Part - III Random thoughts In my previous two columns I looked at some of the aspects of menopause and the role of the two most important hormones that play a prominent role in the life of a woman viz the pre-menstrual, menstrual and menopausal phases of her life. I also noted how the onset of menopause can cause important changes in a woman’s life and sometimes have drastic affects on her physical and mental health and behaviour. In today’s column I would like to discuss some of the treatments available to deal with the many drastic changes in a woman’s life of this ‘natural’ phenomenon. All information is courtesy Wikipedia. I had previously already mentioned what some of these symptoms could be, but any listing will only give a part of the picture and, luckily, not all women suffer from all the symptoms. It is worth mentioning that, in some women, menopause may bring about a sense of loss related to the end of fertility. In addition, this change often occurs when other stressors may be present in a woman’s life. These stressors may be: 1) caring for and/or death of elderly parents; 2) empty-nest syndrome when children leave home; and 3) the birth of grandchildren, which places middle-aged people into a new category of older people (especially in cultures where being older is a state that is looked down on.) Some research appears to show that melatonin supplementations in peri-menopausal woman can improve thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing depression associated with the menopause. Since the various physiological and psychological effects before, during and after menopause can be rather serious, a lot of research has been done in developed countries and various treatments have been suggested by experts. To relieve the symptoms of menopause, doctors may prescribe hormone therapy replacement (HRT). This can involve the use of either oestrogen alone or with another hormone, progesterone or progestin, in its synthetic form. The two hormones normally help to regulate a woman’s menstrual cycle. Progestin is added to oestrogen to prevent the overgrowth (or hyperplasia) of cells in the lining of the uterus. This overgrowth can lead to uterine cancer. Women who have had a hysterectomy will be given only oestrogen, otherwise a combination will be prescribed. These prescriptions are to be taken orally either daily or only for a certain number of days every month. Selective Estrogen Receptor Modulators (SERM) are a category of drugs, either synthetically produced or derived from a botanical source, that act selectively as antagonists on the oestrogen receptors throughout the body. The most commonly prescribed SERMs are raloxifene and tamosifen. Raloxifene exhibits oestrogen agonist activity on bone and lipids, and antagonist activity on breast and endometrium. Tamoxifen is used by many for treatment of hormone-sensitive breast cancer. Raloxifine prevents vertebral fractures in postmenopausal, osteoporotic women and reduces the risk of invasive breast cancer. Some Selective Serotonin Receptor Inhibitors (SSRI) and Selective Norepine Receptor Inhibitors (SNRI) provide relief from depression. They may, however, cause sleeping problems. Gabopentin or Colonidine may help but do not work as well as hormone therapy. Colonidine can cause constipation and sleeping problems. There is no evidence of consistent benefit of alternate therapies for menopausal symptoms despite their popularity. The effect of soy isoflavones is promising but not clear. Evidence does not support a benefit from phytoestrogens such as coumestrol, femarelle or black cohosh. There is no evidence to support the efficacy of acupuncture as a management for menopausal symptoms. There is also no support for herbal or dietary supplements in the prevention or treatment of the mental changes that occur around menopause. Other therapies include: 1) moisturizers to help with overall dryness; lubricants can help in this; 2) low-dose prescription products, such as oestrogen creams, are generally a safe way to use oestrogen topically to help with thinning and dryness while minimally increasing the levels of oestrogen in the bloodstream; 3) in terms of managing hot flushes, lifestyle measures such as drinking cold liquids, staying in cool rooms, using fans, removing excess clothing and avoiding hot flush triggers such as hot drinks, spicy foods, etc may partially supplement (or even obviate) the use of medications for some women; 4) individual counselling or support groups can sometimes be helpful as women pass through what can be, for some, a very challenging transition time; and 5) osteoporosis can be minimised by stopping smoking , adequate vitamin D intake and regular weight-bearing exercise. The bisphosphate drug, alendronate, may decrease the risk of a fracture in women who have both bone loss and a previous fracture and less so for those with just osteoporosis. It is worth mentioning that the cultural context within which a woman lives can have a significant impact on the way she experiences the menopausal transition. Menopause has been described as a subjective experience, with social and cultural factors playing a prominent role in the way menopause is experienced and perceived. The paradigm within which a woman considers menopause also influences the way she views it: women who understand menopause as a medical condition rate it significantly more negatively than those who view it as a life transition or a symbol of aging. Ethnicity and geographical location also play a role in the experience of menopause. Generally speaking, women raised in the western world or developed countries in Asia live long enough so that a third of their life is spent in post-menopause. For some women, the menopausal transition represents a major life change, similar to menarche in the magnitude of its social and psychological significance. Although the significance of the changes that surround menarche is fairly well recognised, in many developed countries the social and psychological ramifications of the menopause transition are frequently ignored or underestimated. Concluded Email: dr.a.quadeer.khan@gmail.com
