INDEX

S.NO. ARTICLE AUTHOR
1 A Comparison of the remedy picture with the phychological profice of the cancer personality Dr. Harsh Nigam M.B.B.S., M.D., M.F. (Hom.), Kanpur
2 Chronic Renal Failure Dr. Harsh Nigam M.B.B.S., M.D., M.F. (Hom.), Kanpur
3 CLINICAL VERIFICATION OF HOMOEOPATHIC DRUGS IN PSORIASIS Dr. Rajeev Shukla B.Sc., B.H.M.S. (Hons London),Kanpur
4 BEHAVIOURAL PROBLEMS AND ABNORMAL PSYCHOLOGICAL ASPECTS OF CHILDREN Dr. Manish Jain B.Sc., B.H.M.S., H.M.D. (LON), Kanpur
5 PROBLEMS OF MENTALLY SUBNORMAL ADOLESCENTS Dr.Kanta Chhabra D.I. (HOM)London, Kanpur
6 MENOPAUSAL SYNDROME Dr. Poonam Sharma B.H.M.S , Kanpur
7 HOMOEOPATHIC TREATMENT OF AIDS Dr. Durgesh Gupta, Lucknow
8 SPORTS INJURIES & HOMOEOPATHIC TREATMENT Dr. Anil Kumar Jain (Lucknow)
9 When your hand refuses to write Dr. Jintendra Shukla, Lucknow
10 PROSTATE AND HOMOEOPATHY Dr. Sandeep Kumar Mishra, Kanpur
11 SCOPE OF HOMOEOPATHY IN HEAD INJURY Dr. Santosh Tiwari, Kanpur
12 IF YOU HAVE HIGH BLOOD PRESSURE Dr. Parth Sarthi Sharma , Agra
13 ROLE OF HOMOEOPATHY IN SURGICAL CASES DR. PAWAN PAAREEK ,AGRA
14 Dioscorea Villosa in the Treatment of Brown sugar Addiction Dr. Prabhat Kulshreshtha, Agra
15 Psoriasis & Vitiligo DR ABHISHEK BHARTI, Sitapur
16 THE BLOOD AND BLOOD CANCER Dr. Rajendra Kumar ,Ghaziyabad
17 CHOLESTEROL AND THE HEART Dr. Rajendra Kumar,Ghaziyabad
18 Gall Bladder Stone & Kidney Stone Dr. Rajendra Kumar,Ghaziyabad
19 CANCER Dr. Rajendra Kumar,Ghaziyabad
20 OBESITY Dr. Rajendra Kumar ,Ghaziyabad
21 RECOMENDATIONS OF DIET FOR VARIOUS DISORDERS
22 मानव स्वास्थ निरोगी शरीर Dr. Ashok Kumar , Kanpur
23 अपराध और होमियोपैथी Dr. K.L Adarsh, Kanpur
24 होमियोपैथी के द्वारा कैंसर का इलाज़ संभव Dr. Sayad Manzar Azami,Kanpur
25 गाय और बैश भैंस के बंधत्वा और होमियोपैथी उपचार Dr. S.K. Parihaar,Lucknow

6.   MENOPAUSAL SYNDROME


- Dr. Poonam Sharma B.H.M.S.

Although there are so many Gynaecalogical problems in Indian women by which they are suffering today but according to me menopausal changes is major problem by which almost women suffers but due to unawareness of this problems they are unable to take proper management and treatment so they suffer from so many physical as well as psychological problems. They have so many stresses during climacteric changes e.g. fear of less of feminity end of youth, depression etc. I have seen so many women in my college, hospital, clinic & surrondings who are suffering from this problem due to being a lady Homoeopath. I have select this topic and have stared to do work on this directors by collecting more & more information from different books and by clinical observation from hospital and from surroundings and try to prepare a text book at menopenusal syndrome which have sufficient knowledge about menopausal syndrome. I hope that this work will help the readers to treat such patients & shall be very much pleased and it shall be the best rewards for my efforts if it is found useful. By students of Homoeopathic medical colleges, my collegeous & Homoeopathic physician. Thanks

Menopausal syndrome refers to group of synptoms that are experienced by some women during climacteric. The word Menopause is derived from Greek word 'MEN' (Month) and 'PAUO' (to stop) which means permanent cessation of menstruation due to loss of ovarian follicular activity. An another word 'CLIMACTRIC' also often used at this time which is the physiologically period in woman's life during which there is regression of the ovorian functions. this cover a wide period, ranging 5-10years of either of side of menopause. The word 'CLIMACTRIC' is derived from the Greek word 'KLIMAKTER' which means (RUNGE OF THE LADDER) the critical period of the life and is applied to the 5-15 years before the menopause when the endocrine and other changes beings and to the 5-15 years after menopause in that condition the menopausal syndrome are more acute.

