Menstruation is determined by ovarian functon. However, ovarian hormones (especially estrogen) do not just regulate menstruation but are also involved in complex physiological functions including :
- Release of eggs from the ovary for achieving a pregnancy
- Maintainence of bone density
- Cardiac functioning in a young healthy woman
- Mental health
Menopause is essentially cessation of ovarian function. This usually occurs between the age of 47-55 years but can occur earlier (premature menopause) due to genetic factors or surgical removal of the ovaries.
Menopause can lead to the following problems :
- Immediate symptoms such as hot flushes (a feeling of intense heat with sweating), mood swings & depression
- Loss of bone density with increased risk of fractures of the spine, hip or wrist
- Increased risk of coronary artery disease so that the risk becomes equal to that of a male
- Increased risk of dementia and related disorders
To counter these problems various therapies or a combination of them are used to ensure or prolong the mental & physical wellbeing of the woman. However it must be clearly understood that hormonal replacement therapy is medical treatment and not a beauty product or elixir of life.
Hormone replacement therapy is used for the following :
- Short term for relief of perimenopausal symptoms such as mood swings & hot flushes
- To protect & improve bone density to reduce the risk of fracture
- Long term therapy may reduce the risk of dementia & related disorders and may reduce the risk of certain cancers such as colon cancer
- It is not certain whether hormone replacement therapy can be used to reduce the risk of cardiovascular disease (since in elderly women it may reduce the risk of stroke & deep vein thrombosis) and dementia
The problems of hormone therapy arise from the following factors :
- Wrong choice of product for the wrong woman
- Prolonged use of medication
- Wrong age of treatment
- Use of therapy in a woman with risk factors for thromboembolism (clots in legs or stoke) may increae risk of thromboembolism
- In low risk women, estrogen therapy for a short period of time does not increase the risk of breast cancer
Estrogen with or without progesterone : This can be used in the perimenopause (immediate period around menopause) for 5-10 years. Progesterone is added to prevent overgrowth of the lining of the uterus (endometrium) leading to hyperplasia or cancer of endometrium. This is used in women with an intact uterus or women with endometriosis. Selective Estrogen Receptor Modulators (SERMS) and Tibolone : These drugs provide the beneficial effects of estrogen (reduce hot flushes, mood swings & protect or improve bone density) without the harmful effects (especially stimulation of endometrium). The choice of therapy is decided based on the risk factors, age and symptoms of the patients. Bioidentical Hormones : These are plant based chemicals which mimic the benefical effects of estrogen. These are called as phytoestrogens. Soybean extracts are a classic example. There are are numerous others. However, it must be understood that these products have not undergone any rigorous laboratory or field trials or testing. Hence their exact potency and long term effects, side effects & complications are not known. Targeted therapies : These include drugs such as biphosphonates or calcitonin for treatment of osteoporosis (severely weakened bones) and mood modifying drugs such as antidepressants and drugs to modify cardiovascular risk. These therapies are decided after multispeciality consultation. Calicum 1000-1500mg/d along with Vitamin D 400IU/d is also needed to maintain bone health. In addition to these therapies, lifestyle modification & maintainence is extremely important. This includes appropriate diet and exercise.