogen suppl in Indian context? PATCH / CREAMS? Which one members prefer in Indian context (Non oral
HRT maintain E2/E1 ratio in a better way-acceptable to us- i.e. above 1. Why it has not become that popular? I believe in cases where high dose of
oestrogens are not wanted the one can opt for skin patches/implants (slow
release) e.g. CHD, HTN, DM,
Estraderm /oetsrogen/Sandrine
gel/ IMPLANTS?
VAGIFEN(sustained
Release E2 Novo Nerds co.)
Q, 8:- Is Indian Menopausal Society is
propagating this message to gynecologists?
It is often
quoted that HRT should be usually administered for about 7 yrs after attaining natural menopause unless
there is some medical Sytemic compl./
local pathology .Is that true? Or some members like to stop oat 52 yrs of age? In
cases of family H/O Br Ca-avoid oestrogens or Progesterone as HRT? What about following
agents
ESPAUZ (G. R). NORETA HRT 1mg Norethindrone,
Styptin 5mg. Premelle . Prempro,
Progynova (E1?-oestrone? Oetradiol Valerate) , Evalon Cream
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