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Hormones in Obstetrics and Gynaecology
Vijay Zutshi, Asmita Muthal Rathore, Kamla Sharma
GYNAECOLOGY
CHAPTER 1:
Amenorrhea
INTRODUCTION
PRIMARY AMENORRHEA
IMPORTANT DIAGNOSTIC INVESTIGATIONS
Patient with Normal Secondary Sexual Characters
PATIENTS WITH ABSENT SECONDARY SEXUAL CHARACTERS
TREATMENT
Goals of Therapy
FERTILITY PROSPECTS
SECONDARY AMENORRHEA
Diagnosis
TREATMENT OF SECONDARY AMENORRHEA
CONCLUSION
KEY POINTS
CHAPTER 2:
Hormones in Hirsutism and Polycystic Ovarian Syndrome
HIRSUTISM
Androgens in Women
Causes of Hirsutism
Evaluation of Hirsutism
Idiopathic Hirsutism
Ovarian Causes (other than PCOS)
Hyperthecosis Ovary
Ovarian Tumors
Adrenal Causes
Cushing's Syndrome
Congenital Adrenal Hyperplasia-Adult onset (CAH-A)
Adrenal Tumors
Laboratory Evaluation of Hirsutism
POLYCYSTIC OVARY SYNDROME (PCOS)
Clinical Features and Diagnosis
Biochemical Criteria
PCOS and Insulin Resistance
Pathogenesis of PCOS
Treatment of PCOS and Hirsuitism
PCOS
General Measures
To Regulate Menstrual Cycle
To Regulate Menstrual Cycles and Treat Hirsutism
Oral Contraceptions (OCs)
Oral Contraceptives and Corticosteroids
Oral Contraceptives and Antiandrogens
Other Antiandrogens
Insulin-lowering Agents
Treatment of Infertility—Ovulation Induction
Dose Schedule
Improving Ovulation and Pregnancy Rates with CC
Problems with CC
Gonadotropin Therapy (GT)
Results with Conventional Doses
Low-dose Regimens
Metformin with FSH
GnRH with GT
Surgical Treatment
IVF-ET
KEY POINTS
CHAPTER 3:
Hormones in Infertility
INTRODUCTION
Ovulatory Deficiencies Defined by WHO are:
MANAGEMENT
Clomiphene Therapy
Addition of Human Chorionic Gonadotropin (hCG)
Clomiphene Failures
Dexamethasone
Extended Regimens
Pretreatment Supression
GONADOTROPIN THERAPY
Indications
Contraindications
Gonadotropin Preparations
Pretreatment Evaluation
Patient Needs to be Counseled Regarding the Need for:
Regimens
HCG Injection to be with held if-
Hormones in Luteal Phase Support
Results with Gonadotropins
ADJUNCTIVE THERAPIES
PULSATILE GNRH THERAPY
Indications
CONCLUSION
KEY POINTS
CHAPTER 4:
Dysfunctional Uterine Bleeding: Hormonal Management
INTRODUCTION
PATHOPHYSIOLOGY OF DUB
ROUTINE WORKUP OF PATIENT OF DUB
GENERAL MEASURES IN TREATMENT OF DUB
MEDICAL MANAGEMENT IN DUB
Hormonal Therapy in DUB
Progesterone and its Derivatives
Oral Contraceptives
Estrogens
Danazol
GnRH Analogues
CHOICE OF THERAPY
DUB and Medical Disorders
Puberty Menorrhagia
Postmenopausal DUB
PARAMETERS OF SUCCESS AND LONG-TERM FOLLOW-UP
KEY POINTS
CHAPTER 5:
Role of Hormones in the Treatment of Endometriosis
INTRODUCTION
HORMONES USED FOR THE ALLEVIATION OF PAIN
PERIOPERATIVE HORMONAL TREATMENT
Recurrent Endometriosis
Prophylactic Hormonal Treatment
Extrapelvic Endometriosis27
HORMONES FOR THE TREATMENT OF ENDOMETRIOSIS-ASSOCIATED INFERTILITY
Hormone Replacement Therapy (HRT)
CONCLUSION
KEY POINTS
CHAPTER 6:
Dysmenorrhea and Premenstrual Syndrome: Hormonal Management
DYSMENORRHEA
Definition
Pathophysiology
Management of Dysmenorrhea
HORMONES
Oral Pills
Progesterones and Progestogens
Gonadotropin-Releasing Hormone Analogues
