To achieve pregnancy a series of complicated events occurs, which otherwise happens so simply! It is essential to know the normal process so that we can understand the reason; when there is difficulty of getting pregnant.
Ovulation and menstruation – What actually happens?
A woman is born with a lifetime supply of immature eggs in her ovaries. Each month, one matures and is released in a process called ovulation. Ovulation is an important part of the menstrual cycle. In a typical 28-day cycle, a woman's menstrual period begins on day 1. On day 14, ovulation occurs. On day 28, if the egg has not become fertilized, the menstrual cycle begins again with another period.
For ovulation to happen, different parts of the body must all work together. The brain and the ovaries both play roles in this coordination. The ovaries are the two almond-shaped glands sitting within reach of the fallopian tubes. Ovaries produce the eggs as well as the essential sex hormones needed for menstruation and pregnancy.
Just before ovulation, the hypothalamus and pituitary glands in the brain signal the body to start producing hormones. Follicle-stimulating hormone (FSH) prompts fluid-filled chambers in the ovary called follicles to begin growing. In each follicle a single ovum starts growing. Leutinizing hormone (LH) triggers the follicle to rupture when it is matured. In each cycle one ovum is usually released. Women ovulate about 14 days before their next menstrual period would be expected—day 14 on a 28-day cycle. Ovulation occurs within about a day after the surge in LH.
Both FSH and LH play additional roles in the menstrual cycle. They instruct the ovaries to produce estrogen and progesterone, hormones that help ovulation to occur and the uterus to prepare for pregnancy. The uterus is a hollow organ, shaped like a pear and only about three inches long in a non pregnant woman. Its lining, the endometrium, is richly supplied with blood vessels. The endometrium continually renews itself, building up in response to messages sent by estrogen and progesterone.
The Luteinizing Process The menstrual cycle consists of a complex series of events that interact to stimulate ovulation, prepare the uterine lining for a pregnancy, and cause the uterine lining to be shed if pregnancy does not occur. Two glands in the brain, the hypothalamus and the pituitary, send follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to the ovary just before ovulation to stimulate the development of a follicle and its release of an egg into a fallopian tube (ovulation). Follicles are the structures inside the ovary that produce the eggs to be fertilized and that release the hormone estrogen, which stimulates the lining of the uterus to thicken in preparation for pregnancy. After releasing the egg, the empty follicle, called the corpus-luteum, begins producing progesterone. This hormone continues to stimulate the uterine lining to grow and thicken. If the egg is not fertilized, a sudden drop in estrogen and progesterone triggers the uterus to shed its lining and menstruation begins. This marks the start of the next cycle
What actually happens when ovum is fertilized?
For fertilization to occur, healthy sperm must be deposited in a woman's vagina, preferably near the cervix, just about the time of ovulation. Each sperm is about 1/ 1000 inch long; its whip like tail swims up through the cervix, into the uterus, and into the fallopian tubes. Only one sperm is allowed fertilize an egg. Though millions of sperm may start their journey towards the solitary ovum, only a few hundred stay alive during the trip and one fortunate sperm ultimately fertilize the egg.
An egg, which is released during ovulation is usually picked up by the fallopian tube. Women have two fallopian tubes, each about 4 inches long. They are located just above the ovaries and have featherlike fingers called fimbria at their terminals near the ovaries. The fimbria and inner lining of the tubes are lined with cilia, which are like millions of active tiny hairs. These hairs shift the egg from the ovary inside the tubes by suction and cilliary action. An egg is fertilizable for only about 12-72 hours after its release.
The fallopian tubes have smooth tiny musculature throughout their lengths. In the middle, they help by contracting so that the sperm and egg move closer with each other and fertilization happens. At the end nearer the uterus, they are narrow to keep eggs from being released into the uterus too soon.
When sperm are present, they gather around the egg. They discharge enzymes from their heads to help make a hole in the egg to allow penetration. Once one sperm enters the egg, a chemical reaction ensues that pre¬vents other sperm from entering.
In the first half of a woman's menstrual cycle, estrogen makes the endometrial lining begin to thicken with a nutrient rich bedding in case pregnancy should occur. Progesterone then takes over. It is produced mainly in the second half of the cycle by a temporary organ called the corpus luteum. The corpus luteum is formed in the ovary from the follicle that released its egg. Progesterone causes the lining of the uterus to thicken even more. Estrogen and progesterone both play roles in ovulation as well.
