Major source of estrogen in postmenopausal women is
Peripheral conversion of androstenedione
Secretion from adrenals
Testosterone from the ovary
H
All postmenopausal and symptomatic per menopausal women who do not have contraindication paicularlyThose with high-risk factors osteoporosis.Those with premature menopauseEvaluation before staing H:History-personal, medical, gynecological, familyExamination -HT, wt., BMI, BP, breast, vaginal examinationPap smearMammographyLipid profileTransvaginal sonography-endometrial thicknessWork up relevant to symptoms, e.g. urinary continence, carbohydrate intolerance, psychoemotional states.Contraindications of H:PregnancyCA breastCA endometriumUndiagnosed abnormal vaginal bleedingActive liver diseasePresent deep vein thrombosis, thromboembolic disorderInvestigation not routinely needed before staing HEndometrial sampling-Only did if the history of abnormal vaginal bleeding, TVS shows endometrial thickness> 5 mm.Serum FSH-Only did if the diagnosis of menopause is not clear, e.g. vasomotor symptoms in absence of amenorrhoea Bone densitometry-Using DEXA (dual energy X-ray absorptiometry) of lumber veebrae, hip bone for women with risk factors for osteoporosis, persistent backache, bone aches, history of recent fracture, for research purpose
Menopause and HRT