This article describes the latest research and advances in Hormone Replacement Therapy and provides advice for any women who would like to know if and when HRT may be.How To Stop Taking Hrt Patches Uk' title='How To Stop Taking Hrt Patches Uk' />Bio Identical HRT and Testosterone Therapy in Women.HRT Kit Evorel 5.Utrogestan 2. 00 and Testim gel.How To Stop Taking Hrt Patches Uk' title='How To Stop Taking Hrt Patches Uk' />Ive just taken my first dose of testosterone.Not because I want to change my gender or take up body building, but because I would like to feel like a normal woman again.Back in August I wrote about my menopausal journey so far and my experience with synthetic HRT, namely Prempak C.After two months of persistent weight gain I decided to stop taking Prempak C and returned to my GP to ask if she could prescribe bio identical HRT.Not being a fan of bio identical HRT, she referred me to the Gynae Endocrine Clinic at Kings College Hospital in South East London.After a two month wait, I finally saw a Consultant Gynaecologist last week.It wasnt a moment too soon as I was feeling pretty frazzled.The calming effects of having a little oestrogen in my body for a couple of months had worn off and I was back to having hot flushes, night sweats and getting either extremely stressed or irritable over the slightest thing.The other menopausal symptoms that hadnt been helped by Prempak C were still persisting, so I was not a happy camper.I was pretty tense before the appointment, afraid that I would be prescribed synthetic HRT again and have to argue the case for bio identical HRT, but my worries proved to be unfounded.From the friendly nurse, who took a detailed medical history, to the calm and reassuring Consultant, my experience at the clinic was extremely positive.Five minutes into my consultation the Consultant diagnosed Premature Ovarian Failure.Suddenly it all made sense.Years ago, in my early thirties, I was diagnosed with premature menopause, but later that diagnosis was changed to PMT with depression.All these years that Ive been feeling half the woman Im meant to be are not because of something in my head, its because of my poor shrivelling ovaries.Without prompting, the Consultant prescribed bio identical HRT in the form of Oestrogen Evorel 5.Progesterone Utrogestan 2.Testosterone Intrinsa Patches.Fantastic And just what I was hoping for.Now, you may be wondering why I have been prescribed testosterone and why I seem so keen to get my hands on the stuff.When I had my hormone levels checked back in June, my testosterone levels showed up as very low at 0.L. From what Ive been able to ascertain normal levels for women are between 1.L, so its no wonder my sense of well being isnt all it should be.Testosterone is produced in the ovaries and adrenal glands of women and plays a crucial role in a womans libido and overall experience of sexual pleasure.Not only that, testosterone is important in improving bone mineral density and the development of lean muscle mass and strength.It also contributes to an overall sense of well being and energy levels, can improve mood and outlook and increase feelings of confidence and assertiveness.Looking at the list of all the roles testosterone plays it seems to me that testosterone could actually play an important role in shaping personality and behaviour.Could my lack of assertiveness and general low mood and low energy be down to my pitifully low testosterone levels, I wonder The Battle to get hold of Testosterone.Unfortunately, since then, I have been involved in a bit of battle to try and get hold of the testosterone.Medicines Management Team NHS Wiltshire CCG in conjunction with Deborah Lee, SFT Issued February 2014 Review February 2016 Page 1 This is an extra step which.Hormone therapy HT involves the administration of synthetic estrogen and progestogen to replace a womans depleting hormone levels and thus alleviate.My pharmacist said that he had tried ringing other pharmacies in the area, gone on the internet, but had been unable to get hold of the Intrinsa Patches.Apparently, the marketing authorisation holder for the patches, Warner Chilcott UK Ltd, has voluntarily withdrawn the marketing authorisation for commercial reasons.Testosterone for Women.Until it was recently discontinued in the UK, Intrinsa was the only form of testosterone that was specifically developed for treating women.It was only licensed on the NHS for women who have had an early surgically induced menopause, and who are already receiving oestrogen therapy but it was also prescribed privately for women with low libido, or hypoactive sexual desire disorder HSDD.It came in the form of patches that were easy to apply and supplied a measured dosage over a period of days.After tracking down my Consultant and asking him for the name of a testosterone alternative I headed back to my GP and asked her to prescribe testosterone gel.Armed with my new prescription I headed off to the pharmacy only to be told there was none in stock so they had to order it in.When I returned the following day I was told that they had been unable to source it, were still trying, and I needed to come back again the next day.I dont know if this is just because not many people in South London need extra testosterone or whether its a nationwide problem.Still, I applaud my local pharmacy for their persistence.Today, I finally received my tubes of Testim gel.The only problem is that the only testosterone available to