MENOPAUSE

A Clinical Perspective

DEFINITION OF MENOPAUSE

Menopause is the permanent cessation of ovarian follicular function. It is diagnosed retrospectively after a period of 12 months of amenorrhea This signals the end of a womans fertility

RELATED TERMS

Premenopause refers to the phase of normal reproductive life of a woman, it extends from her first to her last regular menstrual period Perimenopause refers to the transitional phase preceding actual menopause by about 2 to 8 years, characterized by signs and symptoms due to declining ovarian follicular activity Post menopause is the time after the complete cessation of menstruation until the end of life

AGE OF MENOPAUSE

Age at which a woman will reach menopause is variable and depends on a number of factors

FACTORS AFFECTING AGE OF MENOPAUSE

Hereditary Factors: Menopause has a strong genetic link. The age at which a womans mother reached menopause is a good predictor of her approximate age of menopause

Smoking: Women who smoke are likely to experience menopause earlier than nonsmokers

Ethnicity: Women from certain ethnic groups have menopause earlier than others ; while average age of menopause for Caucasian women is 51 years, the same is 46 years for Indian women

Chemotherapy/ Ovarian Surgery: Can accelerate the onset of Menopause by damaging the normal ovarian tissue

HORMONAL CHANGES DURING PERIMENOPAUSE

Estrogen levels generally decline but may fluctuate unpredictably, even increase at times causing estrogen dominance Progesterone levels typically decline Testosterone levels show decline FSH levels vary markedly during the perimenopause . High FSH(>30 IU/l) levels may be helpful in confirming the menopause in later stages LH levels rise in response to low levels of estrogen

ESTROGEN LEVELS DURING PERIMENOPAUSE

Pre Menopause

Peri Menopause

Menopause

Post Menopause

Estrogen Levels Age

35

45

~51

Symptom Experience

Less

Strong

PERIMENOPAUSAL SYNDROME

Fluctuating/low levels of hormones especially estrogen and progesterone give rise to signs and symptoms collectively called PERIMENOPAUSAL SYNDROME

SIGNS AND SYMPTOMS OF PERIMENOPAUSE

Physical symptoms

Emotional symptoms

Hot flashes Night sweats Irregular menses Loss of libido Vaginal dryness/itching Fatigue Headaches Thinning of hair

Irritability Fatigue Reduced attention span Difficult concentration Mood swings Sadness Depression

Sleep difficulty
Memory loss/lapse Weight gain Urinary incontinence Dizzy spells

SIGNS AND SYMPTOMS OF PERIMENOPAUSE

Physical symptoms

Emotional symptoms

Sensation of electric shock like pains Palpitations/irregular heartbeat Breast pain/loss of fullness Joint/muscle pain Flatulence/bloating/poor digestion Dryness/itching of skin Backache/stress fractures due to osteoporosis

Anxiety Panic attacks

Receding gums
Increased risk of hypertension/cardiovascular disease

GENERAL MANAGEMENT

Maintain a healthy lifestyle Promote healthy eating habits ,diet should contain healthy ,low fat, fresh foods, dairy products, dark green vegetables, fish, eggs in order to maintain optimal levels of Calcium and Vitamin D Regular exercise goes a long way in staying physically fit by maintaining ideal weight and promotes general wellbeing besides reducing the risk of osteoporosis and symptoms like hot flashes Moderate physical exercise of 30 minutes everyday helps to combat the increased risk of developing cardiovascular disease Pelvic floor exercises can reduce urinary incontinence Create a cool and comfortable environment at home and at work to minimize the discomfort due to hot flashes Regular health checkup to monitor Blood Pressure, levels of Blood Sugar, Lipids, mammogram, Pap Smear, and Bone Densitometry should be done Quit smoking Seek help when symptoms are persistent or more distressing. Do not assume all symptoms to be due to menopause. Suitable contraceptive should be used until actual menopause is reached

POST MENOPAUSAL BLEEDING

Any vaginal bleed more than 12 months after last period is called post menopausal bleeding It should not be ignored as a feature of perimenopausal syndrome Immediate medical advice should be sought to rule out other causes such as Endometrial Carcinoma

CONVENTIONAL THERAPY
Combined oral contraceptive pill Hormone Replacement Therapy (HRT)

HOMOEOPATHIC MANAGEMENT

Despite its benefits, HRT is known to have some adverse effects. It is known to increase the risk of Breast cancer Ovarian cancer Endometrial cancer Heart disease Stroke

In contrast, Homoeopathy offers a wide range of safe and effective

remedies to treat symptoms of perimenopausal syndrome.

