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Mending menopause Source - DNA Dated - 24th November, 2013

Mending menopause

Sunday, Nov 24, 2013, 11:10 IST | Agency: DNA
Lisa Antao
Source: DNA

We spoke to experts to give you the low down on how Hormone Replacement Therapy (HRT) can be sought for treating menopause.

Menopause presents a tough time for women both physically and mentally. We shed light on Hormone Replacement Therapy (HRT), which can be undertaken to treat it.

Case 1: Suman Tripathi (name changed), 52, had no health issues. However, she complained of absent menstrual periods (since the past 14 months) along with hot flushes, lack of sexual desire and arousal, vaginal dryness, severe mood swings and irritability. After counselling it was decided to start 'cyclic HRT' or 'sequential combined HRT'. Following the HRT for a month, Suman reported feeling much better and had significant improvement.

She was advised the treatment for a year following which it was suggested that she could take a three month break and restart the treatment for another six months or so. If the symptoms did not persist, she could opt for discontinuation of the HRT.

Case 2: Neeta Khanna (name changed), 44, had a history of severe hot flushes and mood swings. She was advised soy isoflavones for three months but she had no relief. She was then put on combined HRT and her symptoms decreased by 50 per cent after 15 days, and further declined to 80-90 per cent at the end of the month. After three months she was asymptomatic.

After withdrawal of therapy, after six months she had around 10 per cent hot flushes, which she felt she would be able to cope with hence, treatment was stopped. She had no side effects.

Different treatment for different women

Every woman has a different body and so there is no one single ideal drug for treatment of menopause. Having said that lifestyle changes like diet changes, appropriate exercise regimes, calcium and vitamin D replacement as required are advised to all women. “Treatment is usually customised for an individual depending on presenting symptoms, associated co-morbidities or disorders that the woman presents with. Natural isoflavones or phytoestrogens correct menopausal symptoms in a number of women. If there is inadequate symptom relief then short-term HRT may be considered,” Dr Shefali Pandey, consultant gynaecologist, BSES Hospital.

Numbers are increasing

As women are living longer, and are actively working they need to be given HRT for two to three years, only after assessment and if required, given the lowest possible dose, says Dr Geeta Pandya, consultant gynaec endocrinologist, Jaslok Hospital.

ndian women have lower rates of hot flashes as compared to western women. However, Dr Shefali points out that with changing lifestyles, as well as greater awareness, more women present for health screening at the menopausal transition. Also, with decreasing age at menopause, women spend a larger time in the post menopausal state with its associated morbidities and effect on cardiovascular, metabolic, bone and muscle health as well as on memory and cognition.

Determining the need for HRT

Before undertaking HRT, a series of tests need to be done. “Pre-HRT screening should include tests to rule out sugar, lipid metabolic disturbances, gall stones, gynaecological cancers. Blood pressure monitoring is also suggested. Severe migraines, gynaecological cancers, uncontrolled hypertension, cardiovascular, cerebrovascular disorders have to be carefully screened for prior to commencing HRT,” advises Dr Shefali. Also, women who have severe hot flushes or mood disturbances (after ruling out any underlying psychiatric conditions) could be treated with HRT for short periods with careful screening and intra-therapy.

Pros and cons

Infertility specialist Dr Nandita Palshetkar, says, “Hormone therapy is the most effective FDA approved medicine for relief of menopausal hot flashes, night sweats or vaginal dryness. They might reduce the chances of getting thin, weak bones which break easily (osteoporosis) and reduce the risk of colon cancer.

As for cons, hormone therapy may also increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gall bladder disease. For a woman with a uterus, estrogen increases her chance of getting endometrial cancer (cancer of the uterine lining). Adding progestin lowers this risk.”

Dosage

During menopause both estrogen and progesterone can be given starting with a lower dose and increasing the dose as and when required. “Normally, it is given as pills, and occasional in the form of injections (on a three to six-monthly basis) is given if the patient is unable to take tablets,” informs Dr Geeta. Dr Shefali adds that besides oral tablets, the therapy is also prescribed through the transdermal route via skin patches or creams.

HRT not ideal for everyone

Dr Palshetkar lists women with the following conditions, for whom HRT is not ideal: Those having a history of breast cancer, ovarian cancer or endometrial cancer (cancer of the womb)

Those having a history of blood clots, heart disease or stroke.

Those having untreated high blood pressure (Their blood pressure will need to be controlled before they can start HRT).

Those having liver disease, are pregnant and have undiagnosed abnormal vaginal bleeding.

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