women is that which has been developed for men and it is not licenced for use in women.The instructions for men is to apply one sachet of gel or one tube of cream daily.Simple. For women, the advice given by doctors is to apply one eighth of a sachet or tube daily or one quarter every second day.There is nothing to measure a standard dose, so women just have to guess the correct measurement.It all seems a bit hit and miss and it annoys me that women arent better catered for by the pharmaceutical industry when it comes to testosterone.But for now I am grateful that I finally have all the HRT I need to start my treatment.I have no idea if this particular combination of hormones is going to work or if I will have unpleasant side effects.My body feels like a bit of an experiment at the moment and I am curious to monitor any changes, good and bad.Hopefully I wont grow a moustache and develop acne and a deep voice.But I am hoping, that one day soon, I will start to feel more alive and energised, and be able to enjoy my body and this particular time of life rather than feel a victim of my hormones.Ill keep you posted.Further Reading Part 1 HRT and Me The Story So Far.The contents of this website, including any posts, comments and links, are subject to this Disclaimer please read it by clicking here.Why women need HRT Total Health.This article describes the latest research and advances in Hormone Replacement Therapy and provides advice for any women who would like to know if and when HRT may be suitable for them.Contents. Introduction.There has been much controversy about hormone replacement therapy HRT since the initial publication of a Womens Health Initiative WHI study in 2.This study linked HRT with an increased risk of heart disease, stroke and cancer.However, in later publications by the same authors it is clear that they realise methodological errors.These errors were around the over dosage to older asymptomatic women women with no symptoms, and they have as a result retracted much, but not all, of the bad news.The major reported side effects occurred in the 2.In contrast 9. 5 of British women on HRT start below the age of 6.This is the important group relevant to our discussion but it has not stopped the advisory authorities greatly limiting the use of HRT in these postmenopausal women.Why is HRT prescribed HRT is used to replace hormones that the body no longer produces following the menopause, namely, oestrogen and progesterone, and to thereby relieve the symptoms associated with the menopause.At the most simplistic level it is certain that oestrogen works well for hot flushes, sweats and vaginal dryness, but in reality the value of HRT far exceeds this.However, the skilled use of HRT requires the understanding that different patients of differing ages with different symptoms require different doses of different hormones by different route rather than the one dose fits all philosophy, which was another fundamental problem with the WHI study.PREMPRO, which was the treatment under investigation, was used regardless of the symptoms in fact most women had no symptoms, and regardless of age.The epidemiologists and investigators of this study made the mistake that no general practitioner would ever make because heshe would understand the subtleties and importance of individualisation of therapy for a particular patient.For these reasons, the WHI Study was deeply flawed and it is a pity that the consequence has been to deny patients readily available, adequate and appropriate treatment options.Recently the public has become interested in bio identical hormone treatment.The thinking is that that this is a new American advance.In reality it has been used in Europe, particularly France for about 3.HRT products and instead relies upon natural, human hormones such as oestradiol, oestrone, testosterone and progesterone.Furthermore, the transdermal through the skin route of administration means that as there is no gastro intestinal involvement and therefore the chance of unwanted side effects is radically reduced.Thus transdermal oestradiol has not been associated with the increase in deep veinthrombosis that does occur with oral HRT.The transdermal application is my preferred route in virtually all patients.When is HRT prescribed HRT in whatever form can be started in the postmenopausal years or after a premature menopause in younger women.It is also a vital medication following hysterectomy and bilateral salpingo oophorectomy removal of the fallopian tubes and ovaries and perhaps most important of all, it is strongly indicated for various symptoms that occur in the menopausal transition, which are the 3 5 years before the cessation of periods when climacteric symptoms are usually at their worst.HRT then should not simply be limited for women whose periods have stopped.Post menopause. The symptoms associated with the menopause are usually hot flushes, sweats, headaches and vaginal dryness and these can easily be treated by oral or transdermal oestradiol in the appropriate dose. Chal Dil Mera Mp3 Download on this page. For those women who have a uterus, cyclical or continuous progestogen drug similar to progesterone is necessary either to produce a regular bleed or amenorrhoea and prevent swelling of tissue in the womb endometrial hyperplasia.The advisory bodies suggest that the lowest dose of oestrogen be used for the shortest possible time but in reality we need to use the dose that works and this would