MENOPAUSE- The evil older sister of Puberty.

Menopause is the permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity.

It is the point of time when last and final menstruation occurs.

Clinically, it is diagnosed by:  Stoppage of menstruation (amenorrhoea) for 12 consecutive months without any other Pathology.

Menopausal Transition is the Period of time during which a women passes from reproductive to non-reproductive stage. This Phase covers 4-7 years on either side of menopause.

• It is Genetically Predetermined
• Age is not related to age of menarche or age of last Pregnancy
• It is not related to number of Pregnancies, Lactation, use of oral pills, socioeconomic condition, race, height and weight
• Thinner women have early menopause
• Cigarette smoking and severe malnutrition causes early menopause

• The uterus becomes smaller
• The breast fat is reabsorbed and the glands atrophy. The nipples decrease in size, ultimately the breasts become flat and pendulous.
• The labia becomes flattened and the pubic hair becomes scantier.
• There is loss of bone mass by about 3-5%/year due to deficiency of estrogen
• There is risk of cardiovascular diseases is high due to deficiency of estrogen. Estrogen Prevents cardiovascular diseases.

• Abrupt cessation of Menstruation (rare) or
• Gradual decrease in both amount and duration. It may be spotting or delayed and ultimately lead to cessation
• Irregular with or without excessive bleeding

1. Vasomotor Symptoms: The Characteristic Symptoms of Menopause is ‘Hot Flushes’. It is characterized by sudden feeling of heat followed by profuse sweating. There may also be symptoms of Palpitation, Fatigue and Weakness, due to low estrogen level. It may last for 1-10 minutes and may be unbearable at times. Sleep may be disturbed due to night sweats.                                                                                                                                                           
2. Genital & Urinary System: Due to low estrogen deficiency produces atrophic changes in these organs and causes dyspareunia (painful intercourse) and dysuria (Painful Urination)
3. Osteoporosis & Fracture: After Menopause there is decline in collagen bone matrix resulting in osteoporotic changes. Osteoporosis may lead to back pain, loss of height & kyphosis. Fracture may occur due to fall due to reduced muscle mass. Fracture may involve the vertebral body, Femoral neck (Colle’s Fracture).
4. Psychological Changes: There is increased frequency of anxiety, headache, mood swings, inability to concentrate, insomnia, irritability, dysphasia and depression. This occurs due to decrease in estrogen.
5. Skin and Hair: There is thinning, loss of elasticity and wrinkling of the skin. Purse String Wrinkling around the mouth & crow feet around the eyes are characteristics. Estrogen receptors are present in the skin and maximum are present in facial skin. There is loss of pubic and axillary hair and slight balding due to low level of estrogen with normal level of testosterone.

• Cessation of Menstruation for consecutive 12 months
• Average age- 50 years
• Appearance of Menopausal Symptoms e.g. Hot Flushes, night sweats
• Serum FSH & LH: >40mlU/ml
• Serum estradiol: <20 pg/ml

• Lifestyle Modifications: includes Physical activity, reducing high coffee intake, smoking and excessive alcohol.

•  There should be adequate calcium intake (300 ml of milk), reducing medications that causes bone loss.
• Supplementary calcium: daily intake of 1-1.5 gm can reduce osteoporosis and fracture.
• Vitamin D: Supplementation of vitamin D (1500-2000 IU/day) along with calcium can reduce osteoporosis and fracture. Exposure to sunlight enhances synthesis of cholecalciferol (Vitamin D₃) in skin
• Cessation of smoking and alcohol.

HRT is indicated in Menopausal women to overcome the short-term and long-term consequences of estrogen deficiency.

