Gynecology Case No 15. Various Gynecology Problem.

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Gynecology Case No 15. Various Gynecology Problem.

1.Threatend abortion Cap. Microgest kotodin dibo?
2. Incomplt abortion e cytomis 200 er dosage ki?
3. Infertilty with PID pt er khetre pid correction kore period regular korar jonno Dydrogesteron deya jabe??
tablet:Duphaston 10 mg.
4.Hypomenorrhea er rx ki?
kindly janale vlo hoto apu.
আমাকে একজন কোনো একটা পোস্টে কমেন্টেসে করেছিলো, এই ৪টা প্রশ্নের উত্তর কি হবে ta nie aktu
ভাবলাম. আসলে জানারতো শেষ নাই। আমি এখনো অনেককিছু শিখি প্রতিদিন নতুনভাবে।

Ans1

Capsule 1:-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Indications of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Microgest softgel capsule is indicated in-

Maintenance of Pregnancy in cases of Threatened / Recurrent abortion.
Luteal support during IUI and ART procedures IVF-ET.
Luteal support in cases of proven luteal phase insufficiency.
Along with estrogen in post-menopausal hormone replacement therapy (HRT) either in sequential or in continuous regimen.
To prevent endometrial hyperplasia where endogenous estrogen is present.
As progesterone challenge test in secondary amenorrhoea.
For cycle control along with estrogen therapy.
Dysfunctional uterine bleeding (DUB)
Premenstrual tension.
Endometriosis.
Oocyte donation programme.
Benign mastopathy.

Pharmacology of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Progesterone Micronized softgel capsule contains micronised progesterone, which is structurally and biologically identical to natural endogenous progesterone. Micronisation increases the bioavailability of progesterone. When micronised progesterone is administered after meals, maximal serum progesterone levels are significantly increased. Progesterone concentrations in the endometrial and breast tissue attain high level. Progesterone is approximately 96%-99% bound to serum proteins, primarily to serum albumin (50%-54%). Progesterone is metabolized to pregnanediols and pregnanolones in the liver. The glucuronide and sulfate conjugates of pregnanediol and pregnanolone are excreted in the bile and urine. Progesterone metabolites, which are excreted in bile, may undergo enterohepatic circulation.

Dosage & Administration of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

The usual recommended dose: Progesterone 100 mg/200 mg 2 to 3 soft gel capsules daily by the oral or vaginal routes in divided doses. Flexible dosage regimen can be followed depending on the indication and requirements of patients.

Maintenance of Pregnancy in cases of Threatened / Recurrent abortion: Progesterone 200 to 400 mg per day in divided doses.

In-vitro fertilization and embryo transfer: Progesterone 200 mg thrice a day from the day of embryo transfer till pregnancy is confirmed. If pregnant, it is continued till 12^th week of pregnancy.

HRT: In sequential regimen: Progesterone 200mg daily for 12 days in last 2 weeks of each therapeutic cycle. In continuous regimen: Progesterone 100 mg daily throughout the month along with estrogen.

Oocyte donation program: Progesterone 100mg twice daily from the day of transfer till pregnancy is confirmed. This may be increased to a maximum of 600 mg per day and continued till 12^th week of pregnancy.

Luteal support: Progesterone 100 mg thrice a day from the 17^th day of the cycle for 10 days in induced cycle. If pregnant, it is continued till 12^th week of pregnancy.

Luteal phase insufficiency: Progesterone 100 mg thrice daily to be continued up to 12 weeks of pregnancy, increasing the dose by 100 mg/day/week to a maximum of 600 mg/day in divided doses if required.

In secondary amenorrhoea: Progesterone 300mg for 10 days results in withdrawal bleeding in 80% of cases.

Premenstrual syndrome: Progesterone 100-200 mg daily for 10 days from 17^th to 26^th day of each menstrual cycle.

Benign mastopathy: Progesterone 200-300 mg for 10 days per month, usually from 17^th to 26^th day of the monthly cycle.

Interaction of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Ketoconazole inhibits the metabolism of progesterone.

Contraindications of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Hypersensitivity, hepatic dysfunction, undiagnosed vaginal bleeding, porphyria, cancers of uterus and genital organs, breast cancers, history of stroke or blood clots. It should not be used in a case of miscarriage and tissue left in the uterus.

