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Menopause - Hormone Replacement Therapy

The stage of life after menstrual periods cease and ovaries stop producing eggs is called menopause. It marks the end of fertility and hormone production by ovaries. The usual age is between 45 & 50. Some women, 1% have menopause at or before 40 years of age. This is called premature menopause.

Symptoms resulting from sudden withdrawal of ovarian hormones are particularly distressing. Mood swings, irritability, hot flushes, sleep disturbances, memory loss are some of the symptoms in the months and years leading to and following menopause. Other symptoms include repeated urinary infections, vaginal and skin dryness and weight gain. The period of transition between reproductive age group and menopause is called peri-menopause. It may last upto 10 years.

Factors affecting age of menopause.

  • Family history of menopause
  • Smoking
  • Oophorectomy (removal of ovaries surgically)
  • Radiotherapy/ Chemotherapy for Cancer.
  • Autoimmune disease
  • Ovarian surgeries
  • Genetic conditions

What actually happens at the time of menopause ?

Menopause is a perfectly natural stage in a woman’s life. Ovaries normally produce female hormones, most notably estrogen & progesterone. Estrogen is responsible for bone health, cardio vascular and urogenital health. Beyond menopause, estrogen production by ovaries ceases and the beneficial effects that it has over various systems of body no longer exist.

Symptoms

  • Hot flushes are more common in first few years after menopause. Typically, a woman sweats profusely, feels hot and then cools down. This actually lasts 3-5 minutes and can be especially embarrassing and disturbing
  • Urogenital Atrophy: Urogenital problems are very common after menopause. This happens because of thinning of cells in the urinary and genital systems in absence of estrogen hormone. Muscles of the sphincters also become weak, resulting in occasional leakage of urine, more so, on straining or coughing, laughing or heavy weight lifting. Vaginal dryness and discomfort during sexual intercourse also occurs due to lack of estrogen effect on vaginal cells.
  • Skin becomes thin, brittle, easily bruised and loose with prominent veins. Hair also becomes brittle and dry, leading to hair loss.
  • Osteoporosis & Osteopenia- The relative loss of bone density occurs due to lack of estrogen. Osteoporosis and osteopenia put you at a higher risk of fractures, with wrists, spine and hips being particularly vulnerable.

Cardiovascular Consequences

It is proved that before menopause, women are protected from coronary heart disease due to high levels of heart-friendly high density lipoproteins (HDL) due to the effect of estrogen. Bad cholesterol , low density & very low density lipoprotein levels are lower in pre-menopausal woman. Once menopause occurs, the risk of heart disease rises steeply and doubles for women compared to the men of same age, because the relative composition of these lipoproteins changes.

How do we come to the diagnosis of menopause ?

A history of menstrual periods which have ceased for 12 consecutive months is well enough to diagnose menopause. In most cases, hormone tests are not necessary to reach this diagnosis. In some, levels of follicle stimulating hormone (FSH) are measured, which should be higher 40 and Estrogen levels are typically low.

Hormone replacement

Hormone replacement therapy (HRT) is one of the most commonly used treatments for menopausal symptoms. Hormones like estrogen & progestogen in low doses constitute HRT, which may be available as tablets, gel, patches, vaginal rings, vaginal creams and even spray.

HRT has been suggested to decrease the risk of osteoporosis and prevent vasomotor symptoms like hot flushes, and Alzheimer’s disease. HRT also decreases the risk of colon cancer. However, its effects on coronary heart disease risk are conflicting. Some researchers have found that there is a slightly increased risk of breast cancer while being on HRT. HRT also increase the chances of venous blood clots (deep vein thrombosis). A family and personal history of clotting disorders, and smoking must be taken into consideration before prescribing HRT.

One of the concerns with HRT is cancer of the womb, which is preventable, if progesterone is added to estrogen in women who have an intact uterus.

HRT should be given to women who are not being helped by alternative medicines. HRT is best given in the minimum effective dose, for a minimum time period, under specialist supervision, after ruling out all contraindications. A thorough discussion regarding the pros and cons of HRT with the patient is necessary.

Are there any alternatives to HRT ?

Over the years, various medicines and therapies have been used for menopausal symptoms. These include lifestyle modifications, vaginal lubricants, phytoestrogens, black cohosh, red clover & anti depressants.

Antidepressants have been used for night sweats and hot flushes in low doses, especially for those who cannot take estrogen due to health reasons. Clonidine and Gabapentin have also been used for treating hot flushes.

Simple lifestyle measures like regular aerobic exercises, eating healthy and reducing caffeine intake, smoking and alcohol can also help reduce vasomotor symptoms.

Vaginal estrogen is usually given for vaginal discomfort and urinary problems.

For osteoporosis, various calcium and Vitamin D supplements and bisphosphonates may also be used, with specialist supervision. Weight bearing exercises are also of great help to strenghthen your bones.

Gynaecworld is a center for women's health and well being. With the experience of eminent gynaecologist & fertility specialist, Dr Duru Shah, we make the journey through various stages of your life healthy, focussing on preventive health care.

Every health issue is attended to, and management individualised, suiting your lifestyle and needs!

Be it menarche and its issues, pregnancy- low and high risk, infertility, gynaecological problems like PCOS, fibroids, endometriosis, chronic pelvic pain, laparoscopic & open surgeries, menopausal concerns, nutritional counselling, we are dedicated to providing you the highest quality of health care.

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