Postmenousal Symptoms & Occult signs: How best to sail  in the stormy  sea when fuel of the ship is at bootom ?? How safely we can manipulate the transition phase??

Ans:-At about  42-48 years of age most women  experience perimenopausal symptoms due to the ovarian impending failure . Symptoms include 1) irregular   menses due to anovulatory cycles 2) vasomotor symptoms, such as hot flushes, and 3) symptoms related to decreased estrogen   and androgen levels.  There rise of  FSH & LH  due to decrease of    ovarian  inhibin  levels . Such rise of FSH often evidenced even before estradiol levels fall. I am not sure if I mention the stepwise changes of endocrine profile 1) decrease of ovarian inhibin 2) mild rise of FSH 2 followed by 3) fall of E2 4) final rise of FSH & LH at postmeno level. The other ill effects of oestrogen deprivation:- The decreased estradiol concentrations lead to vaginal   atrophy,   bone loss , and vasomotor   symptoms.

Why we the clinicians are afraid of long term Oestrogen replacement therapy? What dies WHI warns us??

Ans:-While   most clinicians   agree the  short term estrogen replacement   therapy is currently the best treatment for the vasomotor symptoms   and to prevent   osteoporosis scientific data   raises concerns about the risks of this therapy particularly if long period . The Women’s Health   Initiative Study   of continuous estrogen - progestin treatment   reported a small but significant Risk A:--increased risk of breast cancer, Risk 1 of “continuous Estrogen  & progesterone  therapy” -- heart disease,: Risk 2  of “continuous Estrogen  & progesterone  therapy”—may cause pulmonary  embolism  and Risk 3 of “continuous Estrogen  & progesterone  therapy” A:-- stroke. But  Advantage 1:- Women   on hormone replacement   therapy had fewer fractures and Advantage 2 :- a lower incidence   of colon cancer.

  How safe is short term E therapy ??   Ans:-It should be  noted that there is no evidence of adverse effects from short term  estrogen   therapy for the   acute relief  of menopausal symptoms. Currently, hormone   replacement therapy   is indicated   for vasomotor symptoms  and should be used for as short  a duration as possible in the  smallest  dose. For women who    cannot or choose   not to take   estrogen , the antihypertensive   agent Clonidine may help   with the vasomotor   symptoms. A selective estrogen    receptor modulator   such as raloxifene    is helpful  in preventing   bone loss  , but does not alter  the hot flushes. Weight hearing exercise, calcium and vitamin D supplementation   and estrogen   replacement   are important   cornerstones in maintaing  bone mass. Because   the FSH  responds  to the inhibin  and not to estrogen, the FSH   level cannot be  used to titrate the estrogen replacement   dose. In   other words, the FSH   concentration  is still elevated  even though  the estrogen replacement    may be sufficient.

Other   diseases that are  important  to consider  in the perimenopausal  woman include  hypothyroidism diabetes mellitus , hypertension, and  breast  cancer. Women   in this stage  of life may also experience   depression whether    spontaneous  in its onset  or situational due to greif  or middle adjustments, the practitioner   should advocate   aerobic  exercise at least  three time a week, again, with   weight bearing   exercise being advantageous for the prevention of osteoporosis . Bone   mineral density testing such as by dual energy X-ray  absorptiometry   is useful in the  early identification  of osteoporosis   and osteopenia BMD testing is indicated   for all postmenopausal  women aged 65   years  or older   and postmenopausal women at risk  for osteoporosis   and presenting   with a bone  fracture. Alcohol abuse may be seen in up to 10 %   of postmenopausl  women and requires   clinical    suspicion to establish   the diagnosis. 

 What is “Necrotizing   fasciitis”?  What is