Side Effects of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Microgest is devoid of estrogenic, androgenic and mineralocorticoid effects. Mild somnolence and other CNS side effects like depression, breast tenderness and bloating are reported. Side effects are less when vaginal route is used.

Precautions & Warnings of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Severe renal insufficiency, diabetes mellitus, seizures, migraine, headache, heart diseases, depression.

Therapeutic Class of Capsule :-Microgest(200mg) (AS A Progesterone Micronized AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations

1+0+1= upto 16 wks can be applied

Then Allystrenol/Dydrogesterone

1+1+1= upto 28-34 wks

Tablet 2:- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Indications of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Alestor is indicated in:

Intra Uterine Growth Retardation (IUGR)
Threatened abortion
Habitual abortion
Threatened premature delivery

Description of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Alestor is an oral Gestagen. In castrated animals, it has a potent pregnancy-maintaining action without producing hormonal side-effects, in particular no masculinisation of female foetuses. Clinical studies have indicated that Alestor stimulates the endocrine function of the trophoblast. In vitro, Alestor stimulates the placenta to produce more progesterone. In patients with pregnancy at risk, abnormally low levels of placental hormones (HCG, HPL, oestrogens and progesterone) and some specific enzymes (oxytocinase, CAP) were found to be increased to normal during treatment. In the majority of patients with pregnancy at risk who were treated with Alestor the threat of abortion was removed and pregnancy brought to term without complications. Alestor is very well tolerated. Side-effects of any importance have not been observed.

Pharmacology of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Allylestrenol has been found to have a relatively weak progestational effect on the human endometrium. To obtain a full secretory endometrium in oestrogen-primed castrated women or to postpone menstruation (with an oestrogen added) in normal ovulating women, doses of allylestrenol were required which were higher than those recommended for the treatment/prevention of abortion.

In vitro studies have shown that allylestrenol stimulates the synthesis of progesterone in the human placenta. It also brought about a significant (p/. 0,01) increase in the production of some specific placental enzymes (cystine aminopeptidase and heat-stable alkaline phosphatase).

Histological and histochemical changes indicating an increased activity have been found in the placenta, particularly in the syncytiotrophoblast of women with a normal and threatened pregnancy, treated with allylestrenol. The stimulatory effect of allylestrenol on placental function was also suggested by the increased level of placental hormones (pregnanediol, oestriol, HCG and HPL) and enzymes (oxytocinase, CAP) in the maternal urine and plasma, which followed the administration of the drug e.g. in the early weeks as well as in the last trimester of pregnancy.

A study in full-term pregnant women revealed that allylestrenol in high doses (up to 100 mg daily) did suppress the intensity of spontaneous uterine contractions, but had no effect on the sensitivity of the uterine muscle to oxytocin, and no adverse effect on the progress of normal delivery.

Studies in non-pregnant women with and without endocrinological disorders have shown that allylestrenol has no oestrogenic or androgenic properties and no adverse effects on the adrenal function.

No abnormal liver function tests or water and salt retention were observed in healthy female volunteers (non pregnant) who were given allylestrenol.

Dosage & Administration of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Intra Uterine Growth Retardation: 1 tablet three times a day at least two months. Dose to be reduced if symptoms improve.
Threatened abortion: 1 tablet three times daily until symptoms disappear.
Habitual abortion: 1-2 tablets daily as soon as pregnancy is diagnosed. The administration should be continued for at least one month after the end of the critical period.
Threatened premature delivery: Dosage must be determined individually. High dosages (up to 40 mg daily) have been used.

In case of a missed dose, it should be taken as soon as the patient remembers & she should continue the regular dosing schedule. A double dose is not recommended.

Contraindications of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Breast Cancer or history of problem with the breasts like- Nodules,an abnormal Mammogram, or Fibrocystic Diseases.
Severe liver disease such as Cholestatic Jaundice or Hepatitis, Hepatic Cell Tumours, Rotor Syndrome and Dubin Jhonson Syndrome.
Undiagnosed vaginal bleeding
Toxaemia of Pregnancy
Crisis Seizures, Migraines

Side Effects of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Treatment with Alestor (especially a long term treatment) is known to cause some gastrointestinal complaints such as vomiting, nausea, and sometimes epigastric discomfort.