Menopause is conventionally, said to have occured when all menstruation have ceased for 12 months, although menses, proceeding the menopause. Primary event is progressive feature in overian fallicular development and failure in oestrogen & progesterone hormone secretion by overy at that time some graffian follicles which are present in

ovary. shrink in size & ovarian production of oesirogen cease and same time due to negative feed back Mechanism Pituitary glands produces gonadotrophin hormone in excess. After menopause there is gradual atrophy of gential organs uterus dininushed, endomentrium becomes thin & smooth with a full in acidity of the secretion and fornix becomes shallow around a small ceruix, the labia becomes flatter & growth of pubcic hair dininished. Atropic condition occurs in ligament and fascia which supports the uterus due to atrophy prolopse of uterus may be found. Atrophic endometriosis atrophic vaginitis & atrophic changes in vulva may be found.


DEFINATION :


Menpause means permanent cessation of menstruation at the end of reproductive life due to ovarion fallicular inactivity.


AETIOLOGY :


Menpause is primarily due to exhaustion of the stock of oocytes or primordial follicles in the overy with a consequence fall in oestrogen & progesterone secretion only. Known factors : Affacting age at Menopause other than a small effect of smoking is inherited genetic predisposition.


ENDOCRINOLOGY :


The endocrine changes at the climacteric includes decreased oestrogen secretion, decreased or absent progesterone secretion and a compensatory, hyper-activity of the hypothalamus & pituitary. The endocrine changes during the climacteric are usually considered, under those that occur before at the menopause.

(1) Endocrine changes before the menopause : From the age of 35-45 years onwords the Primordial follicles that remains in overy are relatively resistant to stimulaltion by gonadotrophins and in last 5-15 years of reproductive life the menstrual cycle tends to be come anovulatory and irregulars. The failure to ovulate and difficiency in corpus luteum formation causes an absence or decreased in progesterone secretion. The failure in ovulation may initially be intermittent with only occasional a anvvvlatery Cycles but anovulatory cycles becomes increasingly, more frequent with increasing periods of opposed oestrogen secretion immediately preceeding the menopause. The main endocrine changes before the menopause are increased hypothalamic-pituitary activity which is often combined with periods of decrease or absent progesterone scretion and unopposed oestrogen secretion.

(2) Endocrine changes at the menopauses : Men's ceases when insufficient follicle dovelops and insufficient oestrogen is secreted to produce adequate endometrial proliferation, the menopause may occur abruptly with a sudden. exhaustion of the ovarian oocytes and a sudden, fall in oestrogen secretion but more commonly is progressive with decreasing oestrogen secretion and decreasing loss at each menstrual cycle over several month & years. The menstrual cycle may also become XXXV progressively more irregular with failure in ovulation, absent or decreased progesterone secretion and unopposed oestrogen secretion which may be associated with extensive dysfunctional uterine bleeding.
(3) Endocrine changes after the menOpause :
(1) Oestrogen : In postmenopausal women the average total urinary Oestrogen secretion is about 5-6 ug/24 hrs Which is half that of premenopausal woman in the early follicular phase and only one tenth that in the late folliculart phase of the menstrual cycle-after some time its value decreased. Which indicates that oestrogen deficiency increase with increasing age.
(2) Androgens : After menopause the stromal cells of the overy continue to produce Androgen because of increasing L.H. adrenal glands also secrete and rogen thus cumulative effect is a derease in oestrogen & androgen.
(3) Progesterone : The plasma progesterone & 17- hydroxy progesterone levels are reduced in post inenopause condition & these are at this time mainly of adrenal origen & are reduced after menopause due to derease in adrenal cortical activity.
(4) Gonadotrophins : The value of gonadotrophins homones (FSH & LH) immediately increase just after menopause reaching a maximum 2-3 years post menopausl. when the level of FSH & LH become respectivaly 13 fold time & fold greater than the ovarage value of FSH & LH harmone in early proliferate phase of premenopause woman. After ten years of post imenopause level of gonadotrophins beging to fall after 20-30 years. It reaches into normal reproductive life.
Prolactine : Plasma protactive level decreased after the menopause due to decreas in plasma oestrogen. Endocrine changes during the climacteric phases of development -


