Women Care in Geriatrics

Dr Prathibha C.K MD PanchakarmaLectureDepartment of Panchakarma

• Physiology• Geriatry – problems of aging diseases of elderly• Women – end of fertility senile diseases• Jara/ Rasayana Tantra

• Su- Vardhakya – above 70 Yauvana- Hani- above 40 Jarapakwa shareera- above 50• Sha- 41-50 –twak haani 61-70 – shukra haani• Immobility, instability, incontinance, impaired intellect & memory

• Organs of reproduction• Hormones- Pituitary Ovarian• Effect – Menstruation Fertilization

• oestradiol – Ovary• Oestrone- adrenal gland• Androstenedione –oestrone• Fatty women – more estrone

• Help regulate menstruation.• Help prepare the body for fertilisation.• Stimulate the lining of the womb so that it thickens.• Maintain lubrication of the vagina.• Help maintain the acid level in the vagina, thereby protecting against infections.• Work in conjunction with progesterone to help with the breakdown of the endometrium (lining of the womb) in the second stage of the menstrual cycle.• Maintain a supply of calcium to the bones

• Help maintain the health of blood vessel walls.• Reduce the blood cholesterol level.• Bring about the development of secondary sex characteristics, i.e. the breasts and nipples.• Influence body shape at puberty, resulting in women having broader hips and narrower shoulders than men, and a tendency to deposit fat on the hips and thighs.

• Increase elasticity of the skin.• Influence the growth of body hair, so that women have less body hair and more scalp hair than men.• Stop the growth of the arm and leg bones, resulting in women being generally shorter than men.

• Source• Help prepare the body for fertilisation and maintain pregnancy.• Work in conjunction with oestrogen, to help with the breakdown of the endometrium (lining of the womb) in the second stage of themenstrual cycle.• Help regulate menstruation.• Change the mucus produced by the glands in the cervix so that it becomes thick and acidic, thus protecting a potential pregnancy from infection.• Aid development of the glands in the breast.• Increase water and salt retention, which may lead to painful breasts and weight gain.

• Improve the immune system.• Have a relaxant effect on some of the muscles in the body (i.e. stomach, uterus, and fallopian tubes).• Increase production of sebum, leading to more oily skin and spots.• In addition, progesterone may have an impact on mood, leading to an increased irritability. Hence, women often report experiencing changes in mood prior to having a period when the levels of progesterone are at their highest.

• men and women, but at different levels.• Up until the menopause, women have about one-tenth of the amount of male sex hormones that are found in men• After the menopause, these hormones go on being produced for a few years• The amount of androstenedione produced by the adrenal glands is unchanged after the menopause, although after the menopause it is converted to a form of oestrogen (oestrone) in the fatty tissue.

• Increase libido.• Stimulate the growth of pubic, facial and underarm hair.• Possibly enhance mood.• Increase the density of specific bones (for example, the hip bone).

• Reproductive organs• Hormones• Psychological state

• The vaginal walls become less elastic, thinner, and less rigid. The vagina becomes shorter. Secretions become scant and watery.• The external genital tissue decreases and thins (atrophy of the labia).• A woman is born with around seven million ovarian follicles, containing egg cells. This number decreases from birth, until there are none remaining after the menopause.

• Breasts lose tissue and subcutaneous fat, reducing breast size and fullness. There is also a decrease in the number of mammary glands, which the body replaces with fat tissue. These changes make the breast less firm.• flatten and sag, and the nipple may turn in slightly. The area surrounding the nipple (the areola) becomes smaller and may nearly disappear• Lumps are common around the time of menopause. These often turn out to be benign cysts.• Breast cancer risk increases with age

• These hormones also decrease around menopause. The ovaries continue to produce small amounts of testosterone and some estrogen.• The hormones produced by the pituitary gland are also decreased

• women enter their forties, the ovarian follicles become less sensitive to stimulation by the hormone, follicle- stimulating hormone (FSH), which is produced by the pituitary gland beneath the base of the brain. Although the pituitary gland increases the production of FSH, ovulation does not always occur during each menstrual cycle.

• Changes in the length of the menstrual cycle frequently occur in the time leading up to the menopause. Women sometimes notice that their cycle becomes shorter, often lasting for just 18–24 days. This is usually followed by a lengthening of the cycle duration, with occasional periods being missed. Eventually, as the menopause occurs, the periods stop altogether

• Menopause• Atherosclerosis• Osteoporosis• Memory loss• Incontinance• Vaginal dryness• Hair loss

• Up until the menopause, heart disease is five times more common in men than it is in women. Following the menopause, however, there is a sharp increase in the incidence of heart disease amongst women• Oestrogen affects the heart through its ability to influence the blood cholesterol level, the clotting mechanism, the blood vessel walls, and the production of insulin.