Pregnancy & Lactation of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Allylestrenol is specifically designed to be taken during pregnancy. It should be discontinued after delivery as it may affect a nursing infant to a small but noticeable degree.

Precautions & Warnings of Tablet :- Alestor 5mg (AS A Allylestrenol AS A Female Sex hormones).

Patients with the following conditions should be cautious: Heart disease, congestive heart failure, sick sinus syndrome, coronary artery disease, seizures, epilepsy, renal dysfunction, migraine headaches, or breathing diseases including asthma, emphysema, chronic bronchitis, or COPD, breast-feeding.

Dydrogesterone

Tablet 3:-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Indications of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Progesterone deficiencies:

Treatment of threatened miscarriage
Treatment of habitual miscarriage
Treatment of dysmenorrhoea
Treatment of endometriosis
Treatment of secondary amenorrhoea
Treatment of irregular cycles
Treatment of dysfunctional uterine bleeding
Treatment of infertility due to luteal insufficiency
Luteal support as part of an Assisted Reproductive Technology (ART)

Hormone Replacement Therapy: To counteract the effects of unopposed oestrogen on the endometrium in hormone replacement therapy for women with disorders due to natural or surgical induced menopause with an intact uterus.

Pharmacology of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Dydrogesterone is an orally-active progestogen which produces a complete secretory endometrium in an oestrogen-primed uterus thereby providing protection against the increased risk for endometrium hyperplasia and carcinogenesis induced by oestrogens. It is indicated in all cases of endogenous progesterone deficiency. Dydrogesterone has no oestrogenic, no androgenic, no thermogenic, no anabolic and no corticoid activity.

Dosage & Administration of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Always take Presentation 10 mg tablet exactly as your doctor has prescribed.

Presentationerone deficiencies:

Threatened miscarriage: 40 mg (four tablets) at once, then 10 mg (one tablet) every eight hours until symptoms remit.
Habitual miscarriage: 10 mg (one tablet) twice daily until the twentieth week of pregnancy.
Dysmenorrhoea: 10 mg (one tablet) twice daily from day 5 to day 25 of the menstrual cycle.
Endometriosis: 10 mg (one tablet) two or three times daily from day 5 to day 25 of the cycle or continuously.
Dysfunctional bleeding (to arrest bleeding): 10 mg (one tablet) twice daily for five to seven days. Presentation should be given with oestrogen.
Dysfunctional bleeding (to prevent bleeding): 10 mg (one tablet) twice daily from day 11 to day 25 of the cycle. Presentation should be given with oestrogen.
Amenorrhoea: An oestrogen once daily from day 1 to day 25 of the cycle, together with 10 mg Presentation twice daily from day 11 to day 25 of the cycle.
Irregular cycles: 10 mg (one tablet) twice daily from day 11 to day 25 of the cycle.
Infertility due to luteal insufficiency: 10 mg (one tablet) daily from day 14 to day 25 of the cycle. The treatment should be continued for at least 6 consecutive cycles. It is advisable to continue this treatment during the first month of any pregnancy using the doses stated with respect to habitual miscarriage.
Luteal support as part of an Assisted Reproductive Technology (ART) treatment: 10 mg three times daily (three tablets daily) starting at the day of oocyte retrieval and continuing for 10 weeks if pregnancy is confirmed.

Hormone Replacement Therapy: In combination with continuous oestrogentherapy, take one tablet daily for 14 consecutive days of a 28 day cycle. In combination with cyclical oestrogen therapy take one tablet daily during the last 12 to 14 days of oestrogen therapy. For doctors: If endometrial biopsies or ultrasound reveal inadequate Presentationational response, 20 mg Dydrogesterone should be prescribed. For patients: If you are not sure what type of oestrogen therapy you are on, talk to your Doctor before taking Presentation. There is no relevant use of Dydrogesterone before menarche. The safety and efficacy of Dydrogesterone in adolescents aged 12 to 18 years has not been established.

Contraindications of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Known hypersensitivity to the active substance or to any of the excipients. Known or suspected progestogen dependent neoplasms (e.g. meningioma).