PHASE 1- Hypothalamic -:


Pituitary hyporactivity. Start 5-15 years before menopause. increased FSH & LH compensatory for increased fallicle resistance Associated with hot flashes, sleep & mood changes.


PHASE 2- Hypothalamic -:


Ovulation & corpus luteun deficiency & failure. Increased in frequency as menopause opproaches. Deficient or absent progesterone secretion. dysfuction uterine blleeding, endometrical hyperplasia & caricunoma.


PHASE 3


Ovarian follicular failure Inadequate oestradial oestradial secretion & cessation of menses. Ovarian, stroma produces androstenedione, Oestrogen deficiency increase with age. Clinical metabolic & pathological features : The most characerisics synptoms of the cilmacteric results from hyperactivity of the midbrain - hypothalamic - pituitary axis and from changes in the central nervous system including hot flashes, sleep disturbences & mood changes.

The incidence of these symptoms in premenopausal, perimenopaisal & post menopausal woman is shown in following table.


MENOPAUSAL STATUS


Symptom group Pre Peri Post Significient level
Vasomotor symptones 18 47 58 P<0.00
Somatic symptoms 31 38 25 NS
Depressed Mood 17 25 25 P<0.0012
Anxiety/fears 36 37 38 NS
Sleep problem 25 44 49 P<0.0005
Sexual problem 21 28 35 P<0.04
Cognitive difficulties 46 48 51 NS.

(1). VASOMOTOR SYMPTOMS


The most characteristic symptoms of the menopause is 'HOT FLASH'- an intense and often intolerable sensation of heat usually starting in the trunk and spreading upwards to the neck, face forehead and lasts within 1-2 minutes associated profuse sweating. At this time patient may exprience palpitation increased pulse rate more by 20 beats per minute.


(2). SLEEP DISTURBANCES


Sleep disturbances are common & are characterized by early morning wakening & an inability get back to sleep the wakening is associated with increased episodes of dreaming with hot flashes and/or sweating sleep deprivation is associated mood changes including anxiety, irrritability & impaired concentration & memory.


(3). MOOD & PSYCHOLOGICAL CHANGES


Psychological complains & problems may be due to a combination of factors including-
(i) Oestogen deficiency
(ii) The inherent personality
(iii) Advers social circumstances, life events & cultural background.
Middle age life stresses includes.-
(i) Fear of loss of feminity & attractiveness.
(iii) The empty nest syndrome' (children leaving home or loss of a partner due to death or divorce)
(iv) Retirement & loss of position and social contact.
(v) Financial problem.
(vi) Physicial disability of patients husband or parents.
The psychological syndromes includes-
(i) Depression, fluctuation of mood, crying for no reason.
(ii) Irritability short temper and aggressiveness.
(iii) Anxiety nervousness and tension.
(iv) Inability to concentrate, forget fulness and poor memory.
(ii) Fear of getting old


Psycholigical symptom may be less in woman having well support, well adjustment and good position and major in less well supported and less able to adjustment.


