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; 280:605-
13
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

• THANK YOU.