Treatment of Menopause

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Treatment for menopause is necessary only if symptoms like hot flashes, night sweats, hair loss, osteoporosis etc. are severe enough to cause distress. However, many women do not have any symptoms at all during pre as well as the post menopausal time. Or if symptoms do occur, they are so mild that she does not require treatment.

Very often, any symptom that occurs in the perimenopause (the 1 - 2 years before the actual menopause occurs), is dismissed offhand as being due to the menopause.

But, it is always important to investigate the different complaints. Only after all medical conditions are ruled out should it be assumed that the complaints may have their basis on the decreasing estrogen levels after menopause.

For many women, psychological support and a description of the processes involved may be all that is necessary.

Since the symptoms of menopause are essentially those of estrogen deficiency, the ideal solution is to replace that hormone. Unfortunately, estrogen replaced from outside the body seem to have a different effect than the natural estrogen produced inside the body.

The benefits of hormone replacement therapy ( hrt therapy) like control of hot flashes and decreasing atrophy of the genitals, osteoporosis, hair loss etc. should be balanced against the risks of hormone replacement like cancer of the genital tract and breast, gall bladder disease and cardiovascular problems.

Short Term Hormone Replacement Therapy (HRT therapy)

If the hot flashes are very uncomfortable and are the most visible complaint, a very short term hrt therapy lasting for 3 months can be given. This is weaned off gradually over another 2-3 months. It is usually found that once the acute symptoms subside, many women adjust to their menopause with no further problems.

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Long Term Hormone Replacement Therapy (HRT therapy)

If long term HRT therapy is required, then estrogen should always be combined with progesterone even if the uterus has been surgically removed. Progesterone has a protective action against breast cancer and helps in the prophylaxis of osteoporosis. Progesterone also has an effect on the cardiovascular and temperature regulating systems of the body.

In long term HRT therapy, estrogen is taken for the whole month (30 days) and progestogen is added with oestrogen in the last 10 days. Then both the hormones are stopped for one week. If the uterus is present and has not been removed, the patient will have withdrawal bleeding similar to, or slightly lesser than her normal menstrual periods. She should be explained about this fact before starting the hormones as many women consider having regular menses a greater discomfort than the symptoms produced by menopause.

If oestrogen is given alone, (in both long term and short term hrt therapy) then the treatment should be stopped for at least 5-7 days in a month for the withdrawal bleeding to occur.

Duration of HRT Therapy

  • In short term HRT therapy for menopause, duration of treatment for hot flashes in menopause is only 3 months.
  • Long term treatment for menopause is given initially for 6 months. After 6 months, the dosage of oestrogen is decreased gradually for another 2-3 months. The patient's response is checked periodically. If there is a recurrence of symptoms, she is put on oestrogen and progesterone again.

    It is believed that hormone replacement therapy (HRT therapy) should not be given continuously for more than 2 years. The patient is taken off hormones for 6 months, reassessed and the HRT therapy is again started for another 2 years if necessary.

    Every year, the patient is assessed, a mammography to examine her breasts is done and her blood checked for cholesterol and lipid levels. If considered necessary, she should undergo a D&C (Dilatation and Curettage) and an ultrasonography of the endometrium.

    Treatment for menopause should be given in those women for whom the symptoms like hot flashes, night sweats, hair loss, osteoporosis etc, cause great discomfort. The standard treatment is by Hormone replacement Therapy (HRT therapy). But alternatives to hrt therapy are also quite effective in some women.

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