Ans. a. Hot flashRef: Shaws Textbook of Gynecology 16th Ed; Page No-74HORMONE REPLACEMENTTHERAPYBenefits and RisksEstrogen therapy is the most effective FDA-approved method for relief of menopausal vasomotor symptoms (hot flashes), it is also used in genitourinary atrophy and dyspareunia.Hot flashes:Excess amount of sweating and sensation of heat is felt by 75% of menopausal women.It is mediated through the hypothalamic thermoregulatory center.Due to peripheral conversion of androgens to estrone in their peripheral adipose tissues; obese women are less commonly to undergo hot flashes.The Womens Health Initiative (WHI) study of the National Institutes of Health (NIH) studied 27,000 postmenopausal women with a mean age of 63 years. These included women with a uterus on hormone therapy (HT), both estrogen and progestin, and hysterectomized women on estrogen therapy (ET) only.CRITIQUE OF WOMEN'S HEALTH INITIATIVE STUDYExcludes patients with vasomotor symptomsPrimary indication for hormone replacementMean patient age was 63 yearsMissed the 10-year "window of opportunity"Same dose of hormone for all agesOlder women don't need as a high dose as do younger womenPatients were not all healthyHypertension (40%), t cholesterol (15%), diabetes mellitus (7%), myocardial infarction (3%)Benefits: Both HT and ET groups in WHI had decreased osteoporotic fractures and lower rates of colorectal cancer.Risks: Both HT and ET groups in WHI were found to have small increases in deep vein thrombosis (DVT). The HT group also had increased heart attacks and breast cancer, but these were not increased in the ET group.WHI-BENEFIT AND RISK (MEAN AGE OF 63 YEARS) Estrogen and progestinEstrogen onlyVaginal drynessBenefitBenefitHot flashesBenefitBenefitVasomotor symptomsBenefitBenefitOsteoporosisBenefitBenefitBreast cancerRiskNo changeHeart diseaseRiskNo changeStrokeRiskRiskCONTRAINDICATIONSPersonal history of an estrogen-sensitive cancer (breast or endometrium), active liver disease, active thrombosis, or unexplained vaginal bleedingMODALITIESThe route of Estrogen can be administered by oral, transdermal, vaginal, or parenteral routes.All routes will yield the benefits described. Estrogen is contraindicated in Women with uterus cancer.All women with uterus cancer should be treated with progestin therapy to prevent endometrial hyperplasia.The most common current regimen is oral estrogen and progestin given continuously.