be different depending upon which symptom requires treatment and the duration should depend more upon the needs and wishes of the patient than any other factors.Avoiding progestogen.The role of the cyclical progestogen has become problematic because it does appear that the possible major side effects of HRT revealed by the flawed WHI study are related to the progestogen components of the treatment.Many menopausologists have reduced the orthodox 1.It is interesting to note that in the WHI study the incidence of heart attacks, breast cancer and deaths was lower in patients under the age of 6.Therefore patients under the age of 6.There is also another reason to avoid progestogen.Many women particularly those with a history of PMS or hormone responsive depression have progesterone and progestogen intolerance.Such women suffer a return of the cyclical symptoms of depression, bloating, loss of energy and libido for the duration of the progestogen course.These progestogenic side effects are a common reason why women discontinue their HRT.The solution may be to use a weaker or lower dose progestogen or use natural progesterone such as utrogestin.Unfortunately progesterone cream, one of the cornerstones of the bio identical philosophy is not absorbed, does not protect the endometrium and does not work.Insertion of a Mirena IUS to produce atrophy and amenorrhoea is however usually a very efficient solution.Premature menopause.Women who suffer from premature menopause have an increased incidence of osteoporosis, heart attacks and depression because of the early loss of oestrogens.These are preventable by HRT which should be taken for at least until the age of the normal menopause and probably 5 or 1.Post hysterectomy Although it is common for women to have their ovaries removed, usually for very good reasons and with consent, at the time of hysterectomy, these women are frequently left without replacement hormones for the rest of their lives.There are several American studies that demonstrate the extra risks of heart attacks, osteoporosis and even dementia without mentioning the need for oestrogens because replacement hormones are not given by gynaecologists.In my view ooporectomy at hysterectomy without subsequent hormone therapy is an incomplete operation.This treatment failure is a pity not only because these premenopausal women who have suddenly lost their hormones need replacement but this treatment is so straight forward in women after hysterectomy as there are no cycles, no bleeding and no need for any progestogen.However these women usually do need testosterone because they have lost their ovarian androgens.My practice is to insert pellets of oestradiol 5.Alternatively oestrogen and testosterone gel or patches can be used with the patches being specifically licensed for the use in women after hysterectomy.A small dose of an oral oestrogen usually will not do because it may stop flushes and vaginal dryness but it does not improve the mood or the libido and is usually not adequate to protect the bones.Menopausal transition.The years preceding the cessation of periods are often complicated by cyclical symptoms.Apart from heavy painful periods, there may be premenstrual symptoms for seven or ten days a month, menstrual migraine for two or three days which together with general tiredness, depression and loss of libido can result in women only having about 7 good days a month.These PMDD climacteric symptoms should be recognised and the simple treatment consists of elevated plasma oestradiol levels that suppress ovarian activity and cyclical hormonal changes.In this way the cyclical symptoms of this condition cease.There is no evidence that oral oestrogens help in this situation because the work has not been done and published, but certainly transdermal oestrogens in the form of gels, patches or implants have been shown to help in good randomised trials.The most straight forward treatment is to use 2.Oestrogel cream two doses daily.This should be supplemented by small doses of transdermal testosterone.As these patients have a uterus it is important for them to have cyclical progestogen in the form of Norethisterone or equivalent 5 mgs for the first seven days of each calendar month.This will give a regular bleed on about day 1.
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There are many interpretations to the internet for this web marketing or similar terms such as online marketing, internet marketing, emarketing and others. SWOT Examples. Company History.Sandals Beaches is a Caribbean Based Resort Hotel Chain, that was only recently established, but has proved to be highly successful, based on their innovative marketing concepts.This SWOT analysis is about Sandals.Winner of thousands of awards, including Six time winner of the Gold Travel Life Award by Virgin Holidays.Nine time winner of the Baxter Travel Media award for Favorite Resort.Thomas Cook Award for Best Hotel Chain, and Best Wedding and Honeymoon Hotel.Cg Smith Software Ltd Bangalore Hotels' title='Cg Smith Software Ltd Bangalore Hotels' />Autonomous System AS Numbers Last Updated 20140319 Note Autonomous System AS Numbers are used by various routing protocols.IANA allocates AS Numbers to.Trip. Advisor awarded them the 2.Worlds Most Romantic All Inclusive Resort.Travel Leisure Magazine awarded them one of the top 2.Caribbean for 2. 00.Cond Nast Magazine Readers Choice Poll awarded them one of the top 2.Caribbean Resorts for 2.Caribbean Resorts and Spas for 2.They have made the Cond Nast Magazine Gold List every year from 2.In 2. 