If the egg is not fertilized, it dissolves and is absorbed by the body. Then hormone levels drop and the endometrium disintegrates without the hormonal nourishment. This shedding is the monthly menstrual period. The first day of a woman's period is the point at which her hormone levels are at their lowest.
How fertilized ovum is implanted in the uterus?
Inside the fertilized egg, cells begin to divide. If all goes well, the fertilized egg then journeys from the fallopian tube to the uterus where it implants itself in the spongy lining of the uterus. There it grows and develops into an embryo (weeks 2-8), then a fetus for the rest of the pregnancy, and 9 months later, a baby.
Numerous structural and hormonal factors play a part in fertility. What may look like the simplest of human activities—conceiving a baby—can become a miraculous chain of events, especially to a couple having problems getting pregnant.
Basic criteria of a fertile couple
Seven elements are essential to fertility:
1. A woman's ovaries must produce healthy eggs that are released regularly.
2. A man's testicles must be capable of producing healthy sperm that can reach the egg and then penetrate it.
3. During intercourse, the man's semen that contains his sperm has to be deposited at or at least close to the cervix. This puts the sperm in the best position to reach the egg.
4. There has to be a clear passage through the fallopian tube from the ovary to the uterus. This passage is used by both the egg moving down and the sperm moving up. Any obstruction in the fallopian tube interrupts the process of fertilization.
5. The man's sperm have to be able to move freely through the cervix. Any physical or chemical barrier can cause problems.
6. The ovum has 12 to 72 hours of life in which it can be fertilized. The sperm have up to 5 days in which they can fertilize an egg. Timing is critical.
7. Once the egg is fertilized, it has to find a suitable site for implantation in the lining of the uterus.
Showing posts with label Menstruation. Show all posts
Showing posts with label Menstruation. Show all posts
Wednesday, March 18, 2009
Saturday, February 28, 2009
What happened in our body during climacteric and menopause and what is the treatment for menopausal syndrome?
Why menopause occurs?
Yes, menopause occurs as a result of cessation of estrogen activity, but why estrogen activity comes to a halt?
The answer for this is, there are a limited number of ova, which produce estrogens in the female body. A 20-week-old female fetus has as many as 6-7 million ova in their body but at the time of delivery of the female, there are only about 1-2 million remains. This is because of normal physiological ageing. By ageing it does not mean that the baby has aged, but that age-related changes starts even in them. At the time of menarche only 200,000-400,000 ova remain in the ovaries. The others die a natural death during these years. Out of remaining these, only about 400-500 ova will grow to maturity and be released at the time of ovulation. By the time menopause occurs, most of these usually exhaust. The ovary itself develops a shrunken appearance and ovaries cease to produce further estrogen and climacteric followed by menopause sets in. Meager amounts of estrogen continue to be released from other organs like adrenals but these compensate to a limited extent only.
Treatment of menopause and Climacteric symptoms:
It is essential to move toward menopause with a positive attitude. Menopause does not mean the end of life, on the contrary, here starts a new and dynamic phase of a woman's life. It is that stage in a woman's life when she is liberated from the stresses and anxieties of middle age. Her children are adult and settled. She finds more time and space for herself and can take pleasure in both work and leisure. This is the time when she can make use of her talent to the maximum. Many women find sex more enjoyable after menopause as they are no longer concerned about unwanted pregnancies. At times, if sex is painful due to dryness, lubricating jelly ( KY jelly) solves the problem. Sometimes, escape ovulation occur after menopause, though rare, sometimes pregnancy occurs.
Itching of the vulva as sometimes thought, is not a symptom of menopause but dryness is. If there is Itching or heavy discharge, gynaecological checkup is needed to rule out underlying infection-of the lower genital tract.
Regular exercise is required at all stages of life, especially after menopause. Exercise keeps body weight under control, increases basal metabolic rate, which leads to faster burning up of calories, enhances deposition of calcium in the bones and guards the heart from coronary arterial disease. It also offers a feel of wellbeing because of release of certain hormones known as endorphins in the body.
Diet has to be given due attention. A well balanced diet, with plenty of fruits and vegetables will give the body with vitamins, fiber, minerals, and antioxidants, all of which are essential to the body. It is very easy to get obese after menopause, so one should keep the total calorie intake under control and reduce the intake of fats. Vitamins and calcium supplements is essential particularly at this time.
