Upload
drdeeptichawla
View
188
Download
2
Embed Size (px)
DESCRIPTION
Clinical tips for the management of perimenopausal syndrome
Citation preview
MENOPAUSEA 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 woman’s 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 woman’s mother reached menopause is a good predictor of her approximate age of menopause
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
Smoking: Women who smoke are likely to experience menopause earlier than non-smokers
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
Est
rogen L
evels
Pre Menopause Peri Menopause Menopause Post Menopause
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
Hot flashes Night sweats Irregular menses Loss of libido Vaginal dryness/itching Fatigue Headaches Thinning of hair Sleep difficulty Memory loss/lapse Weight gain Urinary incontinence Dizzy spells
Irritability Fatigue Reduced attention span Difficult concentration Mood swings Sadness Depression
Physical symptoms Emotional symptoms
SIGNS AND SYMPTOMS OF PERIMENOPAUSE
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 Receding gums Increased risk of
hypertension/cardiovascular disease
Anxiety Panic attacks
Physical symptoms Emotional symptoms
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 ,CMODR PAWAN GOEL, CMODR ANJALI MIGLANI, SMODR PRADIP KUMAR ROY, SMODR PARMESHWAR BISWAL, MODR ANUBHA SIKKA, MODR SUNITA SINGH, MO
COMPILED BY:
DR DEEPTI CHAWLA ,CMODTE. OF AYUSH GNCT DELHI