Most of women were largely silent about what happened to them during midlife changes .But in present generation ,women has already started to break the wall of silence and started searching for solutions to their menopausal problems….here are they
LIFESTYLE CHANGES :
- Stop smoking
- stop alcohol
- Exercise : Aerobics / walking / treadmill of 30 min in a day improves the general fitness and cardio respiratory function
- Weight bearing exercises and resistance training helpful in protecting from sacropenia ( loss of muscle mass ) and loss of bone mineral density ( BMD ) . These training to be done 2-3 times a week under the supervision of trainer
- Yoga and meditation helps in flexibility of joints and mood stability
- Weight loss ,mood elevation,less sleep disturbances, prevention of sacropenia ,prevention of osteoporosis,prevention of metabolic diseases ( HTN,CHD,CVD etc ) all are benefits of exercise
- Avoid triggering factors like stress , caffeine, spicy foods , aerated drinks and beverages
- Try to be in cold environment, Avoid warm places .Bath with cool water .Use fans or air conditioners. Wear cotton clothes
- Eat soy protein , isoflavons rich food .Black cohosh ,dongquai,evening primrose oil,flaxseed ,gineseng,red clover ,wild yam extract are beneficial in menopause .Drink cool water and juices etc .Take vitamin D and calcium rich diet .
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- Calcium supplements : 1200 -1500 mg / day & Vitamin D supplements : 600 IU /day are useful
- Hormone replacement therapy ( HRT ) : It is advised in women ,who are symptomatic .
- In natural menopause estrogen and progesterone preparations are useful .
- In induced menopause ( after hysterectomy) only estrogen preparations suffice .
- They are used in low doses and shortest period of time .
- Estrogen preparations available as -oral tablets , transdermal patches , gels ,creams , sprays ,intra nasal form , pellets , rings , vaginal tablets . Depending on requirement and type of problem your healthcare provider prescribes
Advantages of HRT :
- Reduction in hip,vertebral and total bone fractures.
- Increases spine and bone BMD .
- Decrease the risk of colorectal cancer
- These are having beneficiary effects on local symptoms like dry vagina , Painful coitus ,urethral symptoms,in prevention of vaginal infections ( gels ,creams,rings,vaginal tablets are helpful )
- Nowadays transdermal patches gaining popularity over oral tablets due to its less side effects.Combined (E&P) patches are also available
- Hotflushes improves with HRT
- Menstrual irregularities gets corrected
- Mood disturbance improves
Disadvantages of HRT :
- Small increase in breast cancer after several years .
- Venous thromboembolism (VTE ) risk increases .
- In women with intact uterus using estrogen alone preparations increases the endometrial cancer ( uterus cancer ) risk .
- Gall bladder disease risk increases ( cholelithiasis,cholecystitis )
- Ovarian cancer risk -it’s a weak association but evidence not established
- Non fatal myocardial infarction ( heart attack ) .Do not take HRT in known coronary heart disease patients
- HRT is not useful for prevention of cerebrovascular accident ( brain stroke )
- Gastric upset and chronic liver problems occurs with oral HRT
- Alzeimer’s disease risk increases
Who do not use HRT :
- In unexplained vaginal bleeding &pregnancy women
- Past history of breast &/uterine cancer patients
- Venous thromboembolism history
- Family history of premenopausal breast cancer
- Hyper triglyceridemia
- Chronic liver disease individuals should not use HRT
- Women effected from myocardial infarction ( heart attack ) should not take HRT
- Antidepressants : Venlaxafine ,paroxetine,fluoxetine also useful in counteracting the mood disturbances and in hotflushes
- Gabapentin : useful in hot flushes
- Biphosphanates : Alendronate , residronate etc are used in osteoporosis along with HRT
- Tibolone : It is having Estrogenic ,progesterogenic ,and androgenic properties . Treats climacteric symptoms& osteoprotective .2.5 mg once a day is sufficient
- Zolendronic acid single IV infusion of 5 mg over 15 min once a year improves the BMD
MISCELLANEOUS INFORMATION –
- In post menopausal women estrone ( E1) is a dominant hormone -it is cardio and osteoprotective .It is produced from testosterone by peripheral conversion in adipocytes .
- Estradiol (E2 ) is most potent form in reproductive age . It is also cardio and osteoprotective .
- Estriol ( E3) least potent form of estrogen .It has good local action on genitourinary structures and controls hotflushes .
- Estrogen available as natural ,semisynthetic and synthetic preparations.
- Estradiol valerate is a semisynthetic compound routinely used .It is water soluble
- Congugated estrogens and medroxy progesterone acetate (0.3 &1.5 mg ) usually used
- Vaginal creams 2-4 gm/day for 2 wks improves the local symptoms
- Estrogen ring releases 8 mg/day for 90 days .Used for local symptoms
- Vaginal tablets – once in a day for 15 day relieves the symptoms
BETTER TO GO FOR SOME TESTS IN MENOPAUSAL PERIOD :
- CBP ,RBS ,CUE
- BMI ,BMD
- Mammography – Every year
- ECG ,Chest X Ray ,2 D Echo
- Lipid profile
- Liver function tests
- Renal function tests
- Thyroid profile
- Pap’s smear , colposcopy,cervix & endometrial biopsy
- Tests and medicines are individualised depending on problems .Your healthcare provider examines and prescribes according to your suffering
- Day to three FSH levels more than 20 IU /L are diagnostic of ovarian failure in women with peri menopausal age and hotflushes
- Estradiol (E2) levels (normal range -10-25 pg / ml ) also reflects the menopausal stage