A Simple Guide to Menopause

A Simple Guide to Menopause (Part 2)
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How to Treat the symptoms of Menopause?
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In most cases of menopause, no treatment is necessary as it is a normal physiological event.
It is important that there is reassurance and psychological support from family and friends.
Menopause may mean the end of fertility but it also means the freedom from all the discomfort and inconvenience of monthly menstruation and fear of pregnancy.

Hormone replacement therapy used to be the best solution for all the symptoms and problems of menopause at one time.
They help to prevent heart disease and osteoporosis as well as to reduce the symptoms of menopause such as hot flushes, skin , breast and vaginal changes.
Oestrogen and progesterone are the two types of female hormones prescribed for and after menopause.
A combination of the two hormones is taken, as progesterone helps to protect the uterus from endometrial cancer.
If the woman have had removal of the womb, she will normally be given only oestrogen.

HRT can be taken as pills as a single oestogen tablet or as combination of oestrogen and progesterone.
Besides tablets, female hormonal patches, implants or vaginal creams can be used to help replace the level of hormones in the menopausal women.

There are benefits to the use of HRT:

1.Relieves hot flushes
2.reduce vaginal dryness.
3.Prevents osteoporosis and protects against fractures.
4.Indirectly improves mood symptoms by relieving the physical discomfort of menopause.
5.Safe for short term use.

There are also risks in using HRT:

1.increase risk for breast cancer for long term users (>5 years).
2.side effects such as vaginal bleeding, nausea, hair loss and headaches.
3.cause PMS (Pre-Menstrual Syndrome) symptoms such as bloating or irritability.
4.cause venous thrombosis due to increased coagulation of blood.

Hormone replacement therapy has recently fell out of favour due to new study which indicate higher incidence of breast and womb cancer taking HRT over a 5 year period.
It is still prescribed more as a single oestrogen tablet rather than a combination pill of oestrogen and progesterone.
Selective estrogen receptor modulators(SERM) like Evista has been used to replace HRT with good effect.
Plant based female hormones has also being used to reduce the symptoms of menopause. Alternative medicines like evening primrose oil has also been used.

For premature menopause where symptoms of menopause are more obvious due to their age, hormone replacement therapy is still given at intervals of 6 to 12 months.

Besides hormonal therapy, medicines such as:
1200mg of calcium daily
800 to 1000 IU of vitamin D daily
may be able to help prevent osteoporosis.

The current treatment for the symptoms of menopuse in the older women are:
1. A healthy life style.
Exercise
Regular exercise strengthen the muscles and bone.
Exercise also burns up calories to reduce obesity and hence prevent diabetes, hypertension and heart disease.
Walking is one of the best weight-bearing exercises to prevent osteoporosis.
Swimming and dancing are also good exercises.

Eat a balanced diet
A good balanced diet helps to prevent obesity, diabetes, osteoporosis, heart disease and colorectal cancer.
More fruit and vegetables will help reduce calories and prevent colorectal cancer.
Foods rich in calcium and Vitamin D such as fish, low fat high calcium milk can prevent osteoporosis.
Alcohol, coffee, tea, canned drinks should be avoided.
Less sugar, salt and saturated fats will reduce the risk of diabetes,hypertension and heart disease.

Control Stress
Medititation, yoga, deep breathing exercises and sufficient sleep reduces stress and heart disease.
Community service work, hobbies, time with family take the mind off work and stress.

Stay smoke-free
The risk of heart disease, lung and cervical cancer can be reduced by not smoking.

2.hot flushes:
Cool showers and cool tempreatures may help to reduce hot flushes.
Hot beverages and spicy foods should be avoided.
Thin cotton clothes are more comfortable.
Drinking a glass of cold water, loosening any tight clothing and using a small fan to cool down can stop the beginning of a hot flush.
Soy products like tofu and soya bean burns up less calories.
Meditation and mild exercise may also help by reducing stress.
hormone replacement therapy (mainly oestrogen) for a short peroid may be used as a last resort.

3.vaginal changes
Water-soluble vaginal lubricants can reduce dryness.
Oestrogen replacement creams may be prescribed to reduce the vaginal discomfort.

