Menopause

Clinic

• Also known as the climacteric, is the time in women's lives when menstrual periods stop permanently
• Hot Flashing
• The age of menopause varies but it usually occurs between 45 and 55. Medical professionals often define menopause as having occurred when a woman has not had any menstrual bleeding for a year. It may also be defined by a decrease in hormone production by the ovaries. In those who have had surgery to remove their uterus but still have functioning ovaries, menopause is not considered to have yet occurred. Following the removal of the uterus, symptoms of menopause typically occur earlier.

In the years before menopause, a woman's periods typically become irregular, which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, sweating, and reddening of the skin. Hot flashes can recur from four to five years. Other symptoms may include vaginal dryness, trouble sleeping, and mood changes. The severity of symptoms varies between women. Menopause before the age of 45 years is considered to be "early menopause" and when ovarian failure/surgical removal of the ovaries occurs before the age of 40 years this is termed "premature ovarian insufficiency".

In addition to symptoms (hot flushes/flashes, night sweats, mood changes, arthralgia and vaginal dryness), the physical consequences of menopause include bone loss, increased central abdominal fat, and adverse changes in a woman's cholesterol profile and vascular function. These changes predispose postmenopausal women to increased risks of osteoporosis and bone fracture, and of cardio-metabolic disease (diabetes and cardiovascular disease).

Menopause is usually a natural change. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries or some types of chemotherapy. At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone. While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine. Menopause is the opposite of menarche, the time when a girl's periods start.

The primary indications for treatment of menopause are symptoms and prevention of bone loss. Mild symptoms may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended; sleeping naked in a cool room and using a fan may help. The most effective treatment for menopausal symptoms is menopausal hormone therapy (MHT). Non hormonal therapies for hot flashes include clonidine, gabapentin, or selective serotonin reuptake inhibitors. These will not improve symptoms such as joint pain or vaginal dryness which affect over 55% of women. Exercise may help with sleeping problems. Many of the concerns about the use of MHT raised by older studies are no longer considered barriers to MHT in healthy women. High-quality evidence for the effectiveness of alternative medicine has not been found. There is tentative evidence for the use of phytoestrogens for symptomatic treatment.

Signs and symptoms

• Vaginal Atrophy / Dryness
• Irregular bleeding (lighter, heavier, spotting)

• Painful intercourse
• Urinary Urgency / Burning /Incontinence

• Bone mineral density decreases
• Lack of energy, joint soreness, stiffness, back pain,
• Breast enlargement, breast pain,
• Heart palpitations, headache, dizziness,
• Dry, itchy skin, thinning, tingling skin, rosacea
• Weight gain
• Interrupted sleeping patterns, heavy night sweats
• Hot flashes

• Mood and memory effects: Anxiety, poor memory, inability to concentrate, depressive mood, irritability, mood swings, and less interest in sexual activity.
• Cognitive impairment can be confused with the mild cognitive impairment that precedes dementia. Tentative evidence has found that forgetfulness affects about half of menopausal women and is probably caused by the effects of declining estrogen levels on the brain, or perhaps by reduced blood flow to the brain during hot flashes.

Long-term effects

• Cardiovascular health: Exposure to endogenous estrogen during reproductive years provides women with protection against cardiovascular disease, which is lost around 10 years after the onset of menopause. The menopausal transition is associated with an increase in fat mass (predominantly in visceral fat), an increase in insulin resistance, dyslipidaemia, and endothelial dysfunction. Women with vasomotor symptoms during menopause seem to have an especially unfavorable cardiometabolic profile, as well as women with premature onset of menopause (before 45 years of age). These risks can be reduced by managing risk factors, such as tobacco smoking, hypertension, increased blood lipids and body weight.

• Bone health: The annual rates of bone mineral density loss are highest starting one year before the final menstrual period and continuing through the two years after it. Thus, post menopausal women are at increased risk of osteopenia, osteoporosis and fractures.

Causes

• Premature ovarian insufficiency
• Induced menopause such as chemotherapy, radiotherapy, oophorectomy, or complications of tubal ligation, hysterectomy, unilateral or bilateral salpingo-oophorectomy or leuprorelin usage.

Age

Menopause typically occurs at some point between 47 and 54 years of age. According to various data, more than 85% of women have their last period between the ages of 47–54 (median 49–50). 2% of women under the age of 40, 5% between the ages of 40–45 and the same number between the ages of 55–58 have their last bleeding. The average age of the last period in the United States is 51 years, in Russia is 50 years, in Greece is 49 years, in Turkey is 47 years, in Egypt is 47 years and in India is 46 years. The menopausal transition or perimenopause leading up to menopause usually lasts 3–4 years (sometimes as long as 5–14 years).

