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Menopause and its problems

Q.1. what is menopause? What are its complications?

Menopause means cessation of menstruation.j the average age at menopause is between 45 and 50 years. Amenorrhoea begins in one of the following manners:

  • Abrupt amenorrhoea

 

  • Menstrual bleeding gradually diminishes before amenorrhoea occurs.

 

  • The menstrual cycles are prolonged with scanty periods.

Complications may occur soon after menopause or may develop late as sequel of prolonged oestrogen deficiency.

Immediate complications

  • Obesity with fat deposits over the abdomen and hips.

 

  • Decreased libido due to oestrogen  deficiency and dyspareunia caused by a narrow vagina and senile vaginitis.

 

  • Urinary symptoms: urethral caruncle causes dysuria and postmenopausal bleeding. Frequency of  micturition, dysuria and stress incontinence are clubbed under the name of micturition, dysuria and stress incontinence are clubbed under the name of urethral syndrome.

 

  • Neurological: a woman may complain of sensations of pins and needles, paraesthesia, headache.

 

  • Vasomotor symptoms: Hot flushes, sweating, palpitation and sleeplessness.

 

  • Emotional changes like depression, irritability.

 

  • Fear of pregnancy.

 

  • Cancer phobia.

 

Late sequelae of menopause

 

  • Cardiovascular changes: hypertension may supervene. High density lipoprotein (HDL) is decreased, and increase in low density lipoprotein (LDL) and triglycerides cause myocardial infarct, and atherosclerosis.

 

  • Stroke

 

  • Osteoporosis: mainly affects the vertebrae, wrist and hip joints. Fracture of these bones increases morbidity in postmenopausal woman. Osteoporosis is progressive and age-related.

 

  • Alzheimer’s disease is age related. Anorectal cancer occurs more after menopause.

 

  • Prolapsed of the genital organs and stress incontinence of urine are caused by atony of the supporting ligaments and pelvic floor muscles.

 

Q.2. Discuss the management and prevention of postmenopausal complications.

  • The woman should be examined clinically. Blood pressure and blood sugar should be checked. A gynecological examination and pap smear will rule out pregnancy and genital cancer. A woman should counseling regarding the diet and regular exercise.

 

  • Counseling regarding contraception is desirable until menopause is confirmed when one year of amenorrhoea is established. Barrier methods are the best, but IUCD and progestogenic contraceptives are approved in a menopausal women.

 

  • Libido can be improved with small doses of testosterone. Viagra is under trail.

 

  • Tranquilisers and antidepressants may be required on short-term basis.

 

  • Clonidine controls the blood pressure as  well as the hot flushes.

 

  • Diet: vitamins improve the wellbeing. Weight bearing exercise such as walk prevents osteoporosis. Soya bean contains phyto-oestrogen and increases HDL and is cardiprotective, and protective against breast cancer. 35 to 60mg daily of soya beans and 1.2 g to calcium is recommended.

 

Hormones are required as:

 

 

  • Short-terms therapy for menopausal symptoms.

 

  • Prophylactic on a long-terms basis.

Long-term therapy is not required in all menopausal women. It is selectively given to women at high risk for:

  • Cardiovascular disease.

 

  • Osteoporosis.

 

  • Alzheimer’s disease, anorectal cancer before administration of HRT, the following investigations are needed.

 

Investigations

  • Pelvic ultrasound study of endometrial thickness and ovarian morphology.

 

  • Pap-smear to rule out cancer of the cervix

 

  • Serum lipid profile, blood sugar

 

  • Bone mineral density (BMD)

 

Q3. What are the causes of premature menopause? How will you investigate and treat such a case?

Premature menopause is recognized by secondary amenorrhoea of at least 3 months duration with raised level of FSH and low oestrogen level in a woman under 40 years of age. It occurs in 1 percent women.

Aetiology

  • Genetic

 

  • Tuberculosis

 

  • Radiation, chemotherapy

 

  • Resistant ovary

 

  • Autoimmune disease

 

  • Smoking and caffeine intake

 

  • Posthysterectomy ovarian failure

 

  • Prolonged GnRH therapy

Genetic: Ten to twenty percent of premature menopause occurs in sex chromosome abnormalities. In 30 to 60 percent, autoimmune diseases such as mumps, thyroid dysfunction, hypoparathyroidism,  addison’s disease are present.

Radiation menopause depends upon its dosage. Some recover from amenorrhoea in a year or so. Alkalytic drugs are storng inducers of premature menopause.

premature menopause can induce menopausal symptoms and complications much earlier and in a severe form. A cause needs to be elucidated and treated.

 

 

 

Q.4. what are the causes of postmenopausal bleeding and how will you investigate the case?

Vaginal bleeding that follows 6 months after secondary amenorrhoea in a woman over the age of 40 years is considered postmenopausal bleeding and needs investigations. Even without amenorroea or irregular bleeding, if a woman over 52 years continues to menstruate, she should be investigated.

Aetiology

  • 30 to 50 percent cases are due to cancer of the genital tract, and 15 percent are caused by uterine cancer alone.
  • More than half the number however have a benign cause.
  • Vulva: trauma, vulvitis, benign tumour and cancer vulva.
  • Vagina: Ring pessary for prolapsed, senile vaginitis, vaginal cancer, postradiation vaginitis .
  • Cervix:  Cervical erosion, vervicitis, polypus, decubitus ulcer, cancer of the cervix.
  • Uterus: senile endometritis, tubercular endometritis , endometrial hyperplasia, polyp, endometrial carcinoma, sarcoma, mixed mesodermal tumour .
  • Fallopian tube malignancy.
  • Ovary: benign ovarian tumours like Brenner, granulose cell an theca cell tumours. Most of the malignant ovarian tumours.
  • Dysfunctional uterine bleeding.
  • Hypertension, blood dyscreasia.
  • Urethral caruncle, papilloma and carcinoma of bladder may be mistaken for vaginal bleeding.
  • Bowel: haemorrhoids, fissures, and rectal bleeding may also be mistaken for vaginal bleeding.
  • Oestrogen therapy and tibolone can cause postmenopausal bleeding.

Diagnosis

A detailed history and general examination will reveal a general cause for postmenopausal bleeding. Abdominal examination will detect a tumour. The speculum and bimanual examination detect the site of bleeding and the lesion responsible for it.

Management

  • Treat the cause
  • If no cause is detected and the woman remains free of further bleeding she should be observed.

 

Key points

  • Average age of menopause is between 45 and 50 years.
  • Menopause before the age of 40 is defined as premature menopause.
  • Continuation of menstruation beyond 52 years, regular or irregular, is considered abnormal and requires investigations.
  • Menopause is an “oestrogen deficiency state”, caused by primary ovarian failure.
  • A part  from menopausal symptoms, late sequelae such as prolapsed, cardio-vascular diseases, stroke, osteoporosis, Alzheimer’s disease and anocolonic cancer, increase the morbidity and adversely affect the quality of life of the menopausal women.

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  • General treatment includes diet, vitamins, calcium, and exercise.

 

HOMOEOPATHY AND MENOPAUSE

  • Homoeopathic treatment has helped millions of women through the change of life, without the dangerous side-effects of the cruder conventional drugs. Homeopathy is the safest treatment before, during, and after menopause because it stimulates the natural hormonal balance without the use of harmful drugs. Homoeopathy is definitely the alternative to HRT.
  • It is the most effective mode in the treatment of hot flushes, mood-swings, menopausal headaches and a host of other troublesome symptoms related to menopause. Evidences and studies have shown the benefit of homeopathy in this condition. Hormonal imbalances respond very well to Homoeopathic treatment.
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