tibolone perimenopause ddavp

The common symptoms in perimenopausal depression (The course of mental illness in women differs from that of men and is greatly influenced by biological, psychological and social changes over the life cycle. The Obstetrical and Gynaecological Society of Malaysia (OGSM) is an independent, non-profit and non-governmental organisation affiliated to the International Federation of Gynaecology and Obstetrics (FIGO) and the Asia-Oceania Federation of Obstetrics and Gynaecology (AOFOG). This delay can make the diagnosis of perimenopausal depression very difficult. Clinicians need to provide a tailored management approach for these women. 06 Aug 2020 Minimising alcohol intake is very important for the patient’s mental and physical health.Treatments for perimenopausal depression usually include antidepressants and gonadal hormones. Agomelatine is a newer antidepressant with positive sedative impact and fewer adverse effects in women with perimenopausal depression.Combining hormone therapy and antidepressant therapy may be required for perimenopausal women with depressive symptoms that do not respond to either treatment alone. Tibolone is a synthetic steroid with a mixed hormonal profile which has shown benefit in treating perimenopausal depression. Tibolone (Livial, Org OD 14), produced by Organon (West Orange, NJ), is a synthetic steroid that has estrogenic, androgenic and progestagenic properties. However, most treatments for mental illnesses have been developed and trialled in the ‘typical’ male patient which may not be the optimal treatment for women with mental ill health related to the menopause. Often, the order in which they are used depends on the clinician’s particular expertise or medical specialty. It has been used in Europe for almost 2 decades, primarily for the prevention of postmenopausal osteoporosis and treatment of climacteric symptoms. It is not termed as “menopausal hormone therapy” (MHT) as it is a synthetic drug (made mainly from Mexican yam) that has the following properties:• Estrogen like activities – helps with prevention of hot flushes, prevention of bone loss (and osteoporosis), and helps decrease dryness in the vagina.• Progesterone like activities – does not increase the lining of the uterus and cuts down the risk of post-menopausal bleeding.• Testosterone like activities – helps increase mood and libido.Tibolone is best taken 1 year after the last period as if taken sooner may cause irregular bleeding.

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