Monogram: Hormone Replacement Therapy in Menopause and Andropause VN Mishra
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fm1Monogram Hormone Replacement Therapy in Menopause and Andropausefm2
fm3Monogram Hormone Replacement Therapy in Menopause and Andropause
Editor VN Mishra MD (Medicine) FICP FIACM FIAOG Professor Department of Medicine Pt Jawahar Lal Nehru Memorial Medical College Raipur, Chhattisgarh, India Associate Editor Nalini Mishra MD (Obs and Gyne) DNB DGO MNAMS FICOG Professor Department of Obstetrics and Gynecology Pt Jawahar Lal Nehru Memorial Medical College Raipur, Chhattisgarh, India
Forewords
Rajesh Upadhyay
KK Pareek
fm4
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Monogram: Hormone Replacement Therapy in Menopause and Andropause
First Edition: 2016
9789352501885
Printed at
fm5Dedicated to
My Parents
Late Shree PN Mishra
Late Mrs Krishna Mishra
and
My Family
For their love, affection and constant encouragement
VN Mishra fm6
fm7Contributors fm9Foreword
Menopause and andropause are important phases of adult women and men and have a great psychosocial impact on them. As the individual changes, hormonal changes occur, and the resulting hormonal imbalance leave an indelible impact on the individual's health and also affects the family. Containing the impact of menopause and andropause has been a matter of intense research for the last several decades. Any hormonal imbalance needs to be treated with appropriate hormone replacement. In this regard, hormone replacement therapy (HRT) had come into vogue nearly a quarter of century back. However, as is the natural history of any new therapy, HRT also had its share of vicissitudes. Initially, it was launched with a bang, then over the years, as evidence kept on accumulating, HRT went into disrepute. Later, HRT was recommended to be used with caveats. Life has come full circle with HRT in menopause and andropause with proponents endorsing HRT and a separate group constituting the detractors of HRT.
The monogram edited by Dr VN Mishra is a comprehensive text and is aimed to classically demystify the concepts and myths associated with menopause as well as andropause. The monogram addresses both the phases in exquisite detail, in an enriching way, and is sure to enlighten the readers. The sections on the basis of HRT and its various constituents, its pros and cons are evidence-based and provide the readers with an updated knowledge about the HRT and its present-day status.
Any limitations that could have been envisaged, have been overcome by the fact that it is a multi-author book, and the chapters have been written by experts in their respective fields from the all corners of India.
This comprehensive text is going to be an enriching source of knowledge on HRT in menopause and andropause for the complete medical fraternity including the physicians and resident doctors. I congratulate Dr VN Mishra for bringing out the text successfully.
Rajesh Upadhyay
President
Association of Physicians of India (API)
Director and Head
Department of Gastroenterology and Hepatology
Max Superspecialty Hospital
New Delhi, Indiafm10
fm11Foreword
It is my pleasure writing the foreword for the MonogramHormone Replacement Therapyin Menopause and Andropause . Postmenopausal hormone replacement therapy (HRT) is the most effective treatment for symptoms of estrogen deficiency, but it has remained controversial over the last three decades. In the past few years, lots of new analyses on this subject have been done and results of well-planned new studies have been published and previous assumptions have been challenged. It seems that over the past one decade, pendulum has swung again in favor of using HRT for short period (<5 years), especially in early postmenopausal period for retarding process of atherosclerosis, cardiovascular and other benefits.
The Indian College of Physicians decided to bring out a monogram on this subject and entrusted Dr (Prof) VN Mishra the responsibility of editing this monogram. On going through the manuscript, I am impressed by the information and the way in which these issues have been contributed by seniormost experts in the field including physicians, cardiologists, orthopedicians, gynecologists, clinical pharmacologists, and neurologists. They have provided current up-to-date information on various facets of this complex entity. A small section on Andropause, the so-called equivalent of menopause and Testosterone Replacement Therapy (TRT) in men, a relatively new concept, has been dealt with in the most authoritative manner by various experts of the field.
All the eminent authors deserve commendation and congratulation for their comprehensive, informative and authoritative discussions. I would like to sincerely thank all the authors on behalf of Indian College of Physician for contributing their chapters in this monogram. I would like to compliment and thank Dr (Prof) VN Mishra for accepting the challenge of editing the monogram on this controversial topic and giving his scholarly and academic inputs. I would also like to thank Dr (Prof) Nalini Mishra, Associate Editor of monogram for giving her valuable contribution. I sincerely hope that this monogram would be an asset for practicing physicians, gynecologists, academicians and postgraduate students.
