- Email: [email protected]
S48 Younger women: Is there ever a need for HRT? dealing with the complications of therapy
S45 (cant)
S46 PREMATURE
B.
Snontaneous a) Genetic 1. Chromosomal
TO THE
Susan R. Davis,
> >
> 2. Metabolic > > > 3. Immunological > >
Director of the Slezak ResearchProgram, The Jean Hailes Foundation,291ClaytonRoad,Clayton3168,Victoria, Australia.
Turners syndrome pure gonadal dysgenesis familial Trisomy 18 and Trisomy 13 17 alphahydroxylase deficiency galactosaemia myotonic dystrophy Di George syndrome ataxis telangiectasia subcutaneous ftmgal infections
b) Autoimmune Associated with autoimmune thyroiditis, Addison’s disease, pernicious anaemia and myasthenia gravis c) Infections eg. Mumps, TS d) Environmental eg. smoking, poor nutrition A woman’s age at menopause is governed by the number of ovarian follicles. In women with premature ovarian failure it is unclear whether there are problems with the multiplication of fetal primordial follicles or whether there is accelerated atresia of follicles in the fetus or after birth, or a combination of all three factors. The main genes for premature ovarian failure appear to be the POF genes on the X chromosome, and mutations of the FSHr.
The ageof presentationof prematureovarian failure and the initial symptomsare dependenton the timing and rapidity of follicular atresia. Whereasrapid and early follicular loss before puberty resultsin primary amenorrhoeaand failed sexual development, without symptomsof oestrogendeficiency, follicular demisepostpuberty culminates in secondary amenorrhoeaand classical symptoms of oestrogendeficiency. The diagnosisof prematureovarianfailure hasnot only majorshort and long term health sequelae,including urogenitalchanges,and potentially deleteriouseffects on bone and the cardiovascular system,but the inherentlossof fertility hasa major impacton preexistinglife expectations andrelationships. Effects of this condition on sexuality, femininity and associated psychologicalchangesneedto be addressed and dealt with in a sensitiveand empatheticmanner. Affected womenneed to fully understand the consequences of prematureovarianfailure in orderto beableto maximisetheir quality of life.
S48
s47 THE MANAGEMENT WITH
MENOPAUSE: CONSEQUENCES WOMEN
YOUNGER DEALING
OF BONE LOSS IN YOUNG WOMEN ESTROGEN DEFICIENCY.
WOMEN: IS THERE EVER A NEED FOR HRT ? WITH THE COMPLICATIONS OF THERAPY
P D Delmas
MD&en,
INSERM Research Unit 403, HopitalE. Herriot,Lyon, France
University of Mtinster, Departmentof Obstetrics& Gynecology, Albert-Schweitzer-St33,48129Munster,Germany.
Prematuremenopause - but alsoestrogendeficiencydueto a variety of endocrine disorders such as hyperprolactinaemia,anorexia It is reasonable for the medicalcommunityto treat young women nervosa,excessivephysical training or due to prolongedGnRH with ovarianfailure with naturalexogenousestrogen,nevertheless it analogtreatment- inducesrapid bonelossthat canresultin fragility may be difficult for thesewomento acknowledgethe benefitsof fractures. It is important,therefore,to assess bonestatusin these HRT dueto the frustrationof reproductivefailure. The subsequent patientsby measuringbonemineraldensity (BMD) at the lumbar withdrawalfrom socialactivities may interfere with the individual spineandhip by dualenergyXray absorptiometry(DXA). Decision well-beingbesidesthe medicalsequelaeassociated with premature to preventbonelossdependsof the underlyingdisease, the duration ovarianfailure. The cyclic useof an estrogenis recommended for of estrogendeficiency,the level of BMD andassociated risk factors reduction of estrogen-deficiencysymptoms and for long-term such as maternalhistory of hip fracture and prevalent fragility prophylaxisagainsturogenitalatrophy, cardiovasculardiseaseand fractures. In mostcaseshormonereplacement therapy(HRT) is the osteoporosis,sometimestwice as much estrogenscomparedto best option, using either the same regimen as in older postmenopausal femalesare required. Sequentialprogestogennot postmenopausal womenor anticontraceptivepills containingat least only induceswithdrawalbleeding,but may help to keepup with the 25 ug of ethinyl estradiol. If there is an absoluteor relative peer group with intact ovarian function. Whetherthe useof oral contraindication to estrogen therapy, alternatives include contraceptivesin comparisonto hormonalreplacementoffers any norethisteroneacetate(NETA), bisphosphonates, nasal calcitonin advantages hasnot beendeterminedyet. The sideeffectsassociated (CT), parathyroid hormone(PTH), calcium and vitamin D. In with HRT in postmenopausal women are to be expected in the patientswith GnRH, smalldosesof NETA (1 mg/d)or subcutaneous younger women too. Therefore, individual counselling and injectionsof PTH have beenshownto preventbonelosswhile nasal continuousadjustmentof therapy taking into account medical, PTH failedto do so. Calciumandvitamin D are of limited valuein social,andpsychologicalfactorsis mandatoryto achievelong-term this indication. Monitoring of treatmentincludesspecific bone compliance. markers- that arereducedby 30%to 60% within 3 months- andby repeatingDXA 1to 2 yearsafter initiatingtreatmentaccordingto the severity of bone loss.
