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MENOPAUSE (HORMONAL THERAPY (RISKS AND SIDE EFFECTS (GENERAL (nausea,…
MENOPAUSE
HORMONAL THERAPY
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women who have not undergone a hysterectomy should be on a regimen with progestogen to reduce risk of endometrial cancer assoc with unopposed oest therapy
ALTERNATIVES
TIBOLONE
weak oestrogenic, progestogenic and androgenic effects
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RALOXIFENE
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Has oestrogenic effects on bone and lipid metabolism but has minimal effect on uterine and breast tissue
therefore ineffective for controlling perimenopausal symptoms but useful in protecting against osteoporosis and it does not cause vaginal bleeding
RISKS AND SIDE EFFECTS
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ENDOMETRIAL CARCINOMA
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the levonorgestrel -releasing intrauterine system (MIRENA) protects the endometrium, effectively when used in conjunction with oest-only HRT in postmenopausal women
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CONTRAINDICATION
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use of oest containing HRT contraindicated following breast carcinoma (including intraductal carcinoma) and following advanced endometrial carcinoma
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ADMINISTRATION
transcutaneous = avoid GI SE and minimise effect on hepatic production of lupoproteins and coag factors
subcut implant = 6mth intervals, testost implant can be used when there is low libido
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DIAGNOSIS
May be confused with premenstrual syndrome [PMS], depression, thyroid dysfunction, preg, phaeochromocytoma, carcinoid syndrome
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if diagnostic doubt - therapeutic trial of HRT - absence of satisfactory response = symtpoms unrelated to low level of oest
NON HORMONAL TREATMENT
FOR VASOMOTOR SYMPTOMS:
SSRI shown to be effective (fluoxetine/paroxetine)
SNRI (venlafaxine)
CLONIDINE = acts directly on hypothalamus - no more effective than placebo
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In elderly women, supplementationwith calcium, calcitonin and vit D reduces risk of hip fracture
OSTEOPOROSIS
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increased rate of fractures: distal radius, vertebral body, upper femur. wedge compression fracture = dowager's hump
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