Treating menopuse

What are the options we have in our hand to counteract endocrine  deficiencies partly induced such changes in reproductive organs , Brain,  Mood changes , Somatic changes( asthenia, sarcopenia  )?? Can we have any one safe drug which will take care of  all the activities of diminished endogenous oestrogens and (??) decreased androgens . No single agent till date is available though Tibolone as a monotherapy will replenish most of the deficiencies in different organs  induced by endogenous hypoestrogenism .   :

Clonidine is treated like migrant labour!!!!  The forgotten antihypertensives!!!! Evolution of antihypertensives since early sixties. The supportive drugs in menopause which are nonhormonal but reasonably effective are 3) Raloxifene for osteoprirtection 4) Clonidine- an antihypertensive  (brand  names are  Arkamin –Unichem 100 mcg  per tab or  Brand name  Catapres –Zydus 150 mcg tab for hot flushes. Extremely effective. Start slowly increase the dose and taper off slowly. . Arkamin(Clonidine)  reduces alpha 2 receptors in brain stem. One can add hydrochlorothiazide in the same Tab (brand name is Arkamin-H , Catapres –DUO)  -to add such drug if  she is hypertensive as well . Additionally in  to counteract Meno sym and skeletal changes , sarcopenia in particular  5) Stretching exercises, Yoga, Fiber diet , engaging in NGO/Social activities will go a long way if husband can’t afford much time with meno woman.   

Mourn for three antihypertensives e .g.  Aldomet, Clonidine, and Esidrex) are dead.   :    Evolution of antihypertnses: Once Clonidine which was a very popular antihypertensive agent  when we were Medical students in early sixties .  On  those days(Fifty five yrs back)  1) Clonidine 2)  alpha Dopa (Aldomet) ,3)  Prazosin (Minipress XL –Pfizer) all were sympatholytic agents were the chief agents to control HTN and Chlorothiazide (brand Esidrex )  were also liberally used eiethr singly or with chlorothiazide ( Esidrex)  . Of such four agents only Prazosin is still alive (not in HDU even) , other are dead. Such ,   three agents are Alpha Dopa-Aldomet, Clonidine, and Esidrex  are dead. However with progress of vascular physiology and cardiology .

.such four drugs were replaced by  5) Beta Blockers. 6)  Ca Channel Blockers, 7) ARB,  8) ACE inhibitors 9)newer agents for hypertensive crisis to be used with the help of syringe pump. Nitrites and Coronary dilators are separate class as is lipid lowering agents which is now used in our discipline of PCO

. Why we the clinicians are afraid of long term Oestrogen replacement therapy? What did WHI warned 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 for  long period

. 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  short  a duration as short as  possible in the  smallest  dose. For women who    cannot or choose   not to take   estrogen , the antihypertensive   agent Clonidine may help   to ameliorate the vasomotor   symptoms

The Women’s Health   Initiative Study   of continuous estrogen - progestin treatment   reported a small but significant Risk A) increased risk of breast cancer, and risk of “continuous Estrogen  & progesterone  therapy”  is  heart disease,: Risk  B  of “continuous Estrogen  & progesterone  therapy”—may cause pulmonary  embolism  and Risk 3 of “continuous Estrogen  & progesterone  therapy” :-- stroke. But, the advantage  enjoyed by  the concerned women   on hormone replacement   therapy that they had fewer fractures and Advantage 2 :- a lower incidence   of colon cancer.

  . A selective estrogen    receptor modulator   such as raloxifene    is helpful  in preventing   bone loss  , but does not alter  the hot flushes. Weight bearing exercise, calcium and vitamin D supplementation   and estrogen   replacement   are important   cornerstones in maintaing bone mass. Because   the FSH release from pit 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.

What about Depression in menopause? Ans: Women   in this stage of life may also experience   depression whether    spontaneous in its onset or situational due to grief or middle adjustments(Midlife crisis).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 increase in this age due to family crisis and depression which have to enquired upon and managed  by proper counseling.