4.incontinence:
Doing simple pelvic floor exercises will strengthen the muscles surrounding the sphincter of the bladder opening.
Wearing a pad in the underwear may reduce the discomfort due to leaks.
Injection of collagen sometimes work to tighten the sphincter of the bladder opening.
Surgery to tighten the muscles of the bladder opening may be used as a last resort.

5.mood changes:
Many women going through menopause may become irritable,anxious or depressed.
Learn how to relax and make time for yourself.
Exercise is good for your health as it keeps your mind off emotional problems!
A hobby or volunteer work that you enjoy may take your mind off your symptoms.
Build up a good support system through talking with friends or a professional counsellor.

6.Osteoporosis:
A balanced diet with adequate calcium and active lifestyle can prevent development of osteoporosis:

Women who are at higher risk are those who
had early menopause or have ovaries removed
have a family history of osteoporosis
have a diet low in calcium and Vitamin D
smoke
are not physically active
are on steroids for long term (E.g. asthmatics)
drink coffee, tea or alcohol regularly
have certain disease such as an overactive thyroid gland

7.Breast Cancer
It is the most common cancer in menpausal women in their 50s.
Early detection by doing monthly breast self examination and a mammography once a year in your 40s and once every two years after age 50 is the best prevention.

8.Cervical Cancer
Cervical cancer is another common cancer among women.
It can be prevented by going for regular Pap smear tests.
Pap smear tests for cervical cancer once every 3 years from age 25 to 65 years if sexually active.
Pap smears can detect precancer so that early treatment can prevent full blown cancer.

9.Regular check-ups
Early detection and checkup can prevent complications such as heart disease and stroke.
A yearly blood pressure with blood sugar and blood cholesterol once every 3 years help to check for danger of heart disease and stroke.

Stay active and be confident about the future.
Take care of your health and personal appearance so that you both look and feel good.

Menopause marks a new Chapter in your life
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While menopause marks the end of fertility, it is NOT the end of health, or a satisfying and enjoyable life. Menopause means freedom from the inconvenience and discomfort of monthly menses.

Every Woman Goes Through Menopause
Knowledge about menopause is important so that you know what to expect.

Most women welcome the cessation of periods.
Others may feel a sense of loss that their childbearing ability is gone.
By understanding the physical and emotional changes of menopause, more women are able to cope with life in the golden years.

A Simple Guide to Menopause

A Simple Guide to Menopause(Part 1)
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What is Menopause?
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Menopause is the cessation of menstruation occuring in women between the ages of 45 and 55 years.
It is important to stress that it is NOT an illness but a natural event.
The age that menopause occur may vary with different women.


What Causes Menopause?
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Natural Menopause
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From puberty a woman starts releasing eggs from their ovaries.
Both the ovaries and eggs produces female hormones.
These hormones thickens lining of the womb in preparation for a pregnancy.
If the pregnancy does not occur, the lining of the womb is shed off as blood and cells(menses).
As the woman grows older, less eggs are produced resulting in reduced production of the female hormones.
This causes the menstrual periods to be less or more than usual.
When no more eggs are produced, the amount of the hormones produced are not enough to cause the lining of the womb to thicken.
As a result menstruation will stop.

Menopause is said to be established when the woman does not have any menstruation for one year.

Premature Menopause
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Premature menopause occurs when the menses stop in a woman before the age of 40 yrs.
The causes of premature menopause are
1.surgery to remove the womb or ovaries in the case of cancer,
2. chemotherapy and
3. radiotherapy.

Without the protective effect of oestrogen, these young women will have a higher chance of having osteoporosis and heart disease later in life .

Women who smokes usually have menopause 2 years earlier than non-smokers.

What are the symptoms and signs in Menopause?
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Most women do not have any symptoms except for the loss of their monthly periods.

In others, the change in female hormones may cause the following symptoms:

1.Irregular menstrual patterns - usually the menses can become lighter or further apart.
One or two periods may be missed.

2.Hot flushes -sudden feeling of heat starting from the chest to the face.
There may be associated sweating, fast heart beats, fainting and insomnia.
The exact cause is not known and may be due to vasomotor disturbances related to the fluctuating hormone levels.
It usually improve after 1-2 years.

