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Hormonal Care during Menopause

What is menopause?

Cessation of regular menstrual cycles/periods in a woman is considered as menopause. Levels of female hormones (Estrogen & progesterone) become very low during menopause.

What are the problems during menopause?

Because of the low estrogen levels, women develop vaginal dryness, pain during sexual intercourse (Dyspareunia), recurrent urine infections. They are prone for thinning of bones (Osteoporosis) as there is loss of estrogenic support to the bone.

What are the symptoms and signs of menopause?

1.  Hot flushes: Sudden feeling of excessive heat/warmth over the face & body followed by excessive sweating and feeling of cold.
2.  Vaginal dryness and pain during sexual intercourse (Dyspareunia)
3.  Recurrent urine infections
4.  Mood swings
5.  Bodyaches, muscle pains
6.  Fragility fractures due to osteoporosis

What are the investigations that can be done?

1.  FSH, LH levels: High during menopause
2.  25 hydroxy vitamin D, calcium and phosphorus levels: To estimate the bone health
3. DEXA scan: To estimate the bone mineral density.

How do we treat?

Supplementation of calcium and vitamin D is a must in the postmenopausal group. Requirement of calcium and vitamin D increase during menopause.

  Calcium (mg) Vitamin D (IU)
Postmenopausal women 1200 mg 800-1000 IU

Hormone replacement therapy (HRT)

Beneficial in majority of the patients between 45-55 years in relieving hot flushes, vaginal dryness, dyspareunia and mood swings. HRT is also helpful in preventing osteoporosis. Low dose of estrogen is used in HRT to avoid adverse events. Progesterone (preferably, micronized) is used in women with intact uterus.

There were many controversies surrounding HRT. In one of the studies, it was found to increase stroke,deep vein thrombosis (Clotting of blood in the leg blood vessels) etc. But it was found in women when it was used beyond the age of 60 years. When used below the age of 55 years, in addition to improving menopausal symptoms and osteoporosis, it also reduced the chance of heart attack.

 

In summary, it is prudent to use HRT in women with menopausal symptoms between the age of 45 – 55 years. It is better to get mammogram and pap smear done before starting HRT.

Other medications

Some medicines like Duloxetine and Venlafaxine can be used for relief of intolerable hot flushes. Estrogen vaginal creams are useful for treating vaginal dryness and recurrent urinary infections. Other medications like teriparatide and bisphosphonates can be used if there is osteoporosis.

Symptoms of Menopause

Symptoms of menopause (Hot flush,vaginal dryness) can be intolerable
Calcium and vitamin D supplementation: Must during menopause
HRT: Very useful in selected postmenopausal women

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