Side Effects of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

The most commonly reported adverse drug reactions of patients treated with Duphaston in clinical trials of indications without oestrogen treatment are migraines/headache, nausea, menstrual disorders and breast pain/tenderness.

Pregnancy & Lactation of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

It is estimated that more than 10 million pregnancies have been exposed to Dydrogesterone. So far there were no indications of a harmful effect of Dydrogesterone use during pregnancy. No data exist on excretion of Dydrogesterone in mother’s milk. Experience with other progestogens indicates that progestogens and the metabolites pass to mother’s milk in small quantities. Whether there is a risk to the child is not known. Therefore Dydrogesterone should not be used during the lactation period.

Precautions & Warnings of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Before initiating Duphaston treatment for abnormal bleeding the etiology for the bleeding should be clarified. Breakthrough bleeding and spotting may occur during the first months of treatment. If breakthrough bleeding or spotting appears after some time on therapy, or continues after treatment has been discontinued, the reason should be investigated, which may include endometrial biopsy to exclude endometrial malignancy. If one of the following disorders occurs during use for the first time or gets worse, stopping the treatment should be considered.

Severe headache, migraine or symptoms that may indicate cerebral ischemia.
Marked increase in blood pressure.
Occurrence of venous thromboembolism (VTE)

In cases of habitual or threatened abortion, the viability of the foetus should be ascertained. It is also necessary to monitor during treatment whether the pregnancy is still progressing and whether the embryo is still alive. Patients with a history of depression must be carefully monitored; if severe depression recurs, treatment with Duphaston must be stopped

Overdose Effects of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Duphaston was well tolerated after oral dosing (maximum daily dose is 360 mg). No reports of ill effects from overdose have been recorded. If a large overdose is discovered within two or three hours and treatment seems desirable, gastric lavage is recommended. There are no specific antidotes and treatment should be symptomatic.

Therapeutic Class of Tablet :-Duphaston 10 mg (AS A Dydrogesterone AS A Female Sex hormones).

Female Sex hormones

If need then Inj. HPC DS

Wkly 1inj upto 20wks

Ans2

In ultrasound Incomplete Abortion – products size 2.5 cm or more then suggest D and C.

If less than 2.5cm then Orally Cytomis BD for 7days and after 14days followup usg.

Tablet4:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Indications of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Cytomis is indicated for-

Prophylaxis of gastric and duodenal ulceration in NSAID users at high risk of complications from gastric ulcer e.g. the elderly, patients with concomitant debilitating disease and patients with a history of ulcer.
Healing of established NSAID- induced gastric and duodenal damage.
Healing of gastric and duodenal ulcers in the absence of NSAID therapy.
Induction of labor.
Prevention and treatment of postpartum hemorrhage.

Pharmacology of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Misoprostol is extensively absorbed, and undergoes rapid de-esterification to its free acid, which is responsible for its clinical activity and, unlike the parent compound, is detectable in plasma. Maximum plasma concentrations of Misoprostol acid are diminished when the dose is taken with food and total availability of Misoprostol acid is reduced by use of concomitant antacid. Misoprostol has both antisecretory (inhibiting gastric acid secretion) and (in animals) mucosal protective properties. NSAIDs inhibit prostaglandin synthesis, and a deficiency of prostaglandins within the gastric mucosa may lead to diminishing bicarbonate and mucus secretion and may contribute to the mucosal damage caused by these agents. Misoprostol can increase bicarbonate and mucus production, but in man this has been shown at doses 200 meg and above that are also antisecretory. It is therefore not possible to tell whether the ability of Misoprostol to reduce the risk of gastric ulcer is the result of its antisecretory effect, its mucosal protective effect, or both.

Dosage & Administration of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Benign gastric and duodenal ulceration and NSAID associated ulceration: 800 mcg daily (in 2-4 divided doses) with breakfast or main meals and at bedtime; treatment should be continued for at least 4 weeks and may be continued for up to 8 weeks if required.

Prophylaxis of NSAID-induced gastric and duodenal ulcer: 200 mcg 2-4 times daily taken with NSAID. If this dose cannot be tolerated, a dose of 100 mcg can be used. Misoprostol should be taken for the duration of NSAID therapy as prescribed by the physician.