3.Vaginal tract changes - With menopause, the walls of the vagina become thinner, dryer because of less secretions, and more prone to infection.
Because ot these changes, sexual intercourse may be uncomfortable or painful.

3.Incontinence - With age and onset of menopause, the muscles around the bladder opening may weaken, leading to leakage of urine with straining or coughing (incontinence).
Muscles of pelvic floor loses tone with possible prolapse of uterus.

4.Breasts tissues may become atrophied with decrease in size of the nipples.
The breast may become more pendulous.

5.Skin may be less smooth and wrinkles may appear.
Hair may also become thinner and dryer.

6.Mood and memory: irritability, anxiety, depression, insomnia (difficulty in sleeping), poor concentration and poor memory may be due to the lowered female hormones or pyschological due to change in the body, skin and appearance.

What are complications of Menopause?
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1.Osteoporosis:
The bones may become brittle, fragile and fracture easily after menopause because oestrogen is important in maintaining bone mass.
Hormone replacement may be able to reduce the bone loss and prevent osteoporosis.

2.Cancer:
Menopause itself does not cause an increased risk of women cancer.
It is rather the age group that they are in which may increase the risk of cancer.

3.Heart disease and stroke
After menopause, women are more likely to get hypertension or high blood cholesterol which increases the risk of a heart attack and stroke.

4.Metabolic disease
Again after menopause, some women tend to burn less energy and gain weight.
Decrease in metabolism leads to accumulation of sugars which can increase the risk of Diabetes

A Simple Guide to Alopecia(Hair Loss)

A Simple Guide to Alopecia(Hair Loss)
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What is Alopecia(Hair Loss)?
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Alopecia or Hair Loss is the partial or complete loss of hair in the scalp, armpit or other areas of the body to the extent that skin is evident and sparse amount of hair is present or completely absent. Hair loss usually develops gradually and may be patchy or diffuse (all over)

Who get Alopecia?
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Hair loss is experienced by both men and women, young or old.

The most common type of hair loss is called

1.male pattern baldness or androgenetic alopecia.

Its causes have been linked to genes, hormones and age.

Other types of hair loss are:

2. an auto-immune condition known as patchy hair loss (alopecia areata),

3.temporary hair loss (telogen effluvium),

4.compulsive hair pulling (trichotillomania) and

5.traction alopecia.

What is the cause of Alopecia?
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The hair is made up of keratin, the same protein that is found in nails and the outer layer of our skin. The average adult has more than 100,000 strands of hair on his scalp.

It is normal to lose about 50 to 100 strands every day.

Old strands of hair are shed so that new ones can grow out of the hair follicles.

However, various factors can lead to sudden or excessive shedding such as:
1.genes(Male pattern baldness, Congenital),

Genetic baldness is caused by the body's failure to produce new hairs and not by excessive hair loss.

Some women also develop a particular pattern of hair loss due to genetics, age, and male hormones that tend to increase in women after menopause.

The pattern is different from that of men. Female pattern baldness involves a thinning throughout the scalp while the frontal hairline generally remains intact.

Congenital Alopecia occurs in a new born who does not develop any more hairs.

2.hormones(excessive DHT or dihydrotestosterone)

Androgens appear to play a role in male pattern baldness. These very same hormones trigger the growth of hair in the pubic, underarm and facial areas at puberty. People with male pattern baldness may have the same male hormone levels as normal people, but these hormones seem to accumulate in certain areas of their scalp and cause the hair follicles there to regress.
Women are protected from male pattern baldness because they produce less androgens, and because their female hormones, estrogen can counter the effect of their male hormones. However, women who produce excess androgens may have male pattern baldness.

Other hormones, such as those from your thyroid glands, can also affect your hair.

Too much or too little hormones from your thyroid gland can cause hair loss.

3.stress,

Sudden emotional stress can also trigger patchy baldness (alopecia areata) or temporary hair loss (telogen effluvium). Temporary hair loss may also be triggered by the stress of giving birth or losing a loved one.

