Hormones in gyenecology

HORMONES IN GYNAECOLOGY

Hormonal replacement therapy
Oestrogen:there is general agreement now that the patient should be started on the minimum effective dose of oestradiol and increase the dose only if needed.exogenous oestrogen are associated with increase d risk of breast cancer,heart disease and venous thromboembolic risk.it can be given systemicaly or localy

the minimum dose of currently available systemic oestrogen are:

0.3-0.625 mg oral conjugated equine oestrogen
1 mg oral micronized oestradiol
25-50 mcg transdermal oestradiol
25-50mg implant
150mcg nasal oestradiol
50mcg oestradiol ring

Exception to this low dose rule are woman with premature ovarian failure who need high dose of oesrogen.
Route of administration:
Oral route partialy metabolized in the liver and do not fully restore the natural ratio 2:1oestradiol:oestrone.
Transdermal patch twice or once weekly.
Transnasaly in pulsed manner. The nasal,gel,ring preparation should be combined with progestogen in female with uterus.


Local(vaginal):recent creams contain oestriol do not produce endometrial hyperplasia (0,01%oestriol cream and pessaries ).
Premarine cream-can potentially cause endometrial hyperplasia and should not be used more than 3 months without progestogenic opposition.

Progestogen

The progestogens are added for endometrial protection .
It is generally accepted that female commencing HRT should start on sequential (continuosus oestrogen with 12 to 14 days progesterone.
Types:
C19-testosterone derived
progestogen(norethisterone,levonorgestrel,norgestrel )
C21-progestrone derived progestogens(dydrogesrone,medroxy progesrone acetate,cyclogest,crinone gel)
Bleeding problems:if bleeding is heavy either increase the dose or durationto 21 days .persistant bleeding more than 6 months warrant IX by u/s and endometrial biobsy.

Progestogenic side effects include fluid retention ,androgenic side effects such as acne ,hirsuitism,mood swings .
To minimise these effect we either decrease the dose or the duration or use intra uterine system or
. (drospirenone(spironolactone analogue

TIBOLONE (LIVIAL):

WORKS BY MIMICKING THE ACTIVITY OF SEX HORMONE OESTROGEN,PROGESTOGENE,AND ANDROGENIC ACTIVITY.
Helps to treat hot flushes and night sweatsand to prevent oeteoporosis.dose is 2.5 mg per day in continuous manner..
Contraindication of HRT:
Personal or family history of breast cancer.
Hormone dependant tumors
Unexplained vaginal bleeding
Liver disaese or renal disease
High level of TG or cholestrol
thrombophilia


Angina or MI
Migraine
Gallstone
Porphyria
Patient with history of endometrial cancer??