4. GENITAL TRACT, LOWOR URINARY TRACT & BREAST :


Genital organs directly affected by oestrogens progestogen deficiency. There may be atrophy in genital organs reduced size of ovary. uterus and breast urinary tract becomes narrover stenosis in vagina endonetrium uterus becomes thin & atrophic glandular tissue of the breast tends to decrease and fat & conecctive tissue to increase due to decrease in ovarian function.
5. SKIN, HAIR & BODY FAT : Skin contains both androgen and oestrogen receptores oestrogen increase skin callagen hyeluronic acid intercellular water and vascularization and fibroblastic proliferation. Skin becomes thick with increasing fat of female.
6. SKELETON : Osteoporosis is more common in post menopausal. Woman due to increased osteoclasting activity leading to greater resorption of bone. So there is decline in callagenous organic matrix especially of vertebral column, femoral neck, & distal part of radius bone. So they have great liability to fracture.
7. CARDIOVASCULAR EFFECTS : There is increased chance of cardiovascular diseases 1-7 times more than normal woman.
DIAGNOSIS :
(1) Cessation of menses for consecutive 6 months during climacteric
(2) Appearances of menopausal symptoms 'HOT flushes & 'NIGHT sweats'
(3) Vaginal cytology- showing maturation index of at least 10/85/5
(4) Serum oestradial < 20 pg/ml.
(5) Serum FSH & LH > 100 miu/ml.


MANAGEMENT : Prevention :


Spontaneous menopause is unavoidable but artificial. menopause indeed by surgery (bilateral oophoretomy) or by radiation (qonadal or intracavity) during reproductive period can be prevented in some extent.


Non Hormonal treatment :-


(1)Better nutritious diet.
(2) Exercise
(3) Supplementory ca in diet.
(4) Hypnotics tranquillisers and sadatives are prescribed for psychosomantic symptoms
(5) Clonidine & adernergic against may be used to reduce the severity & duration of hot flushes.


HORMONE REPLACEMENT THERAPY (HRT) :-


(1) Oestrogen :- Indication :- HRT is not required for all climacteric women patients meriting hormone replacement and other appropriate treatment includes.
(i) Climacteric symptoms
(ii) On symptomatic high risk woman (menopause below age 45 years established osteoporosis or fast bone loser, or combination of osteoporosis rise factor : hypercholes terolaenia > 6 mol/litre)
(iii) All woman requesting hormone replacement who are fully informed and have no contraindications.


Contraindications : Contraindications are few and given below.


(1) Previous thromboemlolic diseases association with hormonal. contraception pregenancy or oestrogen replacement.
(2) Oestrogen dependent cancers of breast & endometriun
(3) Liver diseases with impaired liver funtions.
Choice of Oestrogens : Oestrogens are so many and they have their different struture and formation but when given in equipotent doses having similar effect. Choice depends upon costs and packaging e.g. congugate equine oestrogen, ostradial, ethinyloestradiol and other synthetic oestrogens.


Choice of progestogen


Progestogen also have different categories and having different effect of oestrane, gonane and pregnane derivatives


Oestrogen and progestogen combination :


Several oestrogen and progestogen combinations are available some are given below (e.g.) postoval, prempack, & Trisequence etc.


Routes of Administration :


Oestrogen may be administered orally, transdermally, vaginally or by subcutaneous implant. Oral administration are cheapest and widely used while implantatin is used when other treatment have failed.


Homoeopathic treatment :


There is so many medicines which are used in menopausal syndrome synpomatologically. Some important medicines are given below. Amyl nitrosum, Belladonna, Cactus, Caulophyllum, Cinachona, Conium mac, Gelsemium, Kreosote, Lachesis, Lycopodium, Murex, Natrum mur, Nuxvomica, Oopnorinum Pulsatilla, Sepia Sulphur, Ustilago.