1. Indications of Hormonal Replacement Therapy:

• Relief of Menopausal Symptoms
• Prevention of Osteoporosis
• To maintain the quality of life in menopausal years

2. Risk of HRT:

• Endometrial Cancer
• Breast Cancer
• Venous Thromboembolic (VTE) disease
• Coronary Heart Disease
• Lipid Metabolism
• Dementia, Alzheimer Disease

3. Benefits of HRT:

• Improvement in Vasomotor Symptoms
• Increase in BMD
• Reduced risk of vertebral and  Hip Fractures
• Reduction in colorectal cancers

• Premature Menopause: If Menopause occurs at or below the age of 40, it is said to be Premature. Often, there is familia Diathesis
• Delayed Menopause: If menopause fails to occur even beyond 55 years, it is called Delayed Menopause. The Common Causes are constitutional, uterine, Fibroids, Diabetes Mellitus and estrogenic tumour of ovary. It should not be neglected.
• Artificial Menopause: Permanent cessation of ovarian function done by artificial means eg. Surgical removal of ovariesor radiation is called artificial menopause.
• Surgical Menopause: Menstruating women who have bilateral oophorectomy , experience menopausal symptoms. It is some times more troublesome than menopause
• Radiation Menopause: The function of Ovaries may be suppressed by external gamma radiation in women below the age of 40. This is not permanent and the menstruation may resume after 2 years and even conception is possible. The menopausal symptoms are not intense.

1. Bioforce Blooume 23 Menosan drops: Used for relief from symptoms like hot flushes, palpitation and irritability associated with menopause.
2. Willmar Schwabe Klimaktolan Tablets:  Hot Flushes - Attacks of Perspiration - Sleep Disorders - Loss of Libido - Depression, Irritability
3. NL 19 Menopause Drops: Hormonal Changes, hot flushes, sudden perspiration, Irregular bleeding, prolonged & profuse bleeding, Changes in mood, heaviness in body, pathological changes in uterus & ovaries.
4. Allen A72 Menopause Drop: Heavy periods during menopause, hot flushes, depression, insomnia, mood swings, irritability, night sweats, headaches, painful sexual intercourse, vaginitis, nausea and urinary incontinence.
5. HSL HC-24 Rosemarinus Complex: Stopped or scanty menses, Symptoms appear before change of life. Pre menopausal syndrome, delayed menopause, Bleeding irregular, Either too early or with a gap of 2 to 3 months, Depression, Swelling of Whole Body.
6. REPL Dr Advice No. 33 Climactrine Drops: Atrophy of urogenital epithelium, Vaginal opening dryness, Breast size decrease, osteoporosis, Hot flushes, Anxiety, Irritability, temperature flexibility
7. SBL Homeocal Tablets: Minimizes the effects of hormonal imbalance during pre & post menopausal period. Restores proper metabolism & absorption of essential nutrients needed for optimum bone health & relieves symptoms of osteoporosis.
8. Allen Vitamin D3: Supports Calcium & Bone Metabolism
9. Allen Multi Vitamins: Supports Immune Health & energy metabolism. Provides nutritional support
10. Calcarea Phosphorica: Calcium supplement for all ages. Strengthen bone and reduce risk of fracture besides maintaining tissue elasticity. Osteoporosis, pre and post menopausal period and associated pain in joints, back, movement of neck.
11. Bakson's Calci Aid Tablets: Reduce physical fatigue & improve mental health, Aid uneventful dentition, Strengthen bone and reduce risk of fracture besides maintaining tissue, elasticity. 
12. Dr. Reckeweg R34 (Calcossin): Perturbations in calcareous tissues and the growths of bones, pathological characteristics in the osseous system; exostosis, periostitis, fragility of the bones, osteomalacia, rickets, coxitis and arthritis, as well as nucleus pulposus.
13. Bakson's Fem Aid Syrup: Tones up female Reproductive System and relieves Gynaecological disorders. Regulates menstrual rhythm and normal functioning of uterus. It is highly efficacious in leucorrhoea, amenorrhoea, dysmenorrhoea, menorrhagia and metrorrhagia, which may be seen in conditions like Fibroids, Ovarian cysts, climacteric phase