Tiêu đề Women Health- I- Imtiyaz Medical_Dr A.Ibarhim.pdf ✅

Dr.Amr Ibrahim MB ChB, MD, Alexandria University, Egypt MSc, University of Tsukuba, Japan
▪ A case wanting to start HRT. ▪ A case would like testosterone for low libido. On HRT and SRRI. ▪ A case of bleeding while on HRT. ▪ A case for contraception advice in perimenopause / while on HRT. ▪ Another case but not HRT – Post menopausal bleeding
▪ Ask about LMP, and still period (how often, is it heavy , is it very painful). ▪ Vasomotor: any hot flushes, any night sweating ▪ Mental: any mood changes, any low mood, sleeping issue, memory issue, any issue with concentration. ▪ Urogenital: any pain when you wee, any discharge from down below, any itchiness, any bleeding, any pain during or after sex, any bleeding during or after sex. ▪ Did you try something to help with these symptoms? ▪ If wanting menopause Rx: any ongoing diarrhoea or previous bowel issue? ▪ Lifestyle (Important), esp eating, physical activity, alcohol, smoking ▪ Impact on life. ▪ If pt wanting HRT , please don’t forget to ask about the CI Qs !!! ▪ ICE
Menopause Perimenopause Early Menopause Pre-mature menopause 12-month period free + other symptoms Period indicating approaching menopause Irregular period + other symptoms Menopause between 40- 45 Y Menopause <40 Y Dx Mainly clinical – Please Please remember this ! DD: pregnancy (2 years and 1 year) , endocrine disorders, psychological problems. CI to HRT Breast cancer now or before Oestrogen dependent cancer Undiagnosed PVB Untreated endometrial hyperplasia DVT (unless on AC) now or before Arterial thromboembolism now or recent Active liver disease with abnormal LFTS. Preg Thrombophilic disorder Risks 1. VTE => Slight ↑ in the risk with oral HRT. If Transdermal at stranded dose, no ↑ in the risk. 2. CVD => Combined HRT: slight ↑ in the risk, EHRT: No ↑ in risk. Also, no ↑ in Risk if started < 60 years old. 3. Stroke => Oral HRT (not transdermal): slight ↑. 4. DM => No ↑ in the risk. 5. Breast Cancer => Combine HRT: Slight ↑, EHRT: Slight or no ↑. 6. HRT doesn’t affect the risk of dying from breast Ca or CVD.