Hormone Treatment

Hormone Treatment



Hormone Replacement Therapy - HRT

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Cyproterone Acetate Side effects: Excess body hair in Women Treatment
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Danazol - Side effects
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Diane 35 (Dianette) Side effects: includes cyproterone acetate
Dianette (Diane 35)- includes cyproterone acetate for the treatment of Hirsutism and Acne
Dianette (Diane 35) Side effects: includes cyproterone acetate for treatment of Hirsutism and Acne
Duloxetine Hydrochloride - Benefits For Stress Incontinence Of Urine
Duloxetine Hydrochloride - Benefits For Stress Incontinence Of Urine
Femulen is a progestogen only contraceptive pill - Mini Pill
Angeliq: An Oral HRT With Drosperinone Recommended In High Blood Pressure Patients
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Premarin Hormone Replacement Therapy HRT for Menopause Symptoms
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Noriday is a progestogen only contraceptive pill - Mini Pill
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Femodene Third Generation Oral Contraceptive Pill - Side effects:
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Loestrin Side effects: A combined pill with norethisterone
Logynon A combined pill with norethisterone
Marvelon Third Generation Oral Contraceptive Pill with Desogestrel
Marvelon Side effects: Third Generation Oral Contraceptive Pill with Desogestrel
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Mercilon Side effects: Third Generation Oral Contraceptive Pill with Desogestrel
Microgynon 30 A combined pill with norethisterone
Microgynon 30 Side effects: A combined pill with norethisterone
Yasmin A combined pill with drosperinone
Yasmin Side effects: A combined pill with drosperinone
Ditropan - oxybutinin - Overactive Bladder Syndrome Treatment
Atrophic Vaginitis - Dry Vagina - Menopause Painful Sex - Topical Estrogen - HRT
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Yasmin A combined pill with drosperinone
Yasmin A combined pill with drosperinone
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Premarin Cream - Symptom Relief For Atrophic Vaginitis
Premarin Hormone Replacement Therapy HRT for Menopause Symptoms
Premarin Cream
Atrophic Vaginitis - Dry Vagina - Menopause Painful Sex - Topical Estrogen - HRT
Hirsutism - Excess body hair in Women - Causes Invetigation and Treatment
Dianette (Diane 40)- includes cyproterone acetate for the treatment of Hirsutism and Acne
Noriday is a progestogen only contraceptive pill - Mini Pill
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The Combined Oral Contraceptive Pill: What is the contraceptive patch - Evra?
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Micronor is a progestogen only contraceptive pill - Mini Pill
Noriday is a progestogen only contraceptive pill - Mini Pill
Microgynon 30 A combined pill with norethisterone
Ditropan - oxybutinin - Overactive Bladder Syndrome Treatment
Vagifem Tablets Treatment Relief for Atrophic Vaginitis
Vagifem Tablets Treatment Relief for Atrophic Vaginitis
Vagifem Tablets Treatment Relief for Atrophic Vaginitis
Venlafaxine-Efexor
Yasmin
Yasmin A combined pill with drosperinone
Yasmin A combined pill with drosperinone
Diane 35 (Dianette) Side effects: includes cyproterone acetate
Cyproterone Acetate Side effects: Excess body hair in Women Treatment
Dianette (Diane 35) Side effects: includes cyproterone acetate for treatment of Hirsutism and Acne
Femodene Third Generation Oral Contraceptive Pill - Side effects:
Cerazette Side effects: Oral Progestogen only pill With Desogestrel
Danazol - Side effects
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Microgynon 30 Side effects: A combined pill with norethisterone
Overactive Bladder Syndrome - Cause, Symptoms and Treatments
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OESTROGENS FOR HRT

Cautions

  • prolonged exposure to unopposed oestrogens may increase risk of developing endometrial cancer (see notes above);

  • migraine (or migraine-like headaches);

  • diabetes (increased risk of heart disease);

  • history of breast nodules or fibrocystic disease closely monitor breast status (risk of breast cancer, see notes above);

  • risk factors for oestrogen-dependent tumours (e.g. breast cancer in first-degree relative);

  • uterine fibroids may increase in size, symptoms of endometriosis may be exacerbated;

  • factors predisposing to thromboembolism (see notes above);

  • presence of antiphospholipid antibodies (increased risk of thrombotic events); increased risk of gall-bladder disease reported; hypophyseal tumours;

  • porphyria (see section 9.8.2); interactions:Appendix 1 (oestrogens)

Other conditions

The product literature advises caution in other conditions including

  • hypertension,

  • renal disease,

  • asthma,

  • epilepsy,

  • sickle-cell disease,

  • melanoma,

  • otosclerosis,

  • multiple sclerosis, and

  • systemic lupus erythematosus (but care required if antiphospholipid antibodies present, see above).

