A 48-year-old female suffering from severe menorrhagia (DUB) underwent hysterectomy. She wishes to take hormone replacement therapy. Physical examination and breast are normal but X-ray shows osteoporosis. The treatment of choice is:
Ans. is c, i.e. EstrogenRef: Jeffcoate 7th/ed, p95 onwards; Williams Gynae 1st/ed, p495,499-500* The female underwent hysterectomy, i.e. surgical menopause at the age of 48 years and her X-ray shows osteoporosis -- hence HRT can be advised.* Both estrogen alone or estrogen + progesterone can be used for treating osteoporosis.The choice depends on whether uterus is present or not (i.e. patient is hystrectomised or not).We have already discussed the agents used for treating osteoporosis and as I have mentioned earlier bisphosphonates are the first line of treatment for osteoporosis (Ref: ]olm Hopkins Manual of Obs and Gynae 4th/ed, p513) but it is not given in the options."For women with a uterus, a progestin should be combined with an estrogen, to lower the risk of endometrial cancer." Ref: William Gynae 3rd/edf p495According to Jeffcoate (7th/ed, p96) "all women who have intact uterus or even those who underwent hysterectomy for endometrial Cancer (Stage I), endometroid ovarian tumors or endometriosis or those with severe osteoporosis should receive combined estrogen - progesterone therapy or be considered for selective estrogen receptor modulator therapy (SERM therapy)."In the question the patient has undergone hysterectomy therefore we can use only estrogen.
Progesterone
Estrogen and progesterone
Estrogen
None
Miscellaneous (Gynae)