HRT

HRT, yani hormone replacement therapy, un hormones ki kami poori karti hai jo menopause ke aas paas girte hain, khaas taur par estrogen. Pakistan Menopause Society bain-ul-aqwami naam MHT istemal karti hai, aur is mein estrogen, progestogen, mushtarka ilaaj, androgens aur tibolone ko ginti hai (section 5).

Do bari qismein

Agar aap ki bachedani nikalwai hui hai to HRT aam taur par sirf estrogen hoti hai. Agar bachedani abhi hai to us ki androoni teh ki hifazat ke liye saath aik progestogen diya jata hai. PMS ki sifarishaat yehi taqseem batati hain (section 5.4).

NHS ki website mushtarka HRT ke do tareeqe batati hai: baari baari wala (sequential), jis mein progestogen ke har daur ke aakhir mein mahwari aati hai, un auraton ke liye jinhein abhi mahwari aa rahi hai; aur roz wala (continuous), jis mein donon hormone roz liye jate hain, mahwari band hone ke baad. PMS ki sifarishaat mazeed kehti hain ke roz wali mushtarka HRT mein withdrawal bleed, yani har daur ke baad aane wala khoon, nahin aata (Table 8).

Lene ke tareeqe

Women's Health Concern kehta hai ke estrogen goli ki shakal mein ho sakta hai, ya jild ke raaste gel, patch ya spray ki shakal mein. Progestogen saath hi mushtarka goli ya patch mein aa sakta hai, alag liya ja sakta hai, ya hormone wali coil (LNG-IUS) se aa sakta hai. Usi jagah lagane wala estrogen khushki ke liye aik alag ilaaj hai; NHS ki website kehti hai ke yeh hot flush (achanak garmi lagna) ka ilaaj nahin karta.

HRT shuru karna kam hi aik raat mein button dabane jaisa hota hai. NHS ki website kehti hai ke aam taur par kam dose se shuru kiya jata hai aur alamaat dinon ya hafton mein kam hoti hain. Sar dard, chhaati mein dard ya dhabbe jaise side effects aam taur par halke hote hain aur pehle chand maheenon mein khatam ho jate hain.

NICE NG23 sifarish karta hai ke menopause ke har ilaaj ka 3 maheene par jaiza liya jaye, yeh dekhne ke liye ke woh kitna kaam kar raha hai aur kitna raas aa raha hai, aur phir saal mein aik baar.

NHS ki website kehti hai ke ho sakta hai HRT un auraton ke liye theek na ho jinhein chhaati, ande dani ya bachedani ka cancer raha ho, jin ka high blood pressure baghair ilaaj ke ho ya jinhein jigar ki beemari ho, ya jo haamla hon. Khoon ke lothron ke baad, woh kehti hai, goliyon ki jagah patch ya gel diye ja sakte hain. Pakistan Menopause Society is mein andaam nihani se aisa khoon bhi shamil karti hai jis ki wajah abhi kisi ne na dhoondi ho, jis ki pehle jaanch zaroori hai (section 5.2).

NICE NG23 kuch auraton ke liye HRT ko radd karne ke bajaye kisi maahir ki taraf rehnumai karti hai: jin auraton mein lothron ka khatra zyada ho, jaise khoon jamne ki mauroosi beemari, un ke liye pehle khoon ki beemariyon ka maahir (haematologist) (1.5.29), aur dil ki shiryanon ki beemari (coronary heart disease) ya faalij (stroke) ke baad (1.5.30), ya chhaati ka cancer raha ho ya us ka zyada khatra ho (1.5.31), to menopause ka maahir. Lothron ka khatra zyada ho, jis mein zyada BMI bhi shamil hai, to woh jild ke raaste HRT tajweez karti hai (1.5.28).

Do cheezein akele HRT ko radd nahin kartin. British Menopause Society kehti hai ke aura wala migraine aisa nahin karta, aur migraine wali auraton ke liye jild ke raaste estradiol ko behtar samajhti hai. Women's Health Concern kehta hai ke fibroids (bachedani ki rasoliyan) HRT se inkaar karne ya ise band karne ki wajah nahin.

