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Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) after menopause
With great advances in medicine, the life expectancy of a person is increasing progressively and a women can easily expect to spend one–third of her life span after the age of menopause. In this period, women in the present era continue to be physically, intellectually and sexually active and due consideration needs to be given to their health and well being during this phase of life.

Menopause
Menopause is that point of time, when permanent cessation of menstruation occurs following the loss of ovarian activity (ovaries are the glands which produce the female sex hormones like estrogen). Climacteric is a more encompassing word, indicating the period of time when a woman passes through a transition from the reproductive stage of life to the post–menopausal years. The average age of menopause is from 48–55 years. Thinner women and smokers may have an earlier menopause. Removal of uterus per se does not constitute menopause if the ovaries are left intact. However, it has been observed that these ovaries tend to decline faster that usual in such cases.

Symptoms of Menopause

Disturbances of menstruation including decreased/heavy menstrual flow, irregular menses followed by total cessation of menses.
Hot flushes and sweats: These are present as episodes of a feeling of intense heat followed by sweating and weakness. The episode may last from several seconds to minutes and tends to recur. Flushes are more common at night or during times of stress. Flushes may disappear in about 1–2 years after menopause, but may persist for 5 years or more.
Psychological symptoms like anxiety, increased tension, mood changes, depression and irritability do occur in increased frequency at the time of stress. Flushes may disappear in about 1–2 years after menopause, but may persist for 5 years or more.
Atrophic changes: Estrogen deficiency causes poor lubrication of vagina and results in itching, dryness of vagina and painful intercourse. Poor tone of pelvic muscles may cause recurrent urinary infections and occasional stress urinary incontinence (leakage of urine on coughing, laughing, lifting heavy objects etc.). Estrogen treatment also has a favorable impact on the skin, however, whether it can prevent wrinkling is not clear.
Reduced sexual interest.
General skin changes: Part of the changes of ageing evident in the skin and due to menopause.
The most important implications of menopause are the long term problems which are caused by deficiency of estrogen:
- Increased risk of heart diseases: As compared to men, women are usually protected from developing cardiac problems due to the effect of female sex hormones. This protection is lost after menopause. In women undergoing early menopause, this risk may suddenly double.
- Osteoporosis: After menopause, bones, tend to become weaker and more prone to fractures. There is a 50% reduction in the bone mass in the first 20 years after menopause, this loss is much faster if you have undergone a surgical menopause (both ovaries have been removed at an early age).

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