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

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
• migraine
• 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.

 Menopause Management

·    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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