Menopause

Life after change, For her!

Normal hormone cycle

The regular menstrual cycle attained at the time of puberty is an indication of activation of the biological clock and maturation of the Hypothalamus and Pituitary gland in women. This is the beginning of feminity, natures’ desire for continuation of the human generations. With advancement of the medical science, not only we can suppress conception, we can also induce conception in women with infertility.

The change

Biological clock not only decides about the beginning, it is also programmed for the end of the regular menstrual cycle. The usual time is around 45 years, in some women periods can continue up to 50 years. This is a very important time for women as this is responsible for various physical and psychological changes. Everybody’s sensitivity is not the same, while some women pass this phase silently; others become symptomatic and can present themselves to various medical specialities with different complaints. Usual symptoms are irritability, mood swing, hot flush, sweating, sleep disturbance, loss of appetite, loss or gain in weight, loss of libido, etc. Some women complain of feeling tired, looking aged, excessive skin creases and lack of memory. These symptoms are because of loss of ovarian oestrogen, so called female hormone.

What is Hormone Replacement Therapy (HRT) and what are the benefits?

Replacing a deficient hormone is called HRT. In that way giving somebody thyroid hormone when his or her thyroid is deficient is also HRT but replacing oestrogen in postmenopausal women is referred as HRT commonly. It can be given by tablet or skin patch.

Oestrogen hormone is protective for heart and bone. The chance of heart attack in women after menopause is almost as common as in men. Lack of oestrogen after menopause also makes women vulnerable for developing brittle bone disease, called osteoporosis. In osteoporosis the chance of developing fractures increases in proportion to how brittle the bones are. HRT is helpful both for heart and bones. Also it helps to get rid of the menopausal symptoms such as hot flushes, excessive sweating, mood swing, etc. The best benefit of HRT, I believe, is the feel-good factor, feeling of womenhood.

Does HRT increase the risk of breast cancer?

This is a very very important issue. The opinion is really divided as some studies showed no difference in HRT users and non-users. Even it increase the risk of breast cancer the margin is very small. This should not be reason for not using HRT. We keep on going to roads even if there is a chance of accident, don’t we? We need to know things and that is what is important. A regular check up (clinical and mammography) is good enough to pick up early problem.

What are the precautions to be taken?

Two most important reasons for not recommending HRT are family history of breast cancer and history of thromboembolic diseases (clot in the legs called deep venous thrombosis or clot in the lungs called pulmonary embolism). The tests we recommend before starting are cervical smear (to pick up early cervical cancer) and mammography (special X-ray of the breast). Obviously a good discussion with the prospective recipient of HRT is a must in each and every case.

How long to continue?

Now a days preparations are available with which you need not go through the harassment of regular periods. Skin patches have been developed to avoid gulping tablets daily, like the tablets you need to change the patch everyday once after bath. The dose requirement is not the same for everybody and also a periodic check up is very much advisable.

Whom do you see for this?

Most women present themselves to Gynaecologists first, which is understandable and acceptable. Commonest speciality visited with osteoporosis is Orthopaedics, usually after a fracture. The most important aspect I believe is getting the right message, advice and treatment. At some point of time I am sure you should see Endocrinologist as this is all about hormones and Endocrinology is the speciality which deals with hormonal disorders.

Need for follow up

In the beginning little bit swelling feet can be there and you may gain a couple of pound weight, which over the time disappear. A local reaction to the skin patch is known in some women. How long to continue is a very important question. Obviously, the length will also depend on how good you feel and how well you tolerate the HRT. It is better to raise this issue on follow up rather than fixing a time frame. Remember follow up is a must if you are on HRT, it may be even every six months. Your dose requirement might need to be changed.

This article is prepared by Dr A Bhattacharyya
(Arpan@DiabetesEndocrinology.in)