Antagonists of Vasopressin V1A and Oxytocin
OTHER MODES OF THERAPY OF DYSMENORRHEA
Nonhormonal Pharmacological Therapy
Nonsteroidal Anti-Inflammatory Drug (NSAID)
Calcium Channel Blockers
Leukotriene Receptor Antagonists
Nonpharmacological Therapy
Surgical Therapy
KEY POINTS
PREMENSTRUAL SYNDROME
Introduction
Definition
Etiopathogenesis
Hormonal theory
Neurotransmitter, endorphin and Vitamin B6 theory
Incidence
Clinical Profile
Primary PMS
Secondary PMS
Clinical Presentation
Diagnosis
Treatment
HORMONAL THERAPY IN PMS
Combined Oral Contraceptives (COCs)
Estrogens
Progesterones
Gonadotropin-Releasing Hormone Analogues (GnRH Analogues)
SURGICAL TREATMENT IN PMS
KEY POINTS
CHAPTER 7:
Hormones in Malignancy
INTRODUCTION
ENDOMETRIAL CARCINOMA
HORMONE THERAPY FOR OVARIAN CARCINOMA
HORMONES UNDER SPECIAL CIRCUMSTANCES
HRT in Patients with Cervical Cancer
HRT in Patients with Endometrial Cancer
HRT in Patients Treated for Epithelial Ovarian Tumor
KEY POINTS
OBSTETRICS
CHAPTER 8:
Role of Progestogens and hCG in Threatened and Recurrent Abortion
KEY POINTS
CHAPTER 9:
Micronized Progesterone: Uses in Pregnancy
INTRODUCTION
MICRONIZED PROGESTERONE
Pharmacokinetics
Routes of Administration
Side Effects and Safety
USES OF MICRONIZED PROGESTERONE
Luteal Phase Defect (LPD)
Recurrent Abortion
Threatened Abortion
Preterm Labour
Pregnancy-Induced Hypertension and Intrauterine Growth Retardation
CONCLUSION
KEY POINTS
HRT
CHAPTER 10:
Evaluation and Follow-up of a Case Receiving Hormone Replacement Therapy
INTRODUCTION
Principles of Estrogen Administration
Pretreatment Assessment
Identification of Women at Risk11
Risk Factors for Coronary Heart Disease in Women
Women should not take Estrogens and Progestins if the y15
HISTORY
Misattributed Symptoms
Past History
Detailed Information
Physical Examination
Investigations11
Blood
Imaging Techniques
ENDOMETRIAL BIOPSY/ENDOMETRIAL SAMPLING
Progesterone Challenge Test
Hormone Profile
Lipid Profile
COAGULATION PROFILE
Indications
Investigations
LIVER FUNCTION TESTS
BIOCHEMICAL MARKERS16
MAMMOGRAPHY11
Indications
U.S.G. PELVIS
ENDOMETRIAL BIOPSY
Indications
ENDOMETRIAL ASPIRATION11
PROGESTERONE CHALLENGE TEST17
CURRENT CONTRAINDICATIONS FOR HRT
HRT—NEW INDICATIONS
HRT—NEUTRAL SITUATIONS
FOLLOW-UP ASSESSMENT11
Purpose
Parameters to be Assessed at Follow-up Visit
Side Effects
Inadequate Control of Symptoms
What to do
Abnormal Bleeding on HRT
What should one think of
ROLE OF HYSTEROSCOPY
Vaginal pH as a Marker for Menopausal Status19
Stopping of HRT
CONCLUSION
KEY POINTS
CHAPTER 11:
Hormone Replacement Therapy as Prophylaxis
INTRODUCTION
Consequences of Estrogen Deficiency
Short Term—
Long-term Sequelae
OSTEOPOROSIS
Prevention and Treatment of Osteoporosis
CARDIOVASCULAR DISEASE
ALVEOLAR TOOTH LOSS
VISION DISORDERS
COLON CANCER
EFFECT ON COGNITIVE FUNCTION
UROGENITAL ATROPHY
CONCLUSION
KEY POINTS
CHAPTER 12:
Hormone Replacement Therapy as Treatment
INTRODUCTION
ENDOCRINOLOGY
Gonadotropins
Symptoms
HORMONE REPLACEMENT THERAPY (HRT)
Indications for HRT
PREMATURE OVARIAN FAILURE
POST MENOPAUSAL SYMPTOMS
OSTEOPOROSIS
PRIMARY AMENORRHOEA
ADDBACK THERAPY
Hormones and Route of Administration in HRT (Table 12.2)
