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Hypoestrogenism
Improve citations Filling in the "Diagnosis" section Include additional causes for Hypoestrogenism Options for treatment (HRT) or possible prevention Create a "Pathophysiology" section Effects on different populations

Diagnosis

 * Several different methods to assess estrogen status may be employed to determine estrogen status—the vaginal maturation index and a progestin challenge test. The presence of small parabasal cells (with a high nuclear/cytoplasmic ratio) obtained from a vaginal swab suggests hypoestrogenism, while the existence of superficial cells (large cytoplasm and small pyknotic nucleus) indicates normal estrogen status.
 * Estrogen test
 * Serum FSH

Pathophysiology

 * Estrogen helps maintain thickness and elasticity of vagina epithelium.
 * Vaginal epithelial cells proliferate glycogen in response to estrogen and convert to lactic acid through lactobacillus, maintaining vaginal pH and health

Screening
DEXA scan for bone density

Vasomotor

 * Typical signs of hypoestrogenism include vasomotor symptoms( diminished sleep quality, irritability, difficulty concentrating, reduced quality of life), sleep disturbances, mood changes, vaginal irritation, and dyspareunia due to atrophy.

Genitourinary

 * genital Dryness, burning, irritation, UTIs,
 * The less obvious changes are increased bone loss( Estrogen plays a key role in the skeletal hemostasis and maintains a balance between bone resorption and formation by inhibiting steblast apoptosis and stimulating osteoclast apoptosis. In other words, estrogen promotes bone formation and prevents its resorption; hence, its low levels have adverse effects on BMD),
 * increased risk for cardiovascular disease( abnormal lipid profile)
 * and cognitive impairment(depressive mood, anxiety, mental disorders), and higher incidence of various cancers.
 * Vaginal atrophy with accompanying irritation, itching, sexual discomfort, and urinary problems.

Pregnancy

 * May increase risk of autism in offspring. The risk does does not seem to depend on mother's age.

Causes

 * Thyroid dysfunction
 * Vaginitis
 * Primary Ovarian insufficiency is declining ovarian function and reduced fecundity due to a premature decrease in inital follicle number, increase in follicle destruction, or poor follicular response to gonadotropins, affecting 1% of women

Treatments

 * Lifestyle changes including smoking cessation, reduced alcohol consumption, layered dressing, and proper diet
 * selective serotonin or norepinephrine reuptake inhibitors may reduce the intensity and severity of hot flashes.
 * Clonidine and gabapentin are also effective when used to manage vasomotor complaints.


 * Hormone therapy is indicated to reduce the risk of osteoporosis, diabetes, vasomotor symptoms. . Also resotre genitourinary tract anatomy, reduce vaginal pH. Long term may increase risk of endometrical cancer and breast cancer, strokes, ebolism, dementia . Estrogen is available as oral, transdermal, vaginal, and injectable preparations, while progestin is available as oral, transdermal, intrauterine, and injectable formulas. For those with an intact uterus, estrogen should be combined with progestin for endometrial protection. Vaginal estrogen in low doses may be used alone if vaginal symptoms are the only indication for treatment. women older than 60yrs, or 10-20 years from menopause onset should avoid HT due to higher risk of CHD, VTE, and stroke than women initiating HT in early menopause
 * Selective estrogen receptor modulators (SERMs) can also be used to manage vaginal atrophy.[3] Tissue selective estrogen complex (estrogen + SERM) provides the benefits of estrogen without endometrial stimulation.

Maternal Somatic support after brain death
Our goals:

standard of care (of mother)-what exactly does somatic support consist of?
https://pubmed.ncbi.nlm.nih.gov/12682499/ Brain dead patients are susceptible to hypotension as adrenal insufficency can add to hypotension. This is usually treated with methylprednisolone as it does not cross the placenta
 * Probability of mortality increases in infants born before 32 weeks gestations

combine "past cases" and "notable cases" sections into one
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883204/ — Preceding unsigned comment added by Vincent.Vu2 (talk • contribs) 15:57, 30 July 2020 (UTC)

ethical
Some professionals believe extended somatic support is justifiable if the mother is an organ donor to preserve the organss. Others disagree mentioning suboptimal knowledge regarding adverse effects of medication on the fetus. Ethical justification can be supported if prospective organ donor as the fetus would be the first to benefit from reciving mother's organs. In a retrospective analysis, five of seven pregnant brain dead donors, Of 25 donated organs (5 hearts, 5 livers, 10 kidneys, 5 pancreases) in this analysis, only one liver and one pancreas graft were lost.

— Preceding unsigned comment added by Vincent.Vu2 (talk • contribs) 03:47, 30 July 2020 (UTC)