Induction of labor: Place 25 mcg in the posterior fornix of the vagina. Repeat after every 6 hours if necessary until the maximum dosage of 200 mcg total misoprostol is reached. Fetal heart rate and uterus contractions should be monitored. Alternatively, 100 mcg taken orally. If cervical ripening or active labor does not occur, repeated dose of 100-200 mcg of oral misoprostol is given every 4 hourly until labor is established (as evidenced by a Bishop score of 7 or more). Maximum number of dose is 6. Maternal vital signs, fetal heart rate and contractions should be monitored. Oxytocin can be started 4 hours after last dose of misoprostol. Physician should be notified for signs of fetal distress or tetanic uterine contractions. Oral misoprostol therapy should be monitored by Physician.

Prevention of postpartum hemorrhage: 600 mcg orally immediately following delivery.

Treatment of postpartum hemorrhage: 600 mcg orally or 1000 mcg per rectally.

Interaction of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

There is no evidence of clinically significant interaction between Cytomis and cardiac, pulmonary, CNS drugs and NSAID’s. The bioavailability of Cytomis is decreased with high doses of antacid.

Contraindications of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Misoprostol is contraindicated to anyone with a history of allergy to prostaglandins and it is also contraindicated in pregnancy.

Side Effects of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Generally, Cytomis is well tolerated. The most frequent adverse effects associated with Cytomis therapy involve the GI tract such as diarrhea, abdominal pain, dyspepsia, flatulence, nausea, vomiting, rashes and dizziness. The incidence of diarrhea may be minimized by administering the drug after meal and at bedtime and by avoiding concomitant administration with a magnesium-containing or other laxative antacid.

Pregnancy & Lactation of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Because of the abortifacient property of the Misoprostol component, it is contraindicated in women who are pregnant. It should not be used in women of childbearing potential unless the patient requires nonsteroidal anti-inflammatory drug (NSAID) therapy and is at high risk of developing gastric or duodenal ulceration or for developing complications from gastric or duodenal ulcers associated with the use of the NSAID. In such patients, it may be prescribed if the patient:

has had a negative serum pregnancy test within 2 weeks prior to beginning therapy.
is capable of complying with effective contraceptive measures.
has received both oral and written warnings of the hazards of Misoprostol, the risk of possible contraception failure, and the danger to other women of childbearing potential should the drug be taken by mistake.
will begin it only on the second or third day of the next normal menstrual period.

Excretion of the active metabolite (Misoprostol acid) into milk is possible but has not been studied. Because of the potential for serious adverse reactions in nursing infants, it is not recommended for use by nursing mothers

Therapeutic Class of Tablet:-Cytomis 100 mg. (AS A Misoprostol AS A Drugs acting on the Uterus, Prostaglandin analogues).

Drugs acting on the Uterus, Prostaglandin analogues

Ans3

For regulation of period only OCP and Norethisterone/Medroxyprogesterone, these are needed.

Tablet 5:-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Indications of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Normens is indicated in:

Metropathia hemorrhagic (dysfunctional uterine bleeding),
Premenstrual syndrome,
Postponement of menstruation,
Endometriosis &
Menorrhagia.

Pharmacology of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Norethisterone tablet is a preparation of Norethisterone which has progestational actions similar to those of progesterone, but is a more potent inhibitor of ovulation and has weak estrogenic and androgenic properties. It is used to treat a number of disorders of the menstrual cycle. Norethisterone is absorbed from the gastrointestinal tract and its effects last for at least 24 hours. It is excreted in the urine.

Dosage & Administration of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Oral administration. Not intended for use in children.

Metropathia haemorrhagica (dysfunctional uterine bleeding): 1 tablet 3 times daily for 10 days. Bleeding is arrested usually within 1-3 days. A withdrawal bleeding resembling normal menstruation occurs within 2-4 days after discontinuing treatment.

Prophylaxis against recurrence of dysfunctional bleeding: If there are no signs of resumption of normal ovarian function (no rise in the second half of the cycle of the morning temperature, which should be measured daily) recurrence must be anticipated. Cyclical bleeding can be established with 1 tablet twice daily from the 19th to the 26th day of the cycle.

