1.
HORMONE
REPLACEMENT
THERAPY
PRESENTED BY:
LAMNUNNEM HAOKIP
MSC (N) 1ST YEAR
UNDER THE SUPERVISION OF
SHILPY MA’AM

2.
DEFINITION
MENOPAUSE
Permanent cessation of menstruation at the end of
reproductive life of a woman.
HORMONES
They are special chemicals that our body makes.

3.
CHANGES IN THE BODY
AFTER MENOPAUSE
CHART

4.
Estrogens
• There is a sharp fall in estrogen and also the trophic
hormones. The woman is said to be in s state of true
menopause.
Progesterone:
• Due to loss of ovarian reserve, the progesterone
levels are decreased markedly also known as Anti-
Mullerian Hormone.

5.
Organ changes
• Ovaries: Shrink in size, become wrinkled and white.
• Fallopian tubes: Show feature of atropy.
• The uterus: Become smaller, the endometrium
become thinner and atrophiv.
• Vagina: becomes narrower due to gradual loss of
elasticity.The vaginal pH become alkaline.

6.
• Vulva: Shows feature of atropy, labia becomes
flattened and pubic hair becomes scantier.
• Breast fat: fats reabsorbed and glands atrophy,
nipples decrease in size. The breast becomes flat and
pendulous.
• Bladder and urethra: thin and more prone to
damage and infection.
• Loss of muscle tone: uterine descend, pelvic
relaxation.

7.
SYMPTOMS OF MENOPAUSAL
TRANSITION
FLASH CARDS

8.
Menstrual changes
• Short cycles
• Irregular bleeding.
Vasomotor Symptoms
• Hot flushes
• Night sweats
• Sleep disturbance
Psychological
• Irritability
• Mood swings
• Poor memory
• Depression

9.
Sexual dysfunction
• Vaginal dryness
• Dyspareunia
Urinary
• Incontinence
• Urgency
• Dysuria
Others
• Backaches
• Joint aches

10.
HORMONE
REPLACEMENT
THERAPY
HRT is indicated in menopausal women to overcome
the short term and long term consequences of
estrogen and progesterone deficiency.
HRT is a treatment for women who have low
hormone levels.

11.
INDICATIONS OF HRT
PAMPHLETS

12.
• Relief of menopausal symptoms.
• Relief of vasomotor symptoms.
• Prevention of osteoporosis
• To maintain the quality of life in menopausal years.
• Premature ovarian failure
• Gonadal dysgenesis
• Surgical or radiation menopause.

13.
CONTRAINDICATIONS
OF HRT
History of breast cancer
Undiagnosed genital tract bleeding
History of DVT
Acute liver disease
Gall bladder disease.
Prior endometriosis

14.
HORMONES USED IN
HRT
It can be given in wide range of modalities.
Cream / gel
Skin patch
Tablet
Vaginal ring
Pallet

15.
ESTROGEN THERAPY
• Estrogen Pill : CEE 0.3 mg or 0.625 mg, 0.9 mg is
given daily for a woman ho had hysterectomy for 2-3
months. Estrace, Femtrace.

16.
• Patch: 3.2 mg of 17β estradiol, releasing 50 μg of
estradiol in 24 hours.

17.
• Gel: Is to be applied on to skin over the anterior
abdominal wall of thighs. 1.53 mg of evamist spray.

18.
• Implant: 25-50 mg or 100 mg and can be kept for 6
months. In the anterior abdominal wall.

19.
• Vaginal cream: 1.25 mg daily. Effective specially in
atrophic vaginitis.

20.
PROGESTERONE
THERAPY
• Oral Progestin: Provera, Norgestrel 150 mg/ day.

21.
• Intrauterine progestin: Levenorgestrel like Kyleena,
Mirena 20mcg/ day is given.

22.
• Testosterone: Pallets of 100 mg testosterone. It
improves mood, bone, muscle mass and quality of
life.
• Tibolone: Prevent osteoporosis, atrophic changes of
vagina and hot flushes.
• Parathyroid Hormone(PTH): Teriparatide is given SC
injection of 20μg/day, to prevent osteoporosis and
fracture.

23.
BENEFITS OF HRT
Improvement of vasomotor symptoms. 70-80%
Improvement of urogenital atrophy.
Increase in bone mineral density 2-5%
Decreased risk in vertebral and hip fractures 25-50%
Reduction in colorectal cancer 20%.

24.
SUMMARY
&
CONCLUSION

25.
BIBLIOGRAPHY
REFERENCE
• Hiralal Konar, DC Dutta’s Textbook of Gynaecology. 7th
Edition. Jaypee Health Science Publisher. pp 46 -52.
• Annamma Jacob. A textbook of Midwifery and
Gynaecological Nursing. 4th Edition. Jaypee Brothers
Medical Publisher. pp 904 – 908.
• Lily Podder. Fundamentals of Midwifery Obstetrical
Nursing. ELSEVIER. pp 354 – 358.
• https://www.thenovuscenter.com/resources-los-
angeles/hormone-replacement-therapy/
• Hormone Replacement Therapy : JAAOS - Journal of the
American Academy of Orthopaedic Surgeons (lww.com)