Oral
Estrogen
Progestogens
Only Progestogens
Estradiol Valerate/Dienogest
Tibolone
Selective Estrogen Receptors Modulators and Phytoestrogens
NON-ORAL DELIVERY SYSTEM
Transdermal Delivery
Subcutaneous Implants
Intrauterine Device
Transvaginal Administration
SELECTION OF HORMONE AND REGIMEN
CONTRAINDICATIONS
COUNSELING AND PRETREATMENT ASSESSMENT
KEY POINTS
CHAPTER 13:
Controversies in Hormone Replacement Therapy
INTRODUCTION
HRT AND ENDOMETRIOSIS
HRT AND TRANSCERVICAL RESECTION OF ENDOMETRIUM (TCRE)
HRT AND OVARIAN CANCER
HRT AND BREAST CANCER
HRT AND MEDICAL CONDITIONS
CONCLUSION
KEY POINTS
CHAPTER 14:
Hormone Replacement Therapy in 2004
CARDIOVASCULAR RISKS
THROMBOEMBOLISM
CEREBROVASCULAR DISEASE
OSTEOPOROSIS
BREAST CANCER
COLORECTAL CANCER
ENDOMETRIAL CANCER
OVARIAN CANCER
CONCLUSION
KEY POINTS
CONTRACEPTION
CHAPTER 15:
Oral Contraceptives
INTRODUCTION
TYPES OF ORAL CONTRACEPTIVES
COMBINED PILLS
Preparations available in India (Table 15.1)
How to Administer?
When to start? (Table 15.2)
How to Use?
Starting the Next Packet (Table 15.3)
Missed Pills? What to do?
Mechanism of Action
Health Benefits of COCs
Side Effects of COCs
Minor Side Effects
Major Side Effects
Contraindications
Effectiveness
PROGESTERONE-ONLY PILLS
Mechanism of Action
Indications
How to Administer?
When to start? (Table 15.4)
How to Use
Starting the Next Packet
Forgets One or More Pills
Side Effects
KEY POINTS
CHAPTER 16:
Combined Oral Contraceptives in High-risk Women
INTRODUCTION
CARDIOVASCULAR DISEASE
Hypertension
Venous Thromboembolism
Structural Heart Disorders
BREAST CARCINOMA
DIABETES MELLITUS
The WHO Categories for Temporary Methods (Table 16.1)
KEY POINTS
CHAPTER 17:
Injectable Contraceptives, Implants and Long-acting Progestogens
INTRODUCTION
Depot Medroxyprogesterone Acetate (DMPA)
Mechanism of Action
Norethisterone Enanthate (NET EN)
SIDE EFFECTS
INDICATIONS FOR INJECTABLE CONTRACEPTION
Monthly Injectables as DMPA and NETEN
LONG-ACTING SUBDERMAL PROGESTOGEN IMPLANTS
Norplant
Norplant-2
Implanon
Capsules Releasing ST–1435
Uniplant
CONCLUSION
KEY POINTS
CHAPTER 18:
Emergency Contraception
INTRODUCTION
INDICATIONS OF EMERGENCY CONTRACEPTION
HIGH-DOSE ESTROGENS
Dosage Schedules and Formulations
Side Effects
Disadvantages
ESTROGEN AND PROGESTIN COMBINATION PILL
Yuzpe Method
Mode of Action
Advantages
Side Effects
Disadvantages
Contraindications
INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD)
Advantages
Disadvantages
Contraindications
PROGESTOGENS
Advantages
DANAZOL
Contraindications
ANTIPROGESTINS
Side Effects
Advantages
Disadvantages
CENTCHROMAN
Side Effects
MISCELLANEOUS
COUNSELING BEFORE EC
RECOMMENDATIONS
COMMON QUERIES CONCERNED WITH PRESCRIBERS OF EMERGENCY CONTRACEPTIVE PILLS6
LEGAL, ETHICAL AND SOCIAL CONSIDERATIONS IN PRESCRIBING EC
KEY POINTS
CHAPTER 19:
Hormonal Contraception: What's New
INTRODUCTION
Oral Hormonal Contraceptives
Combined Oral Contraceptives (COCs)
Progesterone Only Pills/Minipills (POPs)
Injectable Hormonal Contraceptives
Contraceptive Implants
HORMONAL IUCDS
CONTRACEPTIVE RINGS
CONTRACEPTIVE PATCHES
KEY-POINTS
INDEX
TOC
Index
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