• 2-20% blood cholesterol level• Triglycerides-7-35%• Atherosclerosis – reduce circulation- risk of a thrombosis• Oestrogen acts directly on the blood vessel walls, causing dilation of the vessels,

• In both men and women, bone mass rises from childhood, until it peaks around the late twenties. Over the following ten years or so, the balance between bone formation and bone breakdown stays stable. After this, from the age of around 40, both men and women gradually start to lose bone mass as part of the general ageing process.• For women, however, bone loss is more rapid and accelerates in the years after the menopause. When oestrogen levels fall around the time of the menopause, the rate of bone resorption by osteoclast cells increases, but the rate of bone formation by osteoblast cells remains the same

• Osteoporosis generally affects the spine first, with crush fractures resulting in a loss of height, curving of the spine and long-term backache. A woman’s risk of developing osteoporosis, and consequent broken bones, depends on the peak bone mass (the peak bone density that is reached in the late twenties), and the rate of bone loss.• Peak bone mass is increased by factors such as a diet rich in calcium and weight-bearing exercise. The age and rate of bone loss is influenced by factors such as the menopause, family history, smoking, and excessive alcohol intake.• A woman’s chances of sustaining hip fracture doubles if her mother has a history of hip fracture.

• Hence, there is a gradual loss in bone mass. For some women, the bone mass falls significantly and the bones become thin and vulnerable to being broken. This is termed ‘osteoporosis’ or ‘brittle bone disease’.• The rate of bone loss increases in the years immediately after the menopause, with up to 20 per cent of bone loss occurring in the first 10 years after menopause. The rate of bone loss slows thereafter.

• Oestrogen has been found to be necessary for the maintenance of healthy tissue in a number of areas of the brain, in particular the area of the brain responsible for memory. This area of the brain is also the place that becomes diseased during Alzheimer’s disease• Studieshave shown that oestrogen improves mood.• progesterone, have been found to decrease some of the positive effects of oestrogen on mood

• It maintains the pliability and softness of the lining of the urethra• Maintains the elasticity of the bladder,• Decreases the irritability of the urethral and bladder muscle.• After the menopause women may experience problems with incontinence, frequency in passing urine and urgency in passing urine

• Oestrogen maintains the thickness and lubrication of the lining of the vagina stimulates the production of useful vaginal bacteria, which help to prevent infection.• Maintains the acid level in the vagina at a level where these useful vaginal bacteria can survive. After the menopause, therefore,• increase in vaginal infections, vaginal dryness, making sexual intercourse uncomfortable or painful.

• women often report skin and hair changes when taking hormone replacement therapy,• findings say that oestrogen increases the collagen (elasticity) level in the skin and enhances the blood supply to the skin.• It has also been suggested that oestrogen increases the lifespan of the hair follicle• thinning and drying of the hair after the menopause.

• Menopausal symptoms• Stress incontinance• Atropic vaginitis• Vaginal yeast infections• Dysperunia• Uterine prolapse• Osteoporosis• Fibroadenitis

• literally means the "end of monthly cycles" from the greek word pausis (cessation) and the root men- (month),• The date of menopause in human females is formally medically defined as the time of the last menstrual period (or menstrual flow of any amount, however small), in those women who have not had a hysterectomy

• cigarette smoking,• higher body mass index,• racial/ethnic factors,• illnesses,• chemotherapy,• radiation• the surgical removal of the uterus and/or both ovaries

• Smoking – women who smoke tend to experience the menopause on average, 1 to 2 years earlier than women who do not smoke.• Weight – women with a greater body mass tend to have a later menopause than thinner women.• Genetics – mothers and daughters tend to experience the menopause at a similar age.

• Bilateal oophorectomy (removal of ovaries),• Cessation of menses as a result of removal of the ovaries is called "surgical menopause". The sudden and complete drop in hormone levels usually produces extreme withdrawal symptoms such as hot flashes, etc. Removal of the uterus without removal of the ovaries, a hysterectomy, does not cause menopause, although pelvic surgery can often precipitate a somewhat earlier menopause, perhaps because of a compromised blood supply to the ovaries.