Hormonal Replacement Therapy (HRT)
HRT, as hormonal replacement is popularly known, is the low dose estrogen either synthetic or in natural form is used in the management of climacteric and menopausal symptoms. As most of the symptoms of climacteric can be attributed to estrogen deficiency and compensatory over activity of certain pituitary hormones, administration of estrogen as supplement relieves most of the symptoms in a majority of women.
Arguments and studies are still going on regarding the safety of HRT, but this greatly improves the quality of life. Any deleterious effect like increased incidence of breast carcinoma, heat attacks or endometrial carcinoma is not yet proved convincingly. However, HRT should be started with proper baseline investigations.
There are so many routes and methods one can have estrogen replacement or HRT. It can be given orally as pill, patch in the skin, vaginally as gel. The consulting gynecologist is the best judge to chose which form the woman needs. Those women are having their uterus intact has to take progesterone sequentially to protect the endometrium from cancer.
Most of the irritating symptoms revert following HRT. Bone density improves. Libido increases with elevated mood and disappearance of vaginal dryness. Slightest chance of being pregnant is eliminated.
My personal view is, when HRT improves the quality to a great extant and nothing is proved beyond doubt about its side effects and even if it is there, percentage is so little, the woman should live life with joy by taking HRT, if she agrees after informed counseling.
Tibolone, another drug claims to give all the good effects without the deleterious effects on heart, blood vessels, breast tissue, and endometrium works fine in some but not all women.
Natural food extract capsules like soya extracts with the helpful isoflavones, vitamin E are absolutely safe and help some but not all the women with menopausal syndrome.
This article is also published at India study Channel
Yes, menopause occurs as a result of cessation of estrogen activity, but why estrogen activity comes to a halt?
The answer for this is, there are a limited number of ova, which produce estrogens in the female body. A 20-week-old female fetus has as many as 6-7 million ova in their body but at the time of delivery of the female, there are only about 1-2 million remains. This is because of normal physiological ageing. By ageing it does not mean that the baby has aged, but that age-related changes starts even in them. At the time of menarche only 200,000-400,000 ova remain in the ovaries. The others die a natural death during these years. Out of remaining these, only about 400-500 ova will grow to maturity and be released at the time of ovulation. By the time menopause occurs, most of these usually exhaust. The ovary itself develops a shrunken appearance and ovaries cease to produce further estrogen and climacteric followed by menopause sets in. Meager amounts of estrogen continue to be released from other organs like adrenals but these compensate to a limited extent only.
Treatment of menopause and Climacteric symptoms:
It is essential to move toward menopause with a positive attitude. Menopause does not mean the end of life, on the contrary, here starts a new and dynamic phase of a woman's life. It is that stage in a woman's life when she is liberated from the stresses and anxieties of middle age. Her children are adult and settled. She finds more time and space for herself and can take pleasure in both work and leisure. This is the time when she can make use of her talent to the maximum. Many women find sex more enjoyable after menopause as they are no longer concerned about unwanted pregnancies. At times, if sex is painful due to dryness, lubricating jelly ( KY jelly) solves the problem. Sometimes, escape ovulation occur after menopause, though rare, sometimes pregnancy occurs.
Itching of the vulva as sometimes thought, is not a symptom of menopause but dryness is. If there is Itching or heavy discharge, gynaecological checkup is needed to rule out underlying infection-of the lower genital tract.
Regular exercise is required at all stages of life, especially after menopause. Exercise keeps body weight under control, increases basal metabolic rate, which leads to faster burning up of calories, enhances deposition of calcium in the bones and guards the heart from coronary arterial disease. It also offers a feel of wellbeing because of release of certain hormones known as endorphins in the body.
Diet has to be given due attention. A well balanced diet, with plenty of fruits and vegetables will give the body with vitamins, fiber, minerals, and antioxidants, all of which are essential to the body. It is very easy to get obese after menopause, so one should keep the total calorie intake under control and reduce the intake of fats. Vitamins and calcium supplements is essential particularly at this time.
Hormonal Replacement Therapy (HRT)
HRT, as hormonal replacement is popularly known, is the low dose estrogen either synthetic or in natural form is used in the management of climacteric and menopausal symptoms. As most of the symptoms of climacteric can be attributed to estrogen deficiency and compensatory over activity of certain pituitary hormones, administration of estrogen as supplement relieves most of the symptoms in a majority of women.