Premenstrual syndrome (including premenstrual mastalgia): Premenstrual symptoms such as headache, migraine, breast discomfort, water retention, tachycardia, and psychological disturbances may be relieved by the administration of 2-3 tablets daily from the 19th to the 26th day of the cycle. Treatment should be repeated for several cycles. When treatment is stopped, the patient may remain symptom-free for a number of months.

Postponement of menstruation: In cases of too frequent menstrual bleeding, and in special circumstances (e.g. operations, travel, sports) the postponement of menstruation is possible. 1 tablet of Norethisterone three times daily, starting 3 days before the expected onset of menstruation. A normal period should occur 2-3 days after the patient has stopped taking tablets.

Endometriosis (pseudo-pregnancy therapy): Long-term treatment is commenced on the 5th day of the cycle with 2 tablets of Norethisterone daily for the first few weeks. In the event of spotting, the dosage is increased to 4, and, if necessary, 5 tablets daily. After bleeding has ceased, the initial dose is usually sufficient. Duration of treatment: 4-6 months continuously, or longer if necessary.

Menorrhagia (hypermenorrhoea): 1 tablet 2-3 times a day from the 19th to the 26th day of the cycle (counting the first day of menstruation as day 1).

Interaction of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Not known.

Contraindications of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Pregnancy
Severe disturbances of liver function
Dubin-Johnson syndrome
Rotor syndrome
Previous or existing liver tumours
History during pregnancy of idiopathic jaundice, severe pruritus or herpes gestationis
Current thromboembolic processes
Hypersensitivity to the active substances or to any of the excipients

Side Effects of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Side-effects are more common during the first months after start of intake of Normens, and subside with a duration of treatment. The side-effects are mentioned below:

Eye disorders- Visual disturbance
GI disorders- Nausea
General disorders and administration site- conditions headache, edema
Nervous system disorders- Migraine, Respiratory, thoracic and mediastinal disorders- Dyspnoea,
Skin and subcutaneous tissue disorders- Hypersensitivity (eg. Rash, urticaria).

Pregnancy & Lactation of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

The administration of Norethisterone during pregnancy is contraindicated. Norethisterone should not be used during lactation.

Precautions & Warnings of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

There is a general opinion, based on statistical evidence that users of combined oral contraceptives experience, more often than non-users, venous thromboembolism, arterial thrombosis, including cerebral and myocardial infarction and subarachnoid haemorrhage. Full recovery from such disorders does not always occur, and it should be realized that in a few cases they are fatal. Although Normens does not contain oestrogen, one should keep the possibility of an increased thromboembolic risk in mind, particularly where there is a history of thromboembolic disease or in the presence of severe diabetes with vascular changes or sickle-cell anaemia.

In rare cases benign, and in even rarer cases, malignant liver tumours leading in isolated cases to life-threatening intra-abdominal haemorrhage have been observed after the use of hormonal substances such as the one contained in Normens. If severe upper abdominal complaints, liver enlargement or signs of intra-abdominal haemorrhage occur, a liver tumour should be included in the differential diagnosis and, if necessary, the preparation should be withdrawn.
Normens can influence carbohydrate metabolism. Parameters of carbohydrate metabolism should be examined carefully in all diabetics before and regularly during treatment.

Reasons for stopping Normens immediately-

Occurrence for the first time of migrainous headaches or more frequent occurrence of unusually severe headaches
Sudden perceptual disorders (e.g. disturbances of vision or hearing)
First signs of thrombophlebitis or thromboembolic symptoms, feeling of pain and tightness in the chest
Pending operations (six weeks beforehand), immobilisation (e.g. after accidents)
Onset of jaundice, hepatitis, general pruritus
Significant rise in blood pressure
Pregnancy.

Overdose Effects of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

There have been no reports from overdosage and treatment is generally unnecessary. There are no special antidotes and treatment should be symptomatic.

Therapeutic Class of Tablet :-Normens 5mg As a Norethisterone Acetate (AS A Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations).

Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations

Tablet 6:-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Indications of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Medogen tablet is a progestin indicated for the treatment of secondary amenorrhea and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as fibroids or uterine cancer. Medogen is also indicated to reduce the incidence of endometrial hyperplasia in nonhysterectomized postmenopausal women receiving daily oral conjugated estrogens 0.625 mg tablets.

Pharmacology of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Medroxyprogesterone acetate (MPA) administered orally or parenterally in the recommended doses to women with adequate endogenous estrogen, transforms proliferative into secretory endometrium. Androgenic and anabolic effects have been noted, but the drug is apparently devoid of significant estrogenic activity. While parenterally administered MPA inhibits gonadotropin production, which in turn prevents follicular maturation and ovulation, available data indicate that this does not occur when the usually recommended oral dosage is given as single daily doses.

Dosage & Administration of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Secondary Amenorrhea: Medroxyprogesterone acetate tablets may be given in dosages of 5 or 10 mg daily for 5 to 10 days. A dose for inducing an optimum secretory transformation of an endometrium that has been adequately primed with either endogenous or exogenous estrogen is 10 mg of this tablet daily for 10 days. In cases of secondary amenorrhea, therapy may be started at any time. Progestin withdrawal bleeding usually occurs within three to seven days after discontinuing this tablet therapy.

Abnormal Uterine Bleeding Due to Hormonal Imbalance in the Absence of Organic Pathology: Beginning on the calculated 16th or 21st day of the menstrual cycle, 5 or 10 mg of this tablet may be given daily for 5 to 10 days. To produce an optimum secretory transformation of an endometrium that has been adequately primed with either endogenous or exogenous estrogen, 10 mg of this tablet daily for 10 days beginning on the 16th day of the cycle is suggested. Progestin withdrawal bleeding usually occurs within three to seven days after discontinuing therapy with this tablet. Patients with a past history of recurrent episodes of abnormal uterine bleeding may benefit from planned menstrual cycling with this tablet.

Reduction of Endometrial Hyperplasia in Postmenopausal Women Receiving Daily 0.625 mg Conjugated Estrogens: When estrogen is prescribed for a postmenopausal woman with a uterus, a progestin should also be initiated to reduce the risk of endometrial cancer. A woman without a uterus does not need progestin. Use of estrogen, alone or in combination with a progestin, should be with the lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman. Patients should be re-evaluated periodically as clinically appropriate (for example, 3 to 6 month intervals) to determine if treatment is still necessary. For women who have a uterus, adequate diagnostic measures, such as endometrial sampling, when indicated, should be undertaken to rule out malignancy in cases of undiagnosed persistent or recurring abnormal vaginal bleeding.

Medroxyprogesterone acetate tablet tablets may be given in dosages of 5 or 10 mg daily for 12 to 14 consecutive days per month, in postmenopausal women receiving daily 0.625 mg conjugated estrogens, either beginning on the 1st day of the cycle or the 16th day of the cycle. Patients should be started at the lowest dose. The lowest effective dose of this tablet has not been determined.

Contraindications of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Medroxyprogesterone Acetate is contraindicated in women with any of the following conditions:

Undiagnosed abnormal genital bleeding.
Known, suspected, or history of breast cancer.
Known or suspected estrogen- or progesterone-dependent neoplasia.
Active DVT, PE, or a history of these conditions
Active arterial thromboembolic disease (for example, stroke and MI), or a history of these conditions.
Known anaphylactic reaction or angioedema to Medroxyprogesterone Acetate
Known liver impairment or disease.
Known or suspected pregnancy.

Side Effects of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

The following adverse reactions have been reported in women taking Medogen tablets, without concomitant estrogens treatment:

Genitourinary system: Abnormal uterine bleeding (irregular, increase, decrease), change in menstrual flow, breakthrough bleeding, spotting, amenorrhea, changes in cervical erosion and cervical secretions.
Breasts: Breast tenderness, mastodynia or galactorrhea has been reported.
Cardiovascular: Thromboembolic disorders including thrombophlebitis and pulmonary embolism have been reported.
Gastrointestinal: Nausea, cholestatic jaundice.
Skin: Sensitivity reactions consisting of urticaria, pruritus, edema and generalized rash have occurred. Acne, alopecia and hirsutism have been reported.
Eyes: Neuro-ocular lesions, for example, retinal thrombosis, and optic neuritis.
Central nervous system: Mental depression, insomnia, somnolence, dizziness, headache, nervousness.

