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  Menopause 
Premature Menopause 
Hormone Replacement Therapy 
 

 

Menopause Introduction: Menopause is called when period's stops permanently because of female hormone deficiency in females. It usually occurs between 40 to 50 year of age. But in some women it may occur at early age meaning menopause before the age of 40 year. Premature menopause occurs due to various causes of premature menopause (i.e. early menopause). 
Early menopause is called when ovarian function stops i.e. menses stops before usual age.
The causes of premature menopause are idiopathic, anti-ovarian antibody, radiation or chemotherapy exposure, chromosomal defect, surgery, traumatic, viral infection of ovaries, estrogen synthesis defect, Ovarian dysgenesis, chromosomal defect, mumps oophoritis, surgical removal of ovaries, autoimmune diseases & idiopathic.

Symptoms of menopause are hot flushes, weakness, irritability, depression, insomnia (less sleep), body pain & less desire for genital, dryness of vagina during intercourse & absent orgasm or pain during intercourse & sometimes excess sweating. Patient may suffer sensation of heaviness in head, weakness, palpitation, fainting, vertigo& sometimes sensation of insect crawling over the skiin. Other symptoms which may be perceived by patient are anxiety, depression, fear, dryness (decreased lubrication) during coitus, decreased desire for genital& low enjoyment & absent orgasm. 

Sometimes symptom may start 2 to 3 year before the actual menopause. This is called Perimenopause. In long term if not properly treated it may lead to bone fractures & deformity of back spine. 

Hormone changes after menopause: oestradiol, oestrone, androstenidione,& testosterone decreases & LH,FSH increases.

Investigations & Diagnosis: it is diagnosed by high value of LH & FSH hormone & low value of female genital hormones.


Treatment: For hot flushes before or after menopause we give female hormone for short time, within two to six months hot flushes disappear. 

1) Hormone Replacement therapy is prescription of female genitalhormone & other hormone for relief of menopausal symptoms & other consequences. Hormone replacement can be given as:
1) Synthetic or natural female hormone are replaced with immediate relief of all the symptoms without any side effects. It is available as oral tablets, skiin patch, dermal gels or vaginal creams. The various hormones used for this purpose have potency mild to strong.
2) Phytoestrogens: Natural source female hormones are also available hich have no side effect
3) Prohormones: many natural products are available which works as prhormones for female genitalhormones. They are devoid of any side effects.
3) Certain ayurvedic tablets are available which can cure these symptoms without side effects. 
4) Progestogens
5)MedroxyprogesteroneDesgestrol
6) Megestrol
7) Norethisterone
8) Hydroxyprogesterone
9) Natural Progesterone
10) Norgestimate
11) Cyproterone Acetate
12) Tibolone
13) Androgen Replacement is also some times required when there is associated low genital desire or lack of enjoyment of genitalactivity.
14) Clonidine
16) For prevention of osteoporosis in female, various treatments given are hormones Ethnyl estradiol (Premarin), Tibolone & Raloxifene is prescribed along with biphosphonates, calcium & Vitamin D. 

Defferential diagnosis of flushing 
Physiologic flushing : Menopause, Ingestion of monosodium glutamate (Chinese restaurant syndrome), Ingestion of hot drings
Drugs : Alcohol ( disulfiram, metronidazome or chlorprppamise), Diltizen, Nifedipine, Nicrotinic acid, Levodopa, Bromocriptine, Thyrotropin-releasing hormone, Amyl nitrate, 
Neoplastic disorders, Carcinoid syndrome, VIPoma syndrome, Medullary carcinoma of the thyroid, Systemic mastocytosis, Basophilic chronic myelocytic leukemia, Renal cell carcinoma, Agnogenic flushing 
Premature Menopause / Ovarian Failure

Premature Ovarian Failure is called when ovarian function stops before the age of 40 year age. Approximately 0.1% females suffer with this problem. Symptoms are absence of period along with some of the below mentioned symptoms. Those associated symptoms are hot flushes, weakness, irritability, depression, insomnia (less sleep), body pain & less desire for genital, dryness of vagina during intercourse & absent orgasm or pain during intercourse & sometimes excess sweating. Patient may suffer sensation of heaviness in head, weakness, palpitation, fainting, vertigo& sometimes sensation of insect crawling over the skiin

Causes of Premature Ovarian Failure: 

Genetic Alterations or Tendencies :Structural alternations in or absence of an X chromosome, Trisomy X with our without mosaicism, Reduced germ cell number, Accelerated atresia of germs cell (?), In association with myotoria systrophica, Enzymatic defects, 17-Hydroxylase deficiency galactosemia
Defects in Gonadotropin Secretion or Action :Secretion of biologically inactive gonadotropin, a or subunit defects, FSH receptor (FSHR) mutations, Postreceptor defects (e.g. resistant ovary or savage syndrome)
Immune Dysfunction : Associated with other Autommune disorders, Isolated, Congenital thymic aplasia
Physical Insults : Chemotherapeutic (especially alklylating) agents, Ionisinz radiation, Viral agents, Cigarette smoking, Surgical exitirpation Idiopathic 
For proper diagnosis all above causes investigated then treated accordingly. 

(XII) Hormone replacement therapy in female prescribed when female hormone is deficient as after menopause or after surgical removal of ovaries. Symptoms of female hormone deficiency are hot flushes, anxiety, depression, fear, dryness (decreased lubrication) during coitus, decreased desire for genital & low enjoyment & absent orgasm.
Hormone replacement from out side is given as female genital hormone & other hormone for relief of menopausalsymptoms & other consequences.Hormone replacement can be given as:
1) synthetic or natural female genital hormone are replaced with immediate relief of all the symptoms without any side effects. It is available as oral tablets, skiin patch, dermal gels or vaginal creams. The various hormones used for this purpose have potency mild to strong.
2) Phytoestrogens: Natural source female hormones are also available which have no side effect
3) Prohormones: many natural products are available which works as prhormones for female genital hormones. They are devoid of any side effects.
3) Certain ayurvedic tablets are available which can cure these symptoms without side effects. 
4) Progestogens
5) Medroxyprogesterone Desgestrol
6) Megestrol
7) Norethisterone
8) Hydroxyprogesterone
9) Natural Progesterone
10) Norgestimate
11) Cyproterone Acetate
12) Tibolone
13) Androgen Replacement is also some times required when there is associated low genital desire or lack of enjoyment of genitalactivity.
14) Clonidine

Monitoring for Side Effects: We do frequent Blood pressure & biochemical monitoring, mammography & other tests to see the good effects as well as any side effects. 
(7I) Turner Syndrome is a chromosomal defect in females leading to short height, absent breast development, less pubic & axially hair & absence of menstruation. 

(8) For prevention of osteoporosis in female, various treatments given are hormones Ethnyl estradiol (Premarin), Tibolone & Raloxifene is prescribed along with biphosphonates, calcium & Vitamin D. 
 

 

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