Hormone Therapies In Obstetrics And Gynaecology

HORMONE THERAPIES IN OBSTETRICS AND GYNAECOLOGY BY ME AZIKEN UBTH/UNIBEN

Hormone use in gynaecology • • • • • • •

Inducing second sexual Xtics in some pts PMS. COC to suppress ovulation Medical Rx of Fibroid. GnRHa Medical Rx of endometriosis. GnRHa Infertility management Management of menopausal symptoms ***Obst== early pregnancy support

Menopause and HRT • Menopause – cessation of ovarian function • Climacteric- period of decline in fertility and sexual function- 10yrs before M.pause • Increasing---more menopausal women and problems

Pathophysiology of menopause • Decline in Primordial follicle even before birth • Marked decline before menopause→ -↑H-Pit activity 10yrs before Menopause -Anovulation +luteal phase inadequacy -DUB • At menopause E2 declines dramatically and menstraution ceases • Ovarian stroma → androgen →peripheral conversion to estone • Absence of E2 →symptoms

Symptoms of menopause • Acute=Neuroendocrine Hot flush, night sweat, insomnia,mood changes, anxiety, irritability, loss of memory and concentration (soon after) • Lower urogenital tract atrophy= dyspareunia, loss of libido, urethral syndrome (months later) • Arterial and Skeletal= Coronary heart dx (Years later) Thrombosis Osteoporosis and #

Investigations • Hormone assay • Bone density assessment • Serum lipid profile. HDL, LDL cholesterol and Triglycerides • Others

Treatment: use of HRT in menopause • E2 takes care of the neuro-endocrine symptoms • Concerning CHD: What is the current position?

• Osteoporosis: What is the benefit?

HRT and CVS dx • Cardiovascular dx: a leading cause of death of PM women because of Changes in lipid profile and withdrawal of E2 effect on vessels • Early epidemiological studies suggest beneficial effect of HRT on Cardiovascular dx • Recent randomized trials show no such benefits

Heart and E/P replacement study (HERS) • Randomized • No CHD benefit among women with stable CHD • Increase risk of Thromboembolic events • Hulley et al : Randamized trial of E+ P in secondary prevention of CHD in PM women. J Am Med Assoc 1998; 280:60513

Women’s health initiative trial(WHI) • Largest trial in this field: 16,000 women enrolled • Aim: test if HRT protected against CHD • 0.625mg cong eq E +2.5mg medroxyp acetate daily OR Placebo • 5yrs later= Higher incidence of Br Ca, myocardial infarction, strokes and pul emb • Reduction in colorectal ca and # • Trial was stopped

The Million women Study Lancet 2003;362:419-28 • Risks and Benefit of HRT in women aged 50-64 • UK based study: data from women attending for Breast screening as part of a national health br screening programme • Current users of E+P has increased risk o Br ca • E alone has lower risk than E+P • Recomm by UK comm on Safety medicin

Recommendations • Short term use:2-3 yrs to control vasomotor symptoms • Longer term use for prevention of Osteoporosis: Need to counsel pt on alternative means of preventing osteop • Individualize patient care • Reappraise Risk and Benefit • HRT should not be promoted as prevention for CHD

HRT and Osteoporosis • Osteo affect 70% of women over 80yrs in UK • 60,000, 50,000 and 40,000 hip, colles and Vertebra #s respectively occur in UK annually === mort, morb and cost implication • HRT (E alone or E+P) increases bone mass and not just maintaining it. • Alt= Tibolone, Ca supplement, Biphosphonates and physical exercise.

Other Menopausal cond and HRT • Bladder symptoms. E2 is beneficial • Alzeimers disease- affect 50% of women over 85 yrs. HRT reduces the risk

Various presentations of HRT • • • • • • •

E2 ± P Oral Patches Implants Vaginal ring Gel Nasal spray **Any Invest b4 HRT. Not really but can do opportunistic screening and investigate any abnormal bleeding

CONCLUSION

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