(1) Amyl Nitrosum : Climactic headache and flushes of heat, with anxiety and palpitation, haemorrhages association with facial flushing, must have fresh air, surgring of blood to head and face. Sensation as if blood would start through skin with heat and redness, flushing fallowed by sweat at climacteric.
(2) Belladonna : Menses too earfgly and profuse of hot, bright red blood, fantasitc illusion of the intellect over excitability of all the senses, violent throbbing headache, as through it would brust, hysterical headache with rush of blood to the head Hot flushes from face with redness and heat.
(3) Cactus : Whole body feels as if caged, each wire being twisted tighter; subject is Melancholy, Taciturn, sad and ill humoured having fear of death screams with pain construction in uterine region and ovaries menses early, darkpitch like, cease on lying down.
(4) Caulophyllum : Menses too early and too scanty with spasmodic and servere pain in lower abdomen which radiates in all direction discalouration of skin, with uterine and menstrual disorder, articular inflamation of small joints irregular menses.
(5) Cinchona : Menses too early, too profuse with dark coagulated blood profuse menses with pain and distension of abdomen, great exhausition from loss of blood with heaviness of head, vertigo, dullness of senses coldness of extremities and ringing in ears.
(6) Gelsemium : Neuralgic and congestive pain in uterus bearing down pain extending to back and hips with sensation as if uterus were squeezed by hand and forced downwords pain associated with frontal headache with a wild, confused feeling and dimvision. (7) Glonoin : Congestive headache with hyperaemia of brain, headache due to suppression of menses hot flushes from face sensation of pulsation through out body; menses delayed or sudden cessation with congestion to head, climacteric flushing.
(8) Graphitis : Menses too late, too scanty, of too short duration and too pale uterus is displaced with the os flung for back pressing upon the posterior wall of the vagina; decided aversion to coitus; suited to person who are anaemic, obese constantly cold, constipated and suffered from skin disease.
(9) Lachesis : Menses delayed, acrid, scanty, highly offensive and intermittend flushes of heat in day and chills at night, complaints agg before and after flow and ame during flow. uterine region sensitive to touch pain in ovaries and uterus going from Lt. to Rt.
(10) Lycopodium : Sharp shooting pain extending from Rt. to Lt. ovarian regions menses too profuse, too long flow partly black, clotted or bright red or watery with labour like pain, dryness of vagina with burning and painful coition, bearing down pain as if menses would apear blood discharge from vagina during stool. Physometra :
(11) Murex : Irregular menses with large clots, profuse frequent intense pain agg. from sitting violent sexual excitement by least contact of the parts.
(12) Natrum mur : Decided increase of sadness before menses, menses too late, too short and scanty or too early and profuse flowing day & night palpitation and throbbing headache during and affter flow. Prolapse uteri with bearing down sensation, must sit down, backache ame. lying flat on back or by firm support.
(13) Pulsatilla : Tardy menses, too late scanty thick dark clotted changeable, intermittent flows by fits and starts with errectic pain with chilliness, nausea, downword presure painful, intermiltent delayed scanty and dark menses with pain in back and tired faint feeling together with sad, melancholy weeping mood, agg in warm room and ame. by slowly walking and open air.
(14) Sepia : Flushes of heat over face and head, ascending from pelvic organs with anxiety and faintness perspiration from whole body, great sadness, weeping, indiffirences, headache at every period with scanty flow. retroverted prolapse with swallen, spongy bleeding cervix, bearing down sensation subject is pale, thin weak nervous subject must cross the limbs, aversion to coition.
(15) Ustilago : Menses profuse, too long lasting, comes in gushes of bright red blood especially when rising from a seat burt more frequent dark clotted fetid and stringy blood, uterine is hypertrophied prolapsed with swollen.


Cases : (I)


A 48 years old lady having complain of flashes of heat from face and neck followed with perspiration from whole body. Perspiration ame. her condition having headache vertex burning XLI pain which is agg. berfore and after sleep menses irregular profuse heamorrhge blood dark, clotted. Mentally Pt. is suspicious, loquacious and hurry having avesion to company. I gave her Lachesis 200 single dose followed by placeho after 7 days. She came with improved condition headache absent and flashes of heat reduced, and after few days flashes of heat is not found and menses becomes regular and now she is well.


Cases :(II)


A lady of 46 years having complain of irregular menses comes by appears at interval of dark clotted blood, Hot flushes from face and whole body followed by anxiety and palpittation. Flushes ame by profuse perspiration having small multiple fibroadenoma in whole body since one year. Stool hard with a straining. Mind desire to be alone, weeps with silent grief highly irritable desire for dark and desire for open air. Hot Pt. - flashes reduced by administration of Natruiomur m - 200 single dose weekly up to z months & Finally by 1m 1 dose one.


Conclusion :


The menopause means to most women wheather it be end of youth. loss of femininity and family or a sign that 'time is running out' and other psychological factor for the women. Whom life has treated kindly who leads a full life and adjest easily. The menopause and climacteric should be reqarded as what it is the end of reproductive function. hormone deficiency syndrome. Which can, if necessary, be treated with reassurance that ["The end of the menstruation is not the end of life but the begining of a new phase to be lived and enjoyed to the full most women can adjust and live happily for the remainder of their lives"

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