European Menopause and Andropause Society (EMAS) ki do lambi beemariyon ke liye alag rehnumai hai. Mirgi mein woh jild ke raaste estrogen ko behtar samajhti hai, aur kehti hai ke HRT shuru hone ke baad mirgi ki kuch dawaon mein radd o badal ki zaroorat par sakti hai. Gurdon ki lambi beemari (chronic kidney disease) mein woh kehti hai ke HRT di ja sakti hai.

Waqt ke baare mein Pakistan Menopause Society ki sifarishaat kehti hain ke faide aur khatre ka tawazun sab se achha tab hota hai jab HRT 60 se pehle ya menopause ke 10 saal ke andar shuru ho (section 5.12). America ki The Menopause Society bhi yehi kehti hai, aur is ke saboot ko mazboot darje ka maanti hai. Baad mein shuru karna radd nahin hai. NICE NG23 kehta hai ke sirf estrogen wali HRT ki goliyon se faalij ka jo khatra barhta hai, woh 60 saal ki umar ke baad HRT shuru karne par aur zyada hota hai, aur The Menopause Society kehti hai ke 60 ke baad shuru karne se pehle aap ke apne faide aur khatre ghaur se tolne chahiyen.

Kitna arsa, is par PMS kehti hai ke koi muqarrara hadd nahin honi chahiye: jaari rakhna aap aur aap ke doctor ka mil kar kiya gaya faisla hai (section 5.14). EMAS aur The Menopause Society bhi yehi kehti hain, aur EMAS kehti hai ke 65 saal par maamool ke taur par band kar dene ki sifarish nahin ki jati.

NICE NG23 hot flush aur raat ke paseenon ke liye HRT pesh karne ki sifarish karti hai (1.5.1), aur PMS ki sifarishaat ise un auraton ke liye, jo ise le sakti hain, in alamaat ki sab se moassar pehle darje ki dawa kehti hain (section 7.1.1). NICE NG23 yeh bhi kehta hai ke jo udaasi menopause ki doosri alamaat ke saath shuru ho aur depression ki hadd tak na pahunche, us ke liye HRT ke baare mein socha ja sakta hai (1.5.21).

Faide aur khatre ka hisaab HRT ke faide aur khatre mein hai. Agar HRT aap ke liye theek nahin to hidayat ghair harmoonal ilaaj aur CBT batati hain. NICE NG23 aik baat par bilkul saaf hai: sirf hot flush aur raat ke paseenon ke liye SSRIs aur SNRIs wali depression ki dawaein, ya clonidine, aam taur par pehle ilaaj ke taur par nahin di jani chahiyen.

Agar aap ki umar 45 se zyada hai, alamaat hain aur aap HRT par baat karna chahti hain, to appointment lene ke liye itni wajah kaafi hai. Agar umar 45 se kam hai aur alamaat hain, to NHS ki website kehti hai ke tab bhi doctor ko dikhayen, kyunke yeh waqt se pehle menopause ho sakta hai.

HRT shuru hone ke baad NHS ki website kuch nishaniyan batati hai jin par qadam uthana chahiye. Bhaari khoon, ya pehle chhe maheenon ke baad ghair mutawaqqa khoon, dikhana chahiye, aur bachedani nikalwane ke baad kisi bhi qisam ka khoon bhi. Aik taang mein, aam taur par pindli mein, dard, laali ya soojan ho to fauran doctor ka mashwara chahiye. Chhaati mein gilti ya koi aur tabdeeli ho to GP ki appointment chahiye. Saans phoolne ke saath seene mein dard, ya chehra, bazu ya bolna achanak badal jaye, to fauran emergency mein madad chahiye.

Auratein poochti hain ke kya hormone ki dawa un ke deen ke lihaaz se theek hai, aur kya Ramzan mein is se kuch badalta hai. Sawal bilkul theek hain, aur un ka seedha jawab kam hi milta hai. Roze ka sawal kisi mustanad aalim ka hai; roze ke dauran dawa kab lein, yeh dawa likhne wale ka.

Ghar mein sab se mushkil baat kabhi kabhi kisi rishtedar ka woh dohrana hota hai jo us ne barson pehle suna tha: HRT se cancer hota hai. Khatron wala safha batata hai ke aaj ki hidayat kya kehti hain, aise lafzon mein jo aap ghar walon ko dikha sakein.