In rare cases, a woman's ovaries stop working at a very early age, ranging anywhere from the age of puberty to age 40. This is known as premature ovarian failure and affects 1 to 2% of women by age 40.

Undiagnosed and untreated coeliac disease is a risk factor for early menopause. Coeliac disease can present with several non-gastrointestinal symptoms, in the absence of gastrointestinal symptoms, and most cases escape timely recognition and go undiagnosed, leading to a risk of long-term complications. A strict gluten-free diet reduces the risk. Women with early diagnosis and treatment of coeliac disease present a normal duration of fertile life span.

Women who have undergone hysterectomy with ovary conservation go through menopause on average 1.5 years earlier than the expected age. Another factor that can promote an earlier onset of menopause (usually 1 to 3 years early) is smoking cigarettes.

Surgical menopause[edit]

Menopause can be surgically induced by bilateral oophorectomy (removal of ovaries), which is often, but not always, done in conjunction with removal of the Fallopian tubes (salpingo-oophorectomy) and uterus (hysterectomy). Cessation of menses as a result of removal of the ovaries is called "surgical menopause". Surgical treatments, such as the removal of ovaries, might cause periods to stop altogether. The sudden and complete drop in hormone levels may produce extreme withdrawal symptoms such as hot flashes, etc. The symptoms of early menopause may be more severe.

Removal of the uterus without removal of the ovaries does not directly cause menopause, although pelvic surgery of this type can often precipitate a somewhat earlier menopause, perhaps because of a compromised blood supply to the ovaries.^{[medical citation needed]} The time between surgery and possible early menopause is due to the fact that ovaries are still producing hormones.

Related disease

• Pre Mesopause Hemorrhage

Repertory

Hysteria:Cimic, Ign ,Lach, Ph-ac , Ther , Valer

Remedies

Banerji protocols
First line	Am-c C200 one dose every 10 days when AUB occurs every month. Acon C200 one dose every hour for palpitation Arn C3 every 3 hour, for excessive bleeding Sul C200 one dose every hour for Hot-flushing
Second line	Lach C200 every alternate day Acon, Arn and Sul like first line
Third line	Am-c C200 one dose every 10 days when AUB occurs every month. Caul C200 two doses daily for the whole month and in bleeding to be repeated every 3 hour

Remedies

Top remedy	Sep	Heat flashes during menopause (Intense hot flashes with fainting spells.) The whole body gets drenched with sweat. Vaginal dryness, decreased libido (sexual desire), painful intercourse. Dragging or bearing down sensation in the uterus, feeling as if she has to cross her legs to hold it in. Weight gain (obesity) Hair loss and headache Heavy vaginal bleeding during menopause. Indifferent behavior towards family. Sadness, with no desire to meet friends and no interest in daily activities, makes her feel worse. She feels easily tired. The most preferred is 30 C potency Daily or BD
Heat Flashes And Depression	Lach	Extreme heat flashes during menopause. She cannot bear tight clothing mainly around neck or waist. Depression. Aversion to social interaction. Aversion to do any Work/ Daily routine work. Mostly recommended in 30C potency, once or twice a week
Headache	Amyl-ns	Heat flashes are accompanied by anxiety and palpitations of heart. After heat flashes, excessive sweating follows. There is a desire for fresh open air. The bed coverings are always unbearable from excessive heat. It can also relieve headache during menopause with marked congestion in head, as if head would burst due to pain and congestion. C30 potency once a day.
Obesity	Graph	Marked sensitivity to cold air. Sad and cannot take decisions easily.  Weep easily even on listening to music.
AUB	Sabin	Heavy, gushing, bright red vaginal bleeding. The bleeding is watery mixed with clots. During bleeding, there is pain in the uterus. Pain from sacrum to pubis 30C potency, BD or TDS
Depression	Ign	Excessive weeping, sadness, feeling of loneliness, sleeplessness and reduced social interaction She may sit alone and continue weeping for long. She cuts herself off from society and does not wish to talk to anybody. She wants to be left alone all the time. Mood changes during menopause. (Mood shifts rapidly from happiness to sadness without any apparent cause.)
Osteoporesis	Calc	Osteoporosis + Bone pain

• Cimic
• Sang
• Sul
• Calc-ars: Flesh and obese around menopause