4. Medical conditions

Some medicines, such as blood thinners (anti-coagulants), birth control pills, anti-depressants, anti-thyroid drugs or drugs used in chemotherapy, may cause hair loss.

5.Improper hair care

Having a hairstyle that exerts too much pull(traction) on the scalp can cause your hair to turn brittle and break. Hair breakage can also be caused by over-shampooing and the excessive use of chemical treatments such as dyes, tints, bleaches, and permanent waves.

6.Burns - Excessive heat damages the cells of the skin including the hair roots.

7.Infectious diseases such as syphilis and fungal infection can cause damage to the hair roots.

What are the Signs and Symptoms of Alopecia?
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Male pattern baldness (or androgenetic alopecia) accounts for the majority of all hair losses. This is the most common type of baldness in men, especially older men.

It can also occur in some women, though the instances are rare.

Hair loss is usually gradual.

The hair loss pattern differs between the sexes.

In men, the hair loss usually starts with a receding hairline.

In women, there is a diffuse thinning of the crown.

Male pattern baldness in women is usually not as severe.

Besides male pattern baldness, there are various other types of hair loss.

Patchy baldness (alopecia areata): Here a few bald patches suddenly appear.

Emotional stress(eg examinations) appears to be a triggering factor.

This condition can progress to more serious forms in which all the scalp and body hair may be lost (alopecia totalis).

Temporary hair loss (telogen effluvium): Here clumps of hair begin to fall out suddenly over a few days. It can be caused by severe stress, childbirth, severe illnesses, surgery and some medications. As its name implies, its effect is usually temporary.

Recovery though may take a year or longer depending on the cause.

Compulsive hair pulling (trichotillomania): This causes hair breakage and usually leaves the scalp undamaged. It usually affects children and women and has been linked to a psychological cause.

Traction alopecia: This is hair loss caused by certain hairstyles such as ponytails, buns or braids that pull excessively on the hair.

What tests can be done in Alopecia?
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1.Microscopic examination of a plucked hair

2.Skin biopsy (if skin changes are present)

Ringworm on the scalp may require the use of an oral drug, such as griseofulvin, because creams and lotions applied to the affected area may not get into the hair follicles to kill the fungus.

What is the Treatment and Prevention of Alopecia?
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It is important to determine the underlying cause before treatment.

Most of the conditions are temporary and can be resolved once the underlying cause such as stress is removed.

However, male pattern baldness may have a permanent effect.

There has been some medical progress in helping these people regain their hair.

Two medications Finasteride and Minoxidil work by stimulating the regrowth of hair in hair follicles.

1.Finasteride counteracts the effects of the male hormone testosterone. It is available only by prescription and is taken orally. It is approved for use only in men and is not recommended in women because of its link to birth defects. Finasteride takes a few months to show its effect.
2.Minoxidil is available over the counter. . It is applied on the scalp and works by reversing the regression of hair follicles caused by hormones.It takes a few months before any effect can be seen.

Alopecia areata is sometimes treated by steroid injections into the affected scalp areas while any underlying scalp problems such as tinea capitis (fungal infection) should be treated accordingly.

Causes of telogen effluvium should be addressed and given professional guidance by psychiatrist if necessary. Those due to childbirth should recover spontaneously within a year.
Hair loss from menopause or childbirth often returns to normal 6 months to 2 years later.

For hair loss caused by illness (such as fever), radiation therapy, or medication use, no treatment is necessary. The hair will usually grow back when the illness has ended or the therapy is finished. A wig, hat, or other covering may be desired until the hair grows back.

For hair loss due to heredity, age, and hormones, the topical medication minoxidil can be helpful for both male and female pattern baldness. You may need to wait 6 months before you see results.

The oral medication Propecia (finasteride) is effective in some men. This medicine can decrease sex drive.

When either medication is stopped, the former baldness pattern returns.

Hair transplants performed by a physician is a surgical approach to transferring growing hair from one part of the head to another. It is somewhat painful and expensive, but usually permanent.

Hair weaves, hair pieces, or changes of hair style may disguise hair loss. This is generally the least expensive and safest approach to hair loss. Hair pieces should not be sutured to the scalp because of the risk of scars and infection.