HOMONEREPLACEMENTTHERAPY(HRT)：激素替代疗法（HRT）.pptVIP

HOMONE REPLACEMENT THERAPY (HRT) HOMONE REPLACEMENT THERAPY (HRT) s Sequentially combined HRT E(continuously D1-D21) P(sequentially D11-D21) Continuous combined HRT E P (continuous: D1-D28) HOMONE REPLACEMENT THERAPY (HRT) Women with an intact uterus Vasomotor symptoms Perimenopausal: systemic cyclical combined HRT . Postmenopausal: systemic continuous combined HRT or tibolone. Urogenital symptoms Perimenopausal: low-dose vaginal oestrogen or systemic cyclical combined HRT. Postmenopausal: low-dose vaginal oestrogen or systemic continuous combined HRT.  HOMONE REPLACEMENT THERAPY (HRT) Women who have had a hysterectomy Vasomotor symptoms: systemic oestrogen-only HRT. Urogenital symptoms: low-dose vaginal oestrogen or systemic oestrogen-only HRT.  HOMONE REPLACEMENT THERAPY (HRT)  HOMONE REPLACEMENT THERAPY (HRT)  CONTRAINDICATIONS OF HRT! Pregnancy and breast-feeding Undiagnosed abnormal vaginal bleeding Venous thromboembolic disease Active or recent angina or myocardial infarction Suspected, current or past breast cancer Endometrial cancer or other oestrogen-dependent cancer Active liver disease with abnormal liver function tests  START-UP SYMPTOMS OF HRT! Breast tenderness Nipple sensitivity Bloating Nausea, headaches Appetite Weight gain Leg cramps  INVESTIGATIONS BEFORE HRT! Investigations are not usually necessary before starting HRT unless there is : sudden change in menstrual pattern (IMB/PCB) High risk of breast cancer Personal /family history of VTE Woman has arterial risk factors  ALTERNATIVE TO HRT! “ Tibolone” is a synthetic hormone that acts in the same way as HRT (SERM) Useful for post-menopausal women who want to end their periods. Which has oestrogenic, progestogenic and androgenic properties. (estrogenic activity in bone, CNS vasomotor suppression of hot flushes and helpful in improving sexual function .  STARTING HRT! “A full physical examination is mandatory” Full blood count Renal Profile - Baseline Liv