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ORMELOXIFENE- A New Treatment Modality in DUB

Dysfunctional Uterine Bleeding. MOST COMMON MENSTRUAL DISORDERCAN AFFECT ANY WOMEN FROM MENARCHEE TO MENOPAUSEOFTEN THE FIRST CLINICAL DIAGNOSIS FOR ANY EXCESSIVE MENSTRUAL BLEEDINGDIAGNISIS HAS TO BE CONFIRMED BY A PROCESS OF EXCLUSION OF PATHOLOGICAL CAUSES. Dysfunctional Uterine Bleeding. EXACT PATHOPHYSIOLOGY STILL NOT KNOWNBASIS OF EXCESSIVE BLEEDING IS MOSTLY AN ENDOCRINE ABNORMALITY: -OESTROGEN - PROGESTERONE IMBALANCE (mostly estrogen dominance)ALTERED PROSTAGLANDIN SYNTHESIS INFAV31942

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ORMELOXIFENE- A New Treatment Modality in DUB

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    1. ORMELOXIFENE- A New Treatment Modality in DUB Dr.Surendra Nath Panda, M.S. Professor of Obstetrics and Gynaecology. M.K.C.G.Medical College. Berhampur, Orissa, INDIA

    2. Dysfunctional Uterine Bleeding MOST COMMON MENSTRUAL DISORDER CAN AFFECT ANY WOMEN FROM MENARCHEE TO MENOPAUSE OFTEN THE FIRST CLINICAL DIAGNOSIS FOR ANY EXCESSIVE MENSTRUAL BLEEDING DIAGNISIS HAS TO BE CONFIRMED BY A PROCESS OF EXCLUSION OF PATHOLOGICAL CAUSES

    3. Dysfunctional Uterine Bleeding EXACT PATHOPHYSIOLOGY STILL NOT KNOWN BASIS OF EXCESSIVE BLEEDING IS MOSTLY AN ENDOCRINE ABNORMALITY: -OESTROGEN - PROGESTERONE IMBALANCE (mostly estrogen dominance) ALTERED PROSTAGLANDIN SYNTHESIS INFAVOUR OF E2 THAN E2?

    4. OVULATUION : - PHASE CHANGE: - ENDOMET. HISTOLOGY: - MENSTRUAL PATERN: -

    5. OVULATUION : - PHASE CHANGE: - ENDOMET. HISTOLOGY: - MENSTRUAL PATERN: -

    6. OVULATUION : - PHASE CHANGE: - ENDOMET. HISTOLOGY: - MENSTRUAL PATERN: -

    7. OVULATUION : - PHASE CHANGE: - ENDOMET. HISTOLOGY: - MENSTRUAL PATERN: -

    8. OVULATUION : - PHASE CHANGE: - ENDOMET. HISTOLOGY: - MENSTRUAL PATERN: -

    9. OVULATUION : - PHASE CHANGE: - ENDOMET. HISTOLOGY: - MENSTRUAL PATERN: -

    11. D U B - Management Options

    12. HORMONES Es+Pr Progestogens Estrogen Androgens + Estrogen Danazol GnRha SECOND LINE & mostly Adjuvant NSAIDs Mefenamic acid Ethamsylate Antifibrinolytics EACA Tranexamic acid Radiotherapy ? Medical Treatment for DUB

    13. Treatment has to be indivisualised Not suitable for all ages Response is erratic and unpredictable SIDE EFFECTS - Discontinuation and noncompliance Failures are common Cost effectiveness ? Surgery is often resorted to Medical Treatment for DUB

    14. Surgical Treatment of DUB

    15. Surgical Treatment of DUB

    16. Surgical Treatment of DUB

    17. Surgical Treatment of DUB Curettage Mostly diagnostic Never gives a cure Endometrial resection / ablation Array of methods Recurrence is common Amenorrhoea gives cure HYSTERECTOMY Invasive procedure Not suitable at all ages Not without risks Costly First option in 40+ DUB is the most common indication

    18. Need of the Hour for the Treatment of DUB The ideal therapy should be a designer drug which can block the action of Estrogen on the Endometrium but not its beneficial actions on other tissues

    19. Mechanism of Tissue Response

    20. Selective Ostrogen Receptor Modulators

    23. ORMELOXIFENE

    24. ORMELOXIFENE

    25. ORMELOXIFENE

    26. ORMELOXIFENE

    27. ORMELOXIFENE

    28. ORMELOXIFENE

    29. ORMELOXIFENE

    30. ORMELOXIFENE

    31. ORMELOXIFENE

    32. Summary Dysfunctional Uterine Bleeding is a very common disorder at all ages from menarche to menopause. Though its pathophysioology is still unclear, Estrogen-Progesterone imbalance is usually the basis of bleeding. Available medical treatment modalities are far from satisfactory. Ormeloxifene, the latest Selective Estrogen Receptor Modulator, is closest to the perfect SERM, having the desired antirestrogenic and estrogenic action in different tissues.

    33. It has a very good safety profile and well tolerated, being practically devoid of side effects. Recently approved for clinical use in INDIA, it is an effective and safe drug for the treatment of DUB at all ages, because of its antiestrogenic action on the Endometrium. It is easy to administer and cost effective. However extensive large scale clinical trials are needed to establish its effectiveness and safety Summary

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