00. 7, they were given a World Savers Award by Cond Nast Magazine for their Adopt A School program.In 2. 00. 6 they won second place in the Caribbean Travel and Life Magazine Readers Choice poll for Best All Inclusive Resort.In 2. 00. 5 Modern Bride Magazine voted them the Favorite All Inclusive Resort and in 2.Best All Inclusive Resort chain.American Express gave them the Caribbean Environmental Award for Green Hotel of the year, 2.They earned the Travel Weekly Magellan Award for Overall Eco Friendly Resort in 2.They were voted Travel Weekly America and UK Readers Choice for Best All Inclusive Resort, six years in a row.Travel. 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They need to communicate the resorts view on environmental issues.For instance, Sandals beach resort received a Green Globe Certification for commitment to natural resources, but they dont advertise or communicate it In this economic downturn, Americans want to feel good about spending their money in socially responsible ways and the Green Globe Certification is highly prestigious.They spent a huge amount of capital setting up a new resort in Barbados, only to have it sit there, unoccupied.The government of Barbados does not allow their beaches to be blocked off with fences, and Sandals requires that their guests be kept separate from other people to prevent crime and interlopers.They have been at odds about this issue since 2.As with all tourist destinations, they are dependent on a healthy economy in countries whose citizens have more discretionary income to spend, and vacation regularly.The American trend toward staycations will cause their revenue to decrease.They need to better position themselves against competition, other luxury resorts, Breezes All Inclusive Resorts and other popular destinations for honeymoons and families.Opportunities. Opening new resorts in Belize, or Hawaii, and some non beach areas such as Alaska and Colorado they could also open resorts in other International settings such as China, Japan, Taiwan, France, Spain, Italy, Greece, Australia, Mexico and Brazil.Promote their resorts at all Bridal and ChildBaby Expos in major cities, in order to reach the largest numbers of their target market.They can make use of high definition, interactive sales pitches that will allow honeymooners and families to book their vacations on the spot.Attending the National Wedding Show in London every February.Creating a joint venture with Davids Bridal, creating a presence on all of the major wedding planning websites, Parents Magazine and on Nickelodeon.During the economic downturn, they need to play up the all inclusive angle of their resorts creating a marketing campaign that emphasizes the money saving aspects of their vacation destinations, and the fact that guests dont need to worry about extra expenses.July 2. 00. 9 Sandals announced that they will partner up with Martha Stewart to Launch Martha Stewart Weddings Program in the Caribbean beginning in 2.Guests will be able to book a Martha Stewart Wedding at any of the 1.Sandals Resorts or four Beaches Family Resorts.In addition, they will introduce Martha Stewart Crafts classes for adults at Sandals Resorts and craft camps for families at Beaches Resorts in 2.The Futures Company formerly Yankelovich, said that destination weddings are on the upswing with 3.Threats. One threat that cannot be controlled is the weather.Hurricanes are bad for business all over the Caribbean however, they can offer guarantees so their guests will feel more secure when booking a vacation.There are several ethical arenas that need to be understood when dealing with the tourism industry.If any of these becomes a problem or causes bad PR it can affect the company and eventually their profit margin.Crime rates typically increase with the growth and urbanization of an area and growth of mass tourism is often accompanied by increased crime.The presence of a large number of tourists with a lot of money to spend, and often carrying valuables such as cameras and jewelry, increases the attraction for criminals and brings with it activities like robbery and drug dealing.Tourism can also drive the development of gambling, which may cause negative changes in social behavior.Many jobs in the tourism sector have working and employment conditions that leave much to be desired long hours, unstable employment, low pay, little training and poor chances for qualification.In addition, recent developments in the travel and tourism trade liberalization, competition, concentration, drop in travel fares, growth of subcontracting and introduction of new technologies seem to reinforce the trend towards more precarious, flexible employment conditions.For many such jobs young children are recruited, as they are cheap and flexible employees.The commercial sexual exploitation of children and young women has paralleled the growth of tourism in many parts of the world.Though tourism is not the cause of sexual exploitation, it provides easy access to it.Tourism also brings consumerism to many parts of the world previously denied access to luxury commodities and services.The lure of this easy money has caused many young people, including children, to trade their bodies in exchange for T shirts, personal stereos, bikes and even air tickets out of the country.References. 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