Download - Falencia ovariana
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Hormone Replacement Therapy in Premature Ovarian Failure
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HRT in POF Vs Natural Menopause
►True example of replacement therapy Vs extension therapy
►Started at time of diagnosis AND continued till natural age of menopause
► No long-term ill effects (WHI study) as estrogen years are not increased
►Full dose long-term Vs low dose short-term►5-10% will resume spontaneous ovulation &
menstruation
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Tailor HRT According to Type of POF
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Type I POF - Prepubertal
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Individualize the Treatment
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14 years Turner’s mosaic
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Counseling of the girl & parents COC pillsOccasionally can conceive
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Types of HRT Regimens
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Estrogen Preparations- Indian MarketMarket name Molecule Strength Prep Dose
Evalon Estriol succinate 1.0mg Tab 8-16mg/day
Premarin CEE 0.625mg Tab 0.625mg/day
Progynova Esradiol valerate 1.0mg/2mg Tab 2mg/day
Estraderm patchOr Susten 50
Estradiol 25/50/100 цg patch 1 every 4 days 50 цg
E 2 GelOr Sandrena gel
Estradiol 1.5mg/2.5g1mg/gm
Dermal gel Once a day
Estaspray Estradiol 0.375mg Dermal spray 1-3 accutations/day
Premarine gel CEE 0.625mg/gm Daily x 2weeksVaginal gel then twice a weekEvalon gel Estriol 1mg/gm
E 2 Gel Estradiol 0.025mg/gm
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Transdermal Estrogens
Estragel 1.5mg/2.5g OD
EstaSpray 0.375mg BD
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Currently there appears to be no clear advantage of the transdermal over the oral route
Oral estrogens• Blood levels
• Lipoproteins LDL ↓ HDL ↑ Lpa ↓Prevent oxidation yes TGL ↑• CRP ↑ • SHBG, TBHG ↑• Coagulation factors ↑
Transdermal
more stable, square dose curve
↓ or same same ↓ or same yes same No effect No effect less effect
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Progesterone preparations-Indian MarketDrug Route Sequential (10-14 days) continuous
MPA Oral 5mg daily 2.5mg daily
Norethisterone Oral 1mg daily 0.3 mg daily
Norethindrone Oral 2.5mg daily 0.5mg daily
Dydrogesterone Oral 10mg daily 5mg daily
Drospirenone Oral - 2mg daily
Natural progesterone Oral 300mg daily 200mg daily
Natural progesterone Vaginal 200mg daily 100mg daily
Natural progesterone Vaginal gel 45mg daily 45mg daily
LNG-IUS Intra-uterine _ 20mcg daily
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Various options Tiboloneo Steroido Metabolites are activeo Mildly estrogenic
progestogenic androgenico Amenorrhoeao Good for VMS, libido, boneso No change in breast densityo Endometrial bleeding -5%
• 0.625 mg premarin + MPA 5mg 12 days
• Estragel/estaSpray + LNG IUS or MPA
• Angeliq 1 OD
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Type III POF - Iatrogenic
• Sudden & precipitous fall of estrogens – severe symptoms VMS, risk of CHD, osteoporosis, suicidal depression
• Lack of androgens – lack of energy & libido
• Need to start ET early while in the hospital & full dose or may be higher dose
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HRT in Surgical Menopause
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HRT in Cancer Survivors
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Stem Cell Transplant - POF
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HRT - POF
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Premature ovarian failure Not your failure