Overview of Menopause
The word Menopause “Derived from the Greek word which means for “month” (men) and “cessation” (pausis). It is a natural event in a woman’s life and this is a time of change. Menopause occurs in 40s or early 50s and it give an indicator that fertile phase is ending. It is defined as a stage in which there is cessation of primary functions of ovaries ,the ova are not ripened and the hormones are not released and uterine endometrium /lining does not increase in size and there is cessation of menstrual flow. The menopause is unavoidable change, which is experienced by every woman when reaching the middle age. Menopause can be declared when the adult woman is not pregnant ,not lactating and she is having amenorrhea for complete one year.
Signs of Menopause
There are many signs. These may includes:-
These imbalances are due to hormonal changes. Universally all the woman feels the common sign that is the cessation of menstruation
Physiology of Menstruation in Context to Hormonal Pattern
Transition pattern has a classified pattern, and depends upon the pattern of Pituitary Follicle stimulating hormone (FSH). In younger women ,during menstrual period ovaries produces estradiol ,testosterone and progesterone in cyclic pattern which is under the control of Follicle Stimulating Hormone (FSH),and Luteinizing Hormone (LH) ,which are both produce by Pituitary Gland. Blood estradiol level remained unchanged in young female with passage of time when woman approaches in menopause phase the level of estradiol decreases and FSH increases. It has also been observed that after menopause, other than ovaries the estradiol is produce by, bone blood vessels and even brain. It is seen that in menopause the level of testosterone, dehydroepiandrosterone sulphate (DHEAS) and androstenedione appears to decline less or more with the age. Thus, the effects of menopause have an effect on androgens which has been observed when ovaries are damage during radiation and chemotherapy. Menopause has also been seen when the ovaries are surgically removed; there drastic reduction of hormones resulting in withdrawal symptoms like hot flushes. Removal of uterus without removal of ovaries does not cause menopause, but pelvic surgery may cause earlier menopause.
Classification of Menopause
- Menopause: It may be recognized after 12 months of amenorrhea, the ovary shows reduction in production of estrogen and progesterone and sometimes the term is interchangeable with post menopause.
- Perimenopause: The average age vary from 45-47 years and even earlier than 35 years has also been seen which is characterized with irregular menstrual cycle. In Perimenopause the symptoms are of shorter or longer duration of bleeding .Heavier bleeding may result in mood disturbance, sleepiness and hot flushes.
- Premature Menopause: It occurs before the age of 40 years, and often referred as premature ovarian failure.
- Natural Menopause: This occurs without the medical intervention , normally the women Complains of loss of menstruation period for a period of one year. The average age ranges from 45-55 years .The age of onset of natural menopause depends upon smoking and genetics.
- Induced Menopause: Medical intervention results in loss of ovarian function. When ovaries are removed due to chemotherapy, radiations, or on medical grounds, abrupt onset of symptoms of amenorrhea appears along with hot flushing. These women have greater risk of cardiovascular disease and osteoporosis, than those women who experiences symptoms due to menopause.
Signs and Symptoms of Menopause.
The signs and symptoms ,mostly the women feel during their transition period are due to the effects of low estrogen level of the hormones which also prevails even after the post menopausal transitions. The symptom improves if the transition period is over. The most common symptoms experienced are:-
- Vascular instability results in hot flushes
- night sweat
- increased risk of atherosclerosis
- rapid Heartbeat
- Urogential: Atrophic vaginitis, itching vaginitis, dryness, young women feels dysfunctional bleeding. Increase in frequency of urine.
- Skeletal: Back pain.
- Skin: Breast atrophy, Breast tenderness, decrease inelasticity.
- Sexual Dysfunctional: Dyspareumia, decreased in libido, problem relating to organism, vaginal dryness and vaginal atrophy.
· Hormonal Replacement Therapy: This is indicated when uterus is intact , if Hysterectomy has been done then estrogen may be used .Traditionally ,tablet is used ,presently wide varieties of formulation includes ,skin patches, gel, skin sprays and subcutaneous implants.
· Synthetic Hormonal Therapy: A popular alternative to hormonal therapy is synthetic Hormone. (Which is derived from (Mexican yarn) called tibolone.
Caution: Before commencement of Hormonal replacement therapy the women should discuss her complaints with the treating Doctor regarding, relative risks, whether the hormonal therapy will be beneficial, or outweighs the risk. Hormonal therapy should be started with lowest dose and for short time. If used for prolonged period chances of clot and development of cancer may take place.
· Non hormonal Therapy: Selective Serotonin reuptake inhibitors (SSRIs) commonly used as antidepressant, provide relief for hot flushes, hormone therapy can alleviate vaginal dryness, improve sleep qualities and joint pain. It can also be used for prevention of osteoporotic fracture.
· Selected Estrogen Receptor Modulator (SERMS): These categories of drugs are either synthetically produced or derived from botanical source phytoserm.They selectively agonists or antagonists on estrogen receptors throughout the body. The most commonly precursors SERMS are Raloxifene and Tamoxifen. Raloxifene enlist agonist activity on bone and lipids, antagonist on breast and endometrium. It reduces /prevents vertebral fracture in post menopausal osteoporotic women and reduces the risk of invasive breast cancer. Tamoxifen can be used to treat hormone sensitive breast cancer. Emerging SERM treatment is based on multi botanical compound MF101 (Menerba).
· Antidepressant. Antidepressant drugs like Paroxentine (Paxil),Fluoxetine (Prozac) ,Venlafaxine hydrochloride (Effexor) may be used in hot flushes ,these drugs commonly causes ,nausea and insomnia .Fluoxetine may be indicated in Premenstrual hypertensive mood disorder.
· Antihypertensive drugs: clonidine (catapres) is effective antidepressant for hot flushes.
· Alternative Medicines: Some botanical Sources referred as Phytoestrogen don’t mimic the effects of human steroidal estrogen, but similar and divergent effects. Acupuncture and Acupressure treatment are promising.
Education: Major problem faced by most of the Women during transitional stages and during premenopausal stage is vaginal dryness. To overcome this problem low dose of vaginal estrogen products such as cream, topical estrogen may be recommended which can be used to prevent vaginal thinning and dryness. Other major problem the postmenopausal is facing is hot flushes; using cold drinks ,cold liquid ,staying in cold room ,using fans and removing excess clothing, and avoiding hot drinks ,spring food, etc may be partially supplemented by use of some medicines.
Individual counseling: may be helpful to handle sad, depressed, anxious, confused women this may be challenging during transitional phases of menopause phase.
· Osteoporosis becomes mark during menopause phase; biphosphatic alendronate drugs and Vitamin D supplement intake are recommended which can help to prevent fractures.
· Risk of Acute Myocardial infarction and Cardiovascular Diseases: after menopause rises sharply. Risk factors, such as tobacco smoking, intake of lipids and increase body weight should be managed carefully.
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