HOMOEOPATHIC MEDICINES AND CLINICAL TIPS

Acid Phos.- mental debility, nervous exhaustion, weakness, tearing bone pains, hair loss, menses irregular or too early

Amyl nitrosum- Sensation of blood surging to face and head followed by sweating. Sensation as if blood would burst through skin with heat and redness. Throbbing in head and throughout body. Feeling of anxiety. Palpitations. Feels cold and clammy after flushing has died down. Peculiar derangement of mind, nervous repetition of words Bellis per- chronic fatigue and persistent tiredness
Calc ars- suited to obese, fleshy women, palpitation from slightest emotion and exertion, suffocative attacks, anaemic and sensitive to cold Calcarea carb- fatigue,chilliness,muscular weakness Chamomilla- Irritable, ill humoured, quarrelsome

Cimicifuga- Fainting spells, flushing, headache,Inframammary pains, nervousness, panic, pain in uterus, sinking sensation in stomach, great depression ,dreams of impending evil, tries to injure herself, incessant talking. Electric shock like pains, muscular pains, tinnitus, irregular menses, insomnia, fainting spells

USEFUL HOMOEOPATHIC MEDICINES AND CLINICAL

TIPS

Glonoine- Headache instead of menses, delayed menses, pulsating and throbbing type of pain all over the body, headache from heat, sunlight, gaslight & electric light and lying down, uncovering head, loathing of work with extreme weakness. Extreme irritability from slightest opposition. Sensation of rush of blood to the head Graphites- suited to obese women , sensitive to cold, dryness of skin, constipation, menses delayed, aversion to intercourse, profuse thin leucorrhea, burning sensation on vertex Helonias- profound debility,vaginal,uterine sensitivity Jaborandi- profuse perspiration, increased salivation, hair loss Lachesis- sadness, aversion to work and company, talkativeness, cannot tolerate tight clothing, hot flashes, , intolerance of heat , palpitation, headaches, dizziness, fainting spells, aggravation of symptoms during or after sleep, menses are too short and scanty, symptoms are better after menses Manganum aceticum- hot flashes, cannot tolerate cold weather, menses deranged, too early and scanty in anaemic women

USEFUL HOMOEOPATHIC MEDICINES AND CLINICAL

TIPS

Murex- nervous, weak ,run down women, sadness, anxiety, dread, nymphomania

Pilocarpus- Intense sweating, hot flushes, sometimes accompanied by nausea and excessive salivation. Excessive perspiration from all parts of the body followed by chilliness, and sweating over face, ears and neck
Psorinum- offensive discharges especially sweat and leucorrhoea, severe backache, debility, over sensitiveness to cold

Sangunaria. c- hot flashes, burning sensation in cheeks and chest, offensive leucorrhoea, right sided priodical headache, better by sleep and lying on right side, burning in the vertex, painful breasts, sensation of heat in palms and soles
Senecio. A- insomnia, prolapse uterus

Sepia- Frequent flushes and then shivery, irritable, indifferent, depressed, weepy, wants affection but rejects it, poor libido, nausea ,weakness, indifferent to work and family, painful intercourse

USEFUL HOMOEOPATHIC MEDICINES AND CLINICAL

TIPS

Sulphur- Menses too late, short, scanty. Pruritus vulvae, burning sensation in vagina, leucorrhoea burning and excoriating. Easy flushing with red face and lips Tabacum- : Severe vertigo with marked pallor, sensation of icy coldness, much sweating, feels better by uncovering the abdomen Trillium pendulum- tinnitus, fainting spells, dizziness, backache Yohimbinum- insomnia

CONTRIBUTORS;
DR ASHOK SHARMA ,CMO DR PAWAN GOEL, CMO DR ANJALI MIGLANI, SMO DR PRADIP KUMAR ROY, SMO DR PARMESHWAR BISWAL, MO DR ANUBHA SIKKA, MO DR SUNITA SINGH, MO

COMPILED BY:

DR DEEPTI CHAWLA ,CMO

DTE. OF AYUSH GNCT DELHI