MENOPAUSAL SYNDROME (Edited topic)
Ques. 1 What is menopause?
Ans. Menopause is the physiological even of final cessation of menstruation.
(Climacteric is the transitional period which a woman gradually changes from the reproductive life into one of senescence).
Strictly speaking, the menopause should be defined as the time at which menstruation ceases and not used synonymously with the climacteric, which is the phase of waning ovarian activity and may start two/three years before the menopause and continue for two to five years after it. The climacteric is thus a phase of adjustment between active and inactive ovarian function and may occupy several years of a women’s life.
Ques. 2 What are the causes of menopause?
Ans. Aetiology - 1. Deprivation of oestrogen.2. Ovarian failure.
Ques. 3 What is the period when it can occur?
Ans. Period – The average age of menopause of 47 years with a range from 42 to 52 year. Climacteric lasts lasts for 4 to 5 years and may start 2 to 3 years before menopause and continue 2 to 3 years after it.
Physiological Changes –
- The plain muscle of the fallopian tube undergoes atrophy, cilia disappear from the tubal epithelium and the tubal-plicae are not so prominent.
- The uterus becomes smaller through atrophy of its plain muscles and becomes fibrotic.
- The cervix becomes smaller and its vaginal portion is represented in old women by becomes smaller in the upper part of the vagina.
- The vagina becomes smaller and tends to be conical with the apex of the cone in the situation of the cervix.
- The vulva atrophies and the vaginal orifice become smaller, so that dyspareunia is a common symptom and narrowing of introitus.
- The pelvic cellular tissues become lax and the ligament and tissues, which support the uterus and vagina, lose their tone, so that there is a tendency for prolapse to become more marked.
- Breasts becomes atrophy and pendulous.
- Fall of pubic and axillary hair.
- Body weight decreases and height diminishes after 65 years.
- Oestrogen level falls in the blood.
- S.H. and L.H. are secreted in increasing amount.
- 14 Hypo-chlorhydria develops.
- Dyspepsia and constipation.
- Emotional upsets.
- Gonadal failure.
- The genitalia undergo atrophy & retro-gression.
- The ovaries become shrunken and their surfaces grooved and furrowed.
Ques. 4 What are the clinical features of menopause?
Ans. Clinical Features –
- Psychological – Some women are emotionally disturbed and they feel anxious, fearful or irritable. Also some may suffer from insomnia, headache melancholia or mania etc.
- Some women may suffer from obesity, raised cholesterol, brittleness of hair, dryness of skin, lassitude, osteoarthritis, fibrositis, backche etc.
- Genital tract : (a) Vagina – becomes narrow with ‘tenting’ of vaginal vault, thinning of mucous membrane and loss of gouge. (b) Cervix – portio-vaginalis atrophies and gets flushed with vaginal vault. (c) Uterus – body is felt small and hard. (d) Vulva – progressive atrophy with scanty hair with narrowing of the vaginal introitus.
- Menstrual – The three classical ways in which the periods cease are- (a) gradual diminution in the amount of loss with each regular period until they disappear, (b) gradual increase in the spacing of the periods until they cease for an interval of 6 months. (c) sudden cessation
- Hot flushes and sweats – It may be of mild degree, in some cases there are severe flushes followed by profuse sweats.
Ques. 5 What is the diagnosis of menopause?
Ans. Diagnosis – Confirmed by atrophic vaginal smear and elevated urinary gonado-trophin assay.
Differential Diagnosis – Amenorrhoea and depressed gonadal function may result from severe metabolic and psychic disorders such as adenohypophysial or adrenocortical insufficiency, anorexia nervosa and myxaedema.
Ovaries – Becomes atrophies with gradual decrease in oestrogen production.
PROGNOSIS – The prognosis for an uncomplicated, only mildly disturbing menopause and climacteric is excellent for the well-adjusted, informed women. Neurotic patients, for whom medication is contra indicated, may have to endure considerable distress before they ‘settle down’ to a relatively more agreeable old age.
Ques. 6 How can we manage a case of menopause?
Ans. The methods of management of a menopause patient are :-
- Improvement of health by balanced diet, adequate rest and sleep, regular evacuation of bowel.
- For any emotional upset, sedative like tablet Phenobarbitone, tranquilizers etc. may be given but is should be reduced gradually and then withdrawn completely.
- The patient should be re-assured that menopause does not mean the end of sexual life and family happiness, also explain to her the exact physiological state in simple language.
Prevention of Senile Atrophic Changes – Early and adequate steroid sex hormone therapy will usually reduce the extent of mucosal, muscular, fascial, osseous and frequently, vascular degenerative changes. But, there is controversy of opinions regarding safety of this drug therapy.
Ques. 7 Which Homoeopathic remedies are useful?
Ans. Homoeopathic Remedies –
- SULPHUR – Low spirited, out of humor, inclines to weep. Constant heat of heat on top of head. Sour eructation and great acidity of stomach. Frequent flushes of heat. Leucorrhoea of yellow mucous, corroding pruritus vulva. Frequent wake faint spells.