37
S46 PREMATURE
B.
Snontaneous a) Genetic 1. Chromosomal
TO THE
Susan R. Davis,
> >
> 2. Metabolic > > > 3. Immunological > >
Director of the Slezak ResearchProgram, The Jean Hailes Foundation,291ClaytonRoad,Clayton3168,Victoria, Australia.
Turners syndrome pure gonadal dysgenesis familial Trisomy 18 and Trisomy 13 17 alphahydroxylase deficiency galactosaemia myotonic dystrophy Di George syndrome ataxis telangiectasia subcutaneous ftmgal infections
b) Autoimmune Associated with autoimmune thyroiditis, Addison’s disease, pernicious anaemia and myasthenia gravis c) Infections eg. Mumps, TS d) Environmental eg. smoking, poor nutrition A woman’s age at menopause is governed by the number of ovarian follicles. In women with premature ovarian failure it is unclear whether there are problems with the multiplication of fetal primordial follicles or whether there is accelerated atresia of follicles in the fetus or after birth, or a combination of all three factors. The main genes for premature ovarian failure appear to be the POF genes on the X chromosome, and mutations of the FSHr.
The ageof presentationof prematureovarian failure and the initial symptomsare dependenton the timing and rapidity of follicular atresia. Whereasrapid and early follicular loss before puberty resultsin primary amenorrhoeaand failed sexual development, without symptomsof oestrogendeficiency, follicular demisepostpuberty culminates in secondary amenorrhoeaand classical symptoms of oestrogendeficiency. The diagnosisof prematureovarianfailure hasnot only majorshort and long term health sequelae,including urogenitalchanges,and potentially deleteriouseffects on bone and the cardiovascular system,but the inherentlossof fertility hasa major impacton preexistinglife expectations andrelationships. Effects of this condition on sexuality, femininity and associated psychologicalchangesneedto be addressed and dealt with in a sensitiveand empatheticmanner. Affected womenneed to fully understand the consequences of prematureovarianfailure in orderto beableto maximisetheir quality of life.
S48
s47 THE MANAGEMENT WITH
MENOPAUSE: CONSEQUENCES WOMEN
YOUNGER DEALING
OF BONE LOSS IN YOUNG WOMEN ESTROGEN DEFICIENCY.
WOMEN: IS THERE EVER A NEED FOR HRT ? WITH THE COMPLICATIONS OF THERAPY
P D Delmas
MD&en,
INSERM Research Unit 403, HopitalE. Herriot,Lyon, France
University of Mtinster, Departmentof Obstetrics& Gynecology, Albert-Schweitzer-St33,48129Munster,Germany.
Prematuremenopause - but alsoestrogendeficiencydueto a variety of endocrine disorders such as hyperprolactinaemia,anorexia It is reasonable for the medicalcommunityto treat young women nervosa,excessivephysical training or due to prolongedGnRH with ovarianfailure with naturalexogenousestrogen,nevertheless it analogtreatment- inducesrapid bonelossthat canresultin fragility may be difficult for thesewomento acknowledgethe benefitsof fractures. It is important,therefore,to assess bonestatusin these HRT dueto the frustrationof reproductivefailure. The subsequent patientsby measuringbonemineraldensity (BMD) at the lumbar withdrawalfrom socialactivities may interfere with the individual spineandhip by dualenergyXray absorptiometry(DXA). Decision well-beingbesidesthe medicalsequelaeassociated with premature to preventbonelossdependsof the underlyingdisease, the duration ovarianfailure. The cyclic useof an estrogenis recommended for of estrogendeficiency,the level of BMD andassociated risk factors reduction of estrogen-deficiencysymptoms and for long-term such as maternalhistory of hip fracture and prevalent fragility prophylaxisagainsturogenitalatrophy, cardiovasculardiseaseand fractures. In mostcaseshormonereplacement therapy(HRT) is the osteoporosis,sometimestwice as much estrogenscomparedto best option, using either the same regimen as in older postmenopausal femalesare required. Sequentialprogestogennot postmenopausal womenor anticontraceptivepills containingat least only induceswithdrawalbleeding,but may help to keepup with the 25 ug of ethinyl estradiol. If there is an absoluteor relative peer group with intact ovarian function. Whetherthe useof oral contraindication to estrogen therapy, alternatives include contraceptivesin comparisonto hormonalreplacementoffers any norethisteroneacetate(NETA), bisphosphonates, nasal calcitonin advantages hasnot beendeterminedyet. The sideeffectsassociated (CT), parathyroid hormone(PTH), calcium and vitamin D. In with HRT in postmenopausal women are to be expected in the patientswith GnRH, smalldosesof NETA (1 mg/d)or subcutaneous younger women too. Therefore, individual counselling and injectionsof PTH have beenshownto preventbonelosswhile nasal continuousadjustmentof therapy taking into account medical, PTH failedto do so. Calciumandvitamin D are of limited valuein social,andpsychologicalfactorsis mandatoryto achievelong-term this indication. Monitoring of treatmentincludesspecific bone compliance. markers- that arereducedby 30%to 60% within 3 months- andby repeatingDXA 1to 2 yearsafter initiatingtreatmentaccordingto the severity of bone loss.
37