Evidence for caution in these conditions is unsatisfactory and many women with these conditions may stand to benefit from HRT.

Contra-indications 

  • pregnancy;

  • oestrogen-dependent cancer,

  • history of breast cancer,

  • active thrombophlebitis,

  • active or recent arterial thromboembolic disease (e.g. angina or myocardial infarction),

  • venous thromboembolism, or history of recurrent venous thromboembolism (unless already on anticoagulant treatment),

  • liver disease (where liver function tests have failed to return to normal),

  • Dubin-Johnson and Rotor syndromes (or monitor closely),

  • untreated endometrial hyperplasia,

  • undiagnosed vaginal bleeding,

  • breast-feeding

side effects

  • nausea and vomiting,

  • abdominal cramps and bloating,

  • weight changes,

  • breast enlargement and tenderness,

  • premenstrual-like syndrome,

  • sodium and fluid retention,

  • cholestatic jaundice,

  • glucose intolerance,

  • altered blood lipids?may lead to pancreatitis, rashes and chloasma,

  • changes in libido,

  • depression,

  • mood changes,

  • headache,

  • migraine,

  • dizziness,

  • leg cramps (rule out venous thrombosis),

  • vaginal candidiasis,

  • contact lenses may irritate;

  • transdermal delivery systems may cause contact sensitisation (possible severe hypersensitivity reaction on continued exposure), and headache has been reported on vigorous exercise

Withdrawal bleeding

Cyclical HRT (where a progestogen is taken for 12?14 days of each 28-day oestrogen treatment cycle) usually results inregular withdrawal bleeding towards the end of the progestogen.

The aim of continuous combined HRT (where a combination of oestrogen and progestogen is taken, usually in a single tablet, throughout each 28-day treatment cycle) is to avoid bleeding, butirregular bleeding may occur during the early treatment stages (if it continues endometrial abnormality should be excluded and consideration given to cyclical HRT instead)

Dose

Counselling on patches

Patch should be removed after 3?4 days (or once a week in case of 7-day patch) and replaced with fresh patch on slightly different site; recommended sites: clean, dry, unbroken areas of skin on trunk below waistline; not to be applied on or near breasts or under waistband. If patch falls off in bath allow skin to cool before applying new patch

Table 28.1 - TOPICAL OESTROGENS

Preparation

Oestrogen

Company

Ortho-Gynest Pessaries

Oestriol 500 g

Janssen-Cilag

Ortho-Gynest Cream

Oestriol  0.01%

Janssen-Cilag

Ovestin Cream

Oestriol 0.1%

Organon

Ovestin Pessaries

Oestradiol 1mg

Organon

Premarin  Cream

Conjugated oestrogens 625 mg

Wyeth

Vagifem Pessaries

Oestradiol 25 microg

Novo Nordisk

Estring Ring

Oestradiol (7.5 microg release/day)

Pharmacia and Upjohn

The oestrogen can be administered

  • orally (tablets –Table 28.2),
  • transdermally (patches –Table 28.3 and Table 28.4 or gels),
  • subcutaneously as implants (Figure 28.1),
  • as a nasal spray (Aerodiol – estradiol hemihydrate - Servier)
  • vaginal ring (Menoring – estradiol acetate – Galen Ltd).

The nasal spray and vaginal ring methods have been introduced in 2001.

Table: 28. 2 (29/07/08)

PREPARATION

OESTROGEN

DOSE (mg)

COMPANY

Bedol Oestradiol 2  

Climaval

Oestradiol valerate

1 and 2

Novartis

Elleste Solo

Oestradiol

1 and 2

Searle

Harmogen

Oestrone

1.5

Pharmacia and Upjohn

Hormonin

Oestriol/Oestrone/oestradiol

0.27/1.4/0.6

Shire

Premarin

Conjugated Oestrogens

0.3,0.625 and 1.25

Wyeth

Progynova

Oestradiol valerate

1 and 2

Schering

Zumenon

Oestradiol

1 and 2

Solvay

 

Table 28. 5 Se quential HRT preparations (cyclical progestogen tablets).

PREPARATION

OESTROGEN/PROGESTOGEN

 mg

COMPANY

TABLETS

Nuvelle

Oestradiol / Levonorgestrel

2 / 75mcg

Schering

Climagest 1 mg

Oestradiol / Norethisterone

1 / 1

Novartis

Climagest 2 mg

2 / 1

Novartis

Clinorette Oestradiol 2 / 1