TREATMENT FOR MENOPAUSE

Treatment for menopause like HRT therapy, or alternatives to HRT therapy, are necessary only if symptoms like hot flashes, night sweats, hair loss, osteoporosis etc. are severe enough to cause the woman distress.

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

But, it is necessary to investigate the different complaints that the menopausal woman presents herself with, and only if actual diseases can be 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 oestrogen deficiency, the ideal solution is to replace that hormone. Unfortunately, oestrogen replaced from outside the body seem to have a different effect than the natural oestrogen produced inside the body.

The benefits of hormone replacement therapy ( hrt therapy) like control of hot flashes, 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.

• Long Term hormone replacement therapy (HRT therapy): If long term HRT therapy is required, then oestrogen should always be combined with progesterone. 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, Oestrogen 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 are 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 USG of the endometrium.

Certain medicines have been proved to be very effective against hot flashes ocurring in menopause. These medicines are not estrogen, but about 70% of women with hot flashes who cannot take HRT therapy have found them very helpful.

• Selective Serotonin Re-uptake Inhibitors (SSRI)– This class of drugs is usually used in the treatment of depression and anxiety. Some of them like Effexor, Paxil and Prozac, when given in low doses, have been found to be quite effective in controlling hot flashes and are a good alternative to HRT therapy.

• Clonidine– This medicine is usually used to decrease high blood pressure. It has been seen that while it is quite effective as an alternative to HRT therapy in decreasing hot flashes in some women, it is quite ineffective in others.

• Other Medicines – Other medicines that can be used as an alternative to HRT therapy in the treatment of hot flashes in menopause are Magesterol Acetate and Gabapentine. Magesterol Acetate can decrease hot flashes but can be used only over a short period of time. Gabapentine can cause drowsiness.

General Advice to Decrease Hot Flashes

Certain changes in the lifestyle in conjunction with HRT therapy, or even alone, can quite effectively relieve hot flashes. In many women, hot flashes can be relieved by these steps alone. But, if these are ineffective, short term HRT therapy can be given.

• Stimulants like alcohol or caffeine, spicy food and ciggarettes should be avoided as far as possible. If night sweats are more common, they should be avoided within 3 hours of going to bed.
• Exercise should be avoided after 6 pm to avoid night sweats.
• Night sweats can be prevented, or at least the intensity decreased, by keeping the temperature of the bedroom lower by 2 - 3 degrees and wearing light clothes to bed.
• Loose, cotton clothes are best during the day.
• Take showers with cool water, especially at night to prevent night sweats.
• Use chill pillows or chillows at night to keep cool and avoid night sweats.
• Try meditation and deep breathing to calm down and avoid stress.

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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