KK Pareek
Dean
Indian College of Physicians
Chairman-APICON CME 2016fm12
fm13Preface
It is my great pleasure and privilege to bring out Monogram Hormone Replacement Therapy in Menopause and Andropause published on behalf of Indian College of Physicians (ICP), the academic wing of Association of Physicians of India (API). At the outset, I would like to express my heartfelt sincere gratitude to the learned Dean of ICP Dr KK Pareek, President of API Dr Rajesh Upadhyay and all other office-bearers of ICP and API for bestowing faith in me by nominating me for editing this prestigious monogram.
Menopause is an important milestone in a woman's life, as it not only marks the end of her reproductive career, but also exposes her to new problems of vasomotor instability, genitourinary syndromes, osteoporosis, cognition-related problems including dementia and increased incidence of cardiovascular events. Prior to 2002, Hormone Replacement Therapy (HRT) was considered to be answer to all of these problems and majority of professional organizations were recommending postmenopausal HRT. Publication of Women's Health Initiative (WHI) findings in 2002 and Million Women Study of UK received wide attention consequent to increased reporting of adverse events, such as breast cancer, cardiovascular disease and stroke. This led to precipitous fall in prescriptions for postmenopausal hormone therapy, leading to tens of millions of symptomatic women in the United States alone to discontinue hormone replacement therapy and to avoid starting it.
The effect of postmenopausal hormone therapy on cardiovascular risk is complex and understanding its impact on cardiovascular disease has evolved over the past decade. A lot of new analysis on this subject has been done, results of very meticulously planned new studies have been published and previous assumptions have been challenged. Two recently published studies need special mention. The first being “Early versus Late Intervention Trial with Estradiol” popularly known as ELITE study which has given verdict in favor of Timing Hypothesis of Postmenopausal Hormone Therapy. The second, recently published study “Kronos Early Estrogen Prevention Study” popularly known as KEEPS trial has demonstrated definitive benefits in quality of life with early postmenopausal hormone supplementation in the form of significant reduction in vasomotor symptoms, improvement in sexual function, bone mineral density, and improvement in mood outcomes with decreased depressive symptoms and anxiety. It seems that pendulum has swung again in favor of using HRT although, for short period (<5 years) and in early postmenopausal period for benefits mentioned above, besides retarding process of atherosclerosis.fm14
Hormone replacement therapy has remained surrounded by above controversies for the last three decades leaving physicians, gynecologists, other healthcare providers and patients equally confused. Keeping this in mind, the Indian College of Physicians very aptly decided to bring out a monogram on this subject with a view to provide insight into this complex situation. These issues have been addressed in great length in separate chapters in this monogram which have been contributed by seniormost experts in the field including physicians, cardiologists, orthopedicians, gynecologists, clinical pharmacologists and neurologists. They have provided current up-to-date information on various facets of this complex entity.
A small section of monogram has been devoted to “Andropause”, the so-called equivalent of menopause, a relatively new and controversial concept. The overall prevalence of ‘biochemical hypogonadism’ is quite high in general population. In recently published European Male Aging Study (EMAS), this was found to be 23.3% in 40 to 79 years old men. In the Baltimore Longitudinal Study of Aging, the incidence of hypogonadal testosterone levels was found to increase linearly with age. This speaks volumes regarding the lack of awareness about this condition. Testosterone Replacement Therapy (TRT) has been advocated by many workers to effectively deal with this situation.
I hereby express my sincere thanks and gratitude to all the learned dignitaries for sparing their valuable time in contributing their chapters on this complex subject. All the eminent authors deserve commendation and congratulation for their comprehensive, informative and authoritative expert views. I would also like to thank them all from bottom of my heart on behalf of Indian College of Physicians. Before I conclude, I would like to thank Dr (Prof) Nalini Mishra, Associate Editor of monogram for giving her valuable contribution. Last but not least, I would like to thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for publishing this monogram. I sincerely hope that this monogram would be an asset for practicing physicians, gynecologists, academicians and postgraduate students alike.
VN Mishra
fm15Acknowledgments
My heartfelt gratitude to Dr KK Pareek Dean, Indian College of Physicians (ICP), for giving me an opportunity to edit this monogram.
I am deeply indebted and obliged to Dr Rajesh Upadhyay, President, Association of Physicians of India (API), for his blessings and guidance.
I owe a big thanks to all office-bearers of ICP and API, for their love and faith in me. God bless them all.
I am heartily thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), Mr KK Raman (Production Manager), Mrs Samina Khan (Executive Assistant to the Director–Publishing), Mr Neelambar Pant and Mohit Bhargava (Production Coordinators), Mr Subrata Adhikari (Commissioning Editor), Mr Pankaj Kumar Mandal (Typesetter), Mr Ashutosh Pathak (Proofreader), and other members of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. Thanks to their editorial efforts to improve the book overall.fm16