- LACHESIS – Burning on vertex at menopause. Pressure on vertex. Flushes of heat, frequent uterine haemorrhages. Cannot bear least pressure in uterine region.
- Pulsatilla – Anguish in region of heart. Vertigo when rising from sitting posture of looking up. Alternate redness and paleness of face. Epistaxis when menses should appear. Disordered stomach. Better in open air or cold room. Mild, tearful disposition.
- Conium – Climacteric ailments, nervous attacks, great weakness every morning. Hysteric fits, chilliness. Burning in eyes and impaired vision. Prolapsus uteri, with induration, ulceration and leucorrhoea.
- Sepia – Sadness and weeping Whizzing and roaring in ear. Yellowness of face particularly across nose, like a saddle. Fetid urine, with clay-colored sediment adhering to chamber. Prolapses uteri and vagina, with burning in back. Jerking of limbs at night.
Ques. 8 What is Menopausal Syndrome?
Ans. Menopausal syndrome refers to a group of symptoms that are being experienced by some women during climacteric.
Clinical Features – Symptoms
- Nervous – headache, irritability, sleeplessness, giddiness, fatigue, depression, palpitation, sometimes sensations of ‘pins and needles’ in the soles and palm.
- Alimentary – Constipation, flatulent, dyspepsia.
- Joint; pains.
- Menses stops in 3 ways – (a) Means occurring at progressively increasing intervals, finally ceasing. (b) Sudden cessation of menses. (c) Progressive scanty menstrual loss for a few cycles followed by cessation of menses.
- Vasomotor disturbances – ‘Hot flushes’ every hourly or once a day due to cutaneous vasodilatation are experienced on the neck spreading all over the body. The sensation of heat is followed by sweating.
Ques. 9 What are the signs of menopausal syndrome?
Ans. Signs –
- Valva – atrophic scanty pubic hair, narrowing of vaginal introitus.
- Vagina – Narrowing the canal, loss of rugosity, atrophy of the vaginal membrane.
- Cervix – Shrinks in size, secretion is scanty of absence.
- Uterus- The body is felt small and hard.
- Ovaries – cannot be palpated.
- Increase in weight.
- Obesity – due to deposition of fat on the buttock, thights and breasts.
Ques. 10 How can we investigate the case of menopausal syndrome?
Ans. Investigation –
- Urinary gonadotrophin levels are elevated – In menstruating women; 10 to 25 I.U. per 24 hours. In menopausal women : 50 to 160 I.U. per 24 hours.
- Vaginal smear – showing preponderance of basal cells and it indicates fall in oestrogen.
- Urinary oestrogen and progesterone level diminish.
Ques. 11 What is the management of menopausel syndrome?
Ans. MANAGEMENT –
- Sedative for emotional upsets.
- Adequate rest.
- A good balanced diet.
- Hormonal therapy.
- Correction/treatment of constipation and dyspepsia (if present).
- Psychotherapy – The patient should be reassured to gain her confidence and the biological event should be explained to her.
Homoeopathic remedies : Same as in Menopause.
Ques. 12 How would you investigate a case of Post-menopausal Vaginal Bleeding ? Give its symptoms & treatment.
Ans. Post – menopausal bleeding is abnormal flow from the generative tract 6 months or more following cessation of menstrual function.
Ques. 13 What are the causes of menopausal syndrome?
Ans. The causes of menopausal syndrome are :-
- Growth in ovary.
- Dysfunctional uterine haemorrhage.
- Infections – Vaginitis, endometritis and pyometra with bleeding.
- Injuries in genital organs.
- Blood diseases or hypertension.
- Haemorrhage from anus or rectum or urinary bladder may be mistaken for vaginal bleeding.
- Withdrawal bleeding following indiscriminate oestrogen therapy.
- Malignant growth or benign growth (cervix, corpus, vagina, vulva, fallopian tubes).
Ques. 14 What are the clinical findings of menopausal syndrome?
Ans. CLINICAL FINDINGS – Post – menopausal vaginal bleeding may be painless of painful. Discomfort depends upon the patency of the cervix, the amount and rapidity of blood loss, the presence of infection; or torsion of tumor.
Ques. 15 What are the investigations of menopausal syndrome?
Ans. INVESTIGATIONS – Full history is to be taken on the lines of aetiological factors –
- Through systemic examination.
- Urinary analysis.
- Cervical biopsy, D & C.
- Pelvic examinations (including P/V and P/R) to determine the site of bleeding.
- Vaginal, cervical endometrial cytology.
- Cystoscopy and sigmoidoscopy.
- Whether any history of taking oestrogen.
- Which tract is bleeding.
Ques. 16 What is the management of menopausal syndrome?
Ans. MANAGEMENT –
- In case of recurrence of bleeding, total hysterectomy with bilateral salpingo-oophorectomy.
- Treatment of cause and the women is kept under carefully follow-up.
PROGNOSIS – Periodic vaginal smears and gynaecologic examinations should be arranged and indiscriminate or excessive estrogen treatment avoided.
Homoeopathic remedies – Same as mentioned in Menopause.