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Clinical tips for the management of perimenopausal syndrome by dr.deepti chawla
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Clinical tips for the management of perimenopausal syndrome by dr.deepti chawla

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Clinical tips for the management of perimenopausal syndrome by dr.deepti chawla

Clinical tips for the management of perimenopausal syndrome by dr.deepti chawla

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  • 1. MENOPAUSE A Clinical Perspective
  • 2. DEFINITION OF MENOPAUSE    Menopause is the permanent cessation of ovarian follicular function. It is diagnosed retrospectively after a period of 12 months of amenorrhea This signals the end of a woman’s fertility
  • 3. RELATED TERMS    Premenopause refers to the phase of normal reproductive life of a woman, it extends from her first to her last regular menstrual period Perimenopause refers to the transitional phase preceding actual menopause by about 2 to 8 years, characterized by signs and symptoms due to declining ovarian follicular activity Post menopause is the time after the complete cessation of menstruation until the end of life
  • 4. AGE OF MENOPAUSE  Age at which a woman will reach menopause is variable and depends on a number of factors
  • 5. FACTORS AFFECTING AGE OF MENOPAUSE Hereditary Factors: Menopause has a strong genetic link. The age at which a woman’s mother reached menopause is a good predictor of her approximate age of menopause Smoking: Women who smoke are likely to experience menopause earlier than non-smokers Ethnicity: Women from certain ethnic groups have menopause earlier than others ; while average age of menopause for Caucasian women is 51 years, the same is 46 years for Indian women Chemotherapy/ Ovarian Surgery: Can accelerate the onset of Menopause by damaging the normal ovarian tissue
  • 6. HORMONAL CHANGES DURING PERIMENOPAUSE      Estrogen levels generally decline but may fluctuate unpredictably, even increase at times causing “estrogen dominance” Progesterone levels typically decline Testosterone levels show decline FSH levels vary markedly during the perimenopause . High FSH(>30 IU/l) levels may be helpful in confirming the menopause in later stages LH levels rise in response to low levels of estrogen
  • 7. ESTROGEN LEVELS DURING PERIMENOPAUSE Estrogen Levels Pre Menopause Peri Menopause Age 45 35 Symptom Experience Menopause Post Menopause ~51 Less Strong
  • 8. PERIMENOPAUSAL SYNDROME  Fluctuating/low levels of hormones especially estrogen and progesterone give rise to signs and symptoms collectively called PERIMENOPAUSAL SYNDROME
  • 9. SIGNS AND SYMPTOMS OF PERIMENOPAUSE Physical symptoms Emotional symptoms  Hot flashes  Irritability  Night sweats  Fatigue  Irregular menses  Reduced attention span  Loss of libido  Difficult concentration  Vaginal dryness/itching  Mood swings  Fatigue  Sadness  Headaches  Depression  Thinning of hair  Sleep difficulty  Memory loss/lapse  Weight gain  Urinary incontinence  Dizzy spells
  • 10. SIGNS AND SYMPTOMS OF PERIMENOPAUSE Physical symptoms  Sensation of electric shock like pains  Palpitations/irregular heartbeat  Breast pain/loss of fullness  Joint/muscle pain  Flatulence/bloating/poor digestion  Dryness/itching of skin    Backache/stress fractures due to osteoporosis Receding gums Increased risk of hypertension/cardiovascular disease Emotional symptoms  Anxiety  Panic attacks
  • 11. GENERAL MANAGEMENT           Maintain a healthy lifestyle Promote healthy eating habits ,diet should contain healthy ,low fat, fresh foods, dairy products, dark green vegetables, fish, eggs in order to maintain optimal levels of Calcium and Vitamin D Regular exercise goes a long way in staying physically fit by maintaining ideal weight and promotes general wellbeing besides reducing the risk of osteoporosis and symptoms like hot flashes Moderate physical exercise of 30 minutes everyday helps to combat the increased risk of developing cardiovascular disease Pelvic floor exercises can reduce urinary incontinence Create a cool and comfortable environment at home and at work to minimize the discomfort due to hot flashes Regular health checkup to monitor Blood Pressure, levels of Blood Sugar, Lipids, mammogram, Pap Smear, and Bone Densitometry should be done Quit smoking Seek help when symptoms are persistent or more distressing. Do not assume all symptoms to be due to menopause. Suitable contraceptive should be used until actual menopause is reached
