Hormonal therapy is indicated in menopausal women for

(A) Hot flashes[?]Hot Flashes:They are sudden, intense feelings of heat in the neck face, and torso. They can be accopanied by:Heart palpitations; Sleep disturbances; Profuse perspiration; Cold chills; Anxiety; FlushingHot flashes are: Mainly women over 40 as they transition into menopause as well as pregnant women.Other causes of Hot Flushes:Thyroid disease, epilepsy, autoimmune disorders, insulinomas, pancreatic tumors, leukemias.Hot flushes are waves of vasodilation affecting face & neck last for 2-5 min each more severe during night, disturb sleep.Mechanism:Estrogen deficiency - Reduces hypothalamine endorphine - Release more norepinephrine & serotonin - Leads to inappropriate heat loss mechanism.Hormonal Replacement Therapy:Benefit of HRT for Relief of Symptoms:Hot flashes: Highly effective; Usually required for a relatively short period of time, E.g., 1 to 3 years.Mood disturbance: Improve irritability & anxiety in many menopausal women; Relieve mild depressive symptoms.Hormone Replacement Therapy (HRT) is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency. HRT can be administered orally (in pill form), vaginally (as a cream) or trans dermally (in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. Used before, during & after menopause.Who needs HRT:Symptomatic women who suffer from estrogen deficiency (Therapeutic); High risk cases for menopausal complications such as cardiovascular disease, osteoporosis, stroke, Alzheimer's disease, colonic cancer (prophylactic)Premature & surgical menopause; Gonadal dysgenesis in adolescents.Treatment of Hot Flashes: If mild symptoms & signs advised exercise.Initiate low dose HRT if:Moderate or severe symptoms: Non-hormonal treatments have failed; No interest in non-hormonal therapyTitrate estrogen dosage upward if needed.When estrogen can't be used, offer:SSRI or SNRI; Gabapentin, clonidine, alpha-methyldopa; MPA or MegesterolAttempt discontinuation after 1-2 yearsTREATMENT OPTIONS FOR MENOPAUSAL SYMPTOMS SHOWN TO HAVE CLINICAL BENEFITSSymptomsHormone TherapyNon-hormonal TreatmentsLifestyle ChangeVasomotorOral conjugated estrogens and MPAParoxetineSmoking cessationContinuous and sequentialVenlafaxineDecrease alcohol consumptionOral estradiol and norgestimatelGabapentinRelaxation techniquesTransdermal*. 17 beta estradiol-norethindrone acetate*. 17 beta estradiol - levonogestre*. 17 beta estradiol*. EstradiolClonidine Oral conjugated estrogen (unopposed)Oral 17 beta estradiolEstradiol vaginal ringVaginal atrophyEstradiol vaginal creamVaginal moisturizersSmoking cessationConjugated estrogen vaginal creamVaginal lubricantsregular sexual activityEstradiol vaginal ring OsteoporosisHT not recommended as first-line therapy for prevention or treatmentCalcium & Vitamin D supplementsWeight bearing exercisesBisphosphonatesSmoking cessationRaloxifeneDecrease alcohol consumptionCalcitonin Teriparatide