Pregnancy & Lactation of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Medroxyprogesterone Acetate should not be used during pregnancy. There may be increased risks for hypospadias, clitoral enlargement and labial fusion in children whose mothers are exposed to Medroxyprogesterone Acetate during the first trimester of pregnancy. However, a clear association between these conditions with use of this tablet has not been established. This tablet should not be used during lactation. Detectable amounts of progestin have been identified in the breast milk of nursing mothers receiving progestins.

Precautions & Warnings of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Addition of a progestin when a woman has not had a hysterectomy: Studies of the addition of a progestin for 10 or more days of a cycle of estrogen administration, or daily with estrogen in a continuous regimen, have reported a lowered incidence of endometrial hyperplasia than would be induced by estrogen treatment alone. Endometrial hyperplasia may be a precursor to endometrial cancer. There are, however, possible risks that may be associated with the use of progestins with estrogens compared to estrogen-alone regimens. These include an increased risk of breast cancer.

Unexpected abnormal vaginal bleeding: In cases of unexpected abnormal vaginal bleeding, adequate diagnostic measures are indicated.

Elevated blood pressure: Blood pressure should be monitored at regular intervals with estrogen plus progestin therapy.

Hypertriglyceridemia: In women with pre-existing hypertriglyceridemia, estrogen plus progestin therapy may be associated with elevations of plasma triglycerides leading to pancreatitis. Consider discontinuation of treatment if pancreatitis occurs.

Hepatic Impairment and/or past history of cholestatic jaundice: Estrogens plus progestins may be poorly metabolized in women with impaired liver function. For women with a history of cholestatic jaundice associated with past estrogen use or with pregnancy, caution should be exercised, and in the case of recurrence, medication should be discontinued.

Fluid Retention: Progestins may cause some degree of fluid retention. Women who have conditions which might be influenced by this factor, such as cardiac or renal impairment, warrant careful observation when estrogen plus progestin are prescribed.

Hypocalcemia: Estrogen plus progestin therapy should be used with caution in women with hypoparathyroidism as estrogen-induced hypocalcemia may occur.

Exacerbation of other conditions: Estrogen plus progestin therapy may cause an exacerbation of asthma, diabetes mellitus, epilepsy, migraine, porphyria, systemic lupus erythematosus, and hepatic hemangiomas and should be used with caution in women with these conditions.

Use in Special Populations of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Pediatric Use: Medogen tablets are not indicated in children. Clinical studies have not been conducted in the pediatric population.

Geriatric Use: There have not been sufficient numbers of geriatric women involved in clinical studies utilizing Medogen alone to determine whether those over 65 years of age differ from younger subjects in their response to Medogen alone.

Overdose Effects

Overdosage of estrogen plus progestin therapy may cause nausea and vomiting, breast tenderness, dizziness, abdominal pain, drowsiness/fatigue and withdrawal bleeding may occur in women. Treatment of overdose consists of discontinuation of CE plus MPA together with institution of appropriate symptomatic care.

Therapeutic Class of Tablet :-Medogen 10mg (AS A Medroxyprogesterone Acetate AS A Female Sex hormones).

Female Sex hormones

Ans4

Pls at 1st find out the cause of hypomenorrhoea then treatment according to cause.

General Quaries:-

1.Cytomis খাবার পরে অনেকের আবার ব্লিডিং বেশি হয়। এই ক্ষেত্রে পরবর্তী স্টেপ কী নেওয়া যেতে পারে?

Answer is:- ব্লিডিং তো হবেই, প্রোডাক্ট বের হতে হবে না?

2. 1 no ans e microgest & dydrogesterone duitai ki cholbe eksathe?

Inj hpc ds koto week theke start kora jabe?

Answer is:

1st trimester Microgest

2nd to 34 wks Dydrogesterone.

Hpc boka hoy 11wks theke, kintu onekey 7-8 wks ao dey.

Raiyyan Tahsan Date:07-01-2024 Wednesday Time:-10-19-55 Pm.

Raiyyan Tahsan

Raiyyan Tahsan