  • 12. POST MENOPAUSAL BLEEDING    Any vaginal bleed more than 12 months after last period is called post menopausal bleeding It should not be ignored as a feature of perimenopausal syndrome Immediate medical advice should be sought to rule out other causes such as Endometrial Carcinoma
  • 13. CONVENTIONAL THERAPY Combined oral contraceptive pill  Hormone Replacement Therapy (HRT) 
  • 14. HOMOEOPATHIC MANAGEMENT  Despite its benefits, HRT is known to have some adverse effects. It is known to increase the risk of  Breast cancer  Ovarian cancer  Endometrial cancer  Heart disease  Stroke In contrast, Homoeopathy offers a wide range of safe and effective remedies to treat symptoms of perimenopausal syndrome.
  • 15. HOMOEOPATHIC MEDICINES AND CLINICAL TIPS     Acid Phos.- mental debility, nervous exhaustion, weakness, tearing bone pains, hair loss, menses irregular or too early Amyl nitrosum- Sensation of blood surging to face and head followed by sweating. Sensation as if blood would burst through skin with heat and redness. Throbbing in head and throughout body. Feeling of anxiety. Palpitations. Feels cold and clammy after flushing has died down. Peculiar derangement of mind, nervous repetition of words Bellis per- chronic fatigue and persistent tiredness Calc ars- suited to obese, fleshy women, palpitation from slightest emotion and exertion, suffocative attacks, anaemic and sensitive to cold  Calcarea carb- fatigue,chilliness,muscular weakness  Chamomilla- Irritable, ill humoured, quarrelsome  Cimicifuga- Fainting spells, flushing, headache,Inframammary pains, nervousness, panic, pain in uterus, sinking sensation in stomach, great depression ,dreams of impending evil, tries to injure herself, incessant talking. Electric shock like pains, muscular pains, tinnitus, irregular menses, insomnia, fainting spells
  • 16. USEFUL HOMOEOPATHIC MEDICINES AND CLINICAL TIPS   Glonoine- Headache instead of menses, delayed menses, pulsating and throbbing type of pain all over the body, headache from heat, sunlight, gaslight & electric light and lying down, uncovering head, loathing of work with extreme weakness. Extreme irritability from slightest opposition. Sensation of rush of blood to the head Graphites- suited to obese women , sensitive to cold, dryness of skin, constipation, menses delayed, aversion to intercourse, profuse thin leucorrhea, burning sensation on vertex  Helonias- profound debility,vaginal,uterine sensitivity  Jaborandi- profuse perspiration, increased salivation, hair loss   Lachesis- sadness, aversion to work and company, talkativeness, cannot tolerate tight clothing, hot flashes, , intolerance of heat , palpitation, headaches, dizziness, fainting spells, aggravation of symptoms during or after sleep, menses are too short and scanty, symptoms are better after menses Manganum aceticum- hot flashes, cannot tolerate cold weather, menses deranged, too early and scanty in anaemic women
  • 17. USEFUL HOMOEOPATHIC MEDICINES AND CLINICAL TIPS       Murex- nervous, weak ,run down women, sadness, anxiety, dread, nymphomania Pilocarpus- Intense sweating, hot flushes, sometimes accompanied by nausea and excessive salivation. Excessive perspiration from all parts of the body followed by chilliness, and sweating over face, ears and neck Psorinum- offensive discharges especially sweat and leucorrhoea, severe backache, debility, over sensitiveness to cold Sangunaria. c- hot flashes, burning sensation in cheeks and chest, offensive leucorrhoea, right sided priodical headache, better by sleep and lying on right side, burning in the vertex, painful breasts, sensation of heat in palms and soles Senecio. A- insomnia, prolapse uterus Sepia- Frequent flushes and then shivery, irritable, indifferent, depressed, weepy, wants affection but rejects it, poor libido, nausea ,weakness, indifferent to work and family, painful intercourse
  • 18. USEFUL HOMOEOPATHIC MEDICINES AND CLINICAL TIPS   Sulphur- Menses too late, short, scanty. Pruritus vulvae, burning sensation in vagina, leucorrhoea burning and excoriating. Easy flushing with red face and lips Tabacum- : Severe vertigo with marked pallor, sensation of icy coldness, much sweating, feels better by uncovering the abdomen  Trillium pendulum- tinnitus, fainting spells, dizziness, backache  Yohimbinum- insomnia
  • 19. CONTRIBUTORS; DR ASHOK SHARMA ,CMO DR PAWAN GOEL, CMO DR ANJALI MIGLANI, SMO DR PRADIP KUMAR ROY, SMO DR PARMESHWAR BISWAL, MO DR ANUBHA SIKKA, MO DR SUNITA SINGH, MO COMPILED BY: DR DEEPTI CHAWLA ,CMO DTE. OF AYUSH GNCT DELHI