Date of meno• Cessation of menses as a result of removal of the ovaries is called "surgical menopause". The sudden and complete drop in hormone levels usually produces extreme withdrawal symptoms such as hot flashes, etc. Removal of the uterus without removal of the ovaries, a hysterectomy, does not cause menopause, although pelvic surgery can often precipitate a somewhat earlier menopause, perhaps because of a compromised blood supply to the ovaries.

Terminology• Perimenopause is the term used to describe the menopause transition years.• In women who have a uterus, perimenopause describes the years before and after the final period• The word menopause is also often used in popular parlance to mean all the years of postmenopause

S/S menopause• Vasomotar symptoms - hot flushes, night swets,( cold flashes), migrain, rapid heartbeat• Genital symptoms- vaginal atrophy, Thinning of the membranes of the vulva, the vagina, the cervix, shrinking and loss in elasticity of all of the outer and inner genital areas.,Itching,Dryness, Bleeding Watery discharge,susceptibility to infections• Urinary symptoms – increased frequency,Urinary incontinence, Urinary urgency, UTI

• Skeletal symptoms – LBA, joint pain, muscle pain osteopenia.• Skin, soft tissue - Breast atrophy, breast tenderness +/- swelling, Decreased elasticity of the skin, skin thinning and becoming drier• Psychological – deppression, anxiety, fattigue, irritability, memmory loss(concentration), mood disturbance, sleep disturbance• Sexual- dysperunia,decreased libido, vaginal atrophy

Chikitsa• Ahara• Vihara• Rasayana• Shamana• Shodhana

General guidlines• Satwawajaya• Keeping engaged• Feel more responsible• Turn negativity to Positivity• Changing food habits- use of soya, atasi etc• Regular exersise and Yoga• Rasayana• Head low/Surya namaskara

• Diet- plant based, low saturated fat, trans fat rich• High fibre• Increse fluid intake• Avoid sourses of unnesessory sugar, alcohol , caffin, salt• Avoid smoking

• Exersise reduces• Stress• Wt• Muscle strenthening• Improves balance and stregth(phy & ment)• Normal flow• Flexibility• Reduce LBA

Phyto oes• Shatavari• Amalaki• Yasti• Shatapushpa• Bala• Ashwagandha• Musali• Kumari

Menopause• Basti-Dashamoola Yasti Musthadi• AB-Dhn, Sah, Sukumar, Bala,• SD• SP• Mrudu virechana• Udwartana• Snehana

Shamana• Shatavari Guda• Kushmandavaleha• Balariasta• Dhw arista• Balajeeraka kash• Ashokarista• Saptasara• Kumaryasava• Saraswata arista• Pushyanuga• Triphala• Godanti• Panchamruta parpati• bolaparpati

• YRG• TG• CPV• Shilajatu vati• Maradwaja vati• Manasamitra vati• Smrutisagara Rasa• Swarna makshikabhasma• Tamra Bhasma• Dhanw guliga• Phala sarpi• Kalyanaka ghruta• Shatavari ghruta

Sress incontinace• Local abhyanga- phala sarpi, shuddha bala• Sitz bath• MB• Exersise• Balarista• CPV• Bhangshil• Indukanta Kashaya• Dhanwantara guliga• Shukumara ghruta

Vaginal infections• Local hygine• Sitz bath• Douche• Pichu• Varthi – mashadi• TG• GR• Shigru kashaya• Aragwadha kashaya• Musalreekhadira kashaya• Sapthasara kashaya• Pushyanuga choorna

Atropic vagina• With sneha• Support hepatic• Bhumyamali Ppn• Control DM

Prolapse• Exersise• Pichu/ Pessary• Abhyanga• Mushikadi taila• MB• Decubitus ulcer- murivenna, yasti, jathyadi, shatadhuta ghruta• Gophana bandha

Osteoporosis• Godanti• Pravala• Aaaamalaki• Tiktaka ghruta• Basti• Local basti, pichu, abhyanga

Fibroedinitis• Lepa –dashanga, doshagna, kc, Triphala• Sheapana• GR• TG

Investigation• HB• TC DC ESR• Sugar• Urine alb• X ray• Papsmear• Histopatological- vaginal, check curattage• Elisa- TB, HPV• Colposcopy• Hystosalphingogram• USG• mammogram

Conclusion• Shodhana therapy is to be administered carefully• Satwavajaya chikitsa plays an important role long with shamana in the management of senile women problems

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Women Care in Geriatrics

by sharmadr on Aug 05, 2011

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Women Care in Geriatrics — Presentation Transcript