Progestogens have traditionally been a popular alternative to combined HRT in women with intractable vasomotor symptoms who have contraindications to oestrogen . However, recent studies, for example, WHI/MWS, have questioned the safety of progestogens because of concerns that the increase in risk of breast cancer with HRT is due to the combination of oestrogen and progestogen (rather than oestrogen alone). Thus, caution should be exercised in treating women with progestogens who have an increased risk of breast cancer. The potential risk to the breast also needs to be taken into account when using progestogens as an alternative in those at risk of thromboembolism.
Clonidine, a centrally active alpha2 agonist, has been one of the most popular alternative preparations for the treatment of vasomotor symptoms. Unfortunately it is also one of the preparations for which the least evidence exists for efficacy - at best the trial data show a weak benefit .
Beta blockers have been postulated as a possible option for treating vasomotor symptoms but the small trials which have been conducted have been disappointing.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS SSRIS/SELECTIVE NORADRENALINE REUPTAKE INHIBITORS SNRIS
A significant amount of evidence exists for the efficacy of SSRIs and SNRIs in the treatment of vasomotor symptoms. Although there are some data for SSRIs such as fluoxe-tine and paroxetine, the most convincing data are for the
SNRI (venlafaxine) at a dose of 37.5 mg bd . The key effect with these preparations appears to be stimulation of the noradrenergic as opposed to the serotonergic pathways, hence the preferential effect of SNRIs. The trials demonstrate a 50-60% reduction in hot flush frequency and severity. This compares with an 80-90% symptom reduction with traditional hormone therapy. The main drawback with these preparations (especially the SNRIs) is the high incidence of nausea which often leads to withdrawal from therapy before maximum symptom relief efficacy has been achieved. Trials in this area are ongoing.
Recent work with the antiepileptic drug Gabapentin has shown efficacy for hot flush reduction compared to placebo. Gabapentin at a dose of 900 mg per day has been shown to reduce hot flush frequency by 45% and symptom severity by 54%. Further work is being conducted to confirm the efficacy and safety of this preparation.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.