Arguments and studies are still going on regarding the safety of HRT, but this greatly improves the quality of life. Any deleterious effect like increased incidence of breast carcinoma, heat attacks or endometrial carcinoma is not yet proved convincingly. However, HRT should be started with proper baseline investigations.
There are so many routes and methods one can have estrogen replacement or HRT. It can be given orally as pill, patch in the skin, vaginally as gel. The consulting gynecologist is the best judge to chose which form the woman needs. Those women are having their uterus intact has to take progesterone sequentially to protect the endometrium from cancer.
Most of the irritating symptoms revert following HRT. Bone density improves. Libido increases with elevated mood and disappearance of vaginal dryness. Slightest chance of being pregnant is eliminated.
My personal view is, when HRT improves the quality to a great extant and nothing is proved beyond doubt about its side effects and even if it is there, percentage is so little, the woman should live life with joy by taking HRT, if she agrees after informed counseling.
Tibolone, another drug claims to give all the good effects without the deleterious effects on heart, blood vessels, breast tissue, and endometrium works fine in some but not all women.
Natural food extract capsules like soya extracts with the helpful isoflavones, vitamin E are absolutely safe and help some but not all the women with menopausal syndrome.
This article is also published at India study Channel
Friday, February 27, 2009
What are the changes expected during cessation of menstruation or, menopause.
What is menopause?
Menopause is the pause of the monthly menstrual flow. It can happen all of a sudden, but it is more usual for menopause to happen gradually. That is to say, the amount of bleeding starts diminishing and the interval between bleeding episodes keeps on rising over the months, till it finally comes to an end.
The average age at which women experience menopause ranges from 45-52 years. There is actually a wide deviation in the age at which menopause occurs, depending on the weather, degree of nutrition, obesity and socio-economic status. Family history also has to be taken into account Women who have menopause in their early or mid-forties find that their mothers had an early menopause too. Obese women often have a late menopause, around the age of 55 years. If menopause occurs before the age of 40, it is diagnosed as premature menopause.
Climacteric is the period just prior to menopause, when symptoms first start to emerge, and it continues till the postmenopausal period, i.e. when one has completed a full year without having another period. It is just the reverse of puberty changes, just as menopause is the reverse of menarche changes. Basically, climacteric is the intermediary phase of 1-5 years during which the genital organs involute as a result of stoppage of ovarian activity. Menopause is only a expression of climacteric, and precedes complete stoppage of ovarian functions by a few months to a few years.
In 50 per cent of all women, the changes of climacteric are for the time being deferred by a slight amount of oestrogen from the adrenal gland.
Ultimately the following changes are seen:
Changes of climacteric, which can be seen outside (Physical Changes)
Changes seen in the skin during climacteric / menopause:
Slowly the skin becomes drier than earlier. There is also a loss of tissue from below the skin ensuing in a loss of elasticity and leading to the emergence of wrinkles. Greater than before facial hair is another indication of menopause.
Urge for sex or, libido diminishes after menopause:
The urge for sex declines as vaginal dryness causes painful penetration. Psychological alterations caused by menopause also influence the sex drive. Women may feel unloved, unattractive and surplus, and may pull out into themselves rather than face rejection. Menopause is the time when it is of utmost importance for both partners to be truthful and unrestrained with each other.
From the medical point of view, the decrease in sex drive is due to a decline in the circulating testosterone levels. Testosterone is the male hormone, and though readers will find it amazing, all women have testosterones circulating in their blood stream! This testosterone is responsible for the sex drive. Menopause with its associated decline in ovarian activity results in a fall in the testosterone level as well. This to a great extent affects the sex urge.
The sex organs atrophy with the menopause:
The vulval skin becomes slender and shiny, and prone to trauma. Subcutaneous fat of the vulva diminishes in amount. Both the labia minora reduce in size and be inclined to disappear. The opening of the vagina gets smaller and loses its elasticity. Later on, pubic hair becomes meager and scarce.
The vagina becomes 'tent shaped' and undergoes contracture in length and width. But those continue sexual activities these chane may not appear. The uterus and cervix become small. The ovaries become atrophied and dried-up in appearance. Breasts get shriveled and tend to become flat, with the exception of in obese women, where they remain large and pendulous. This is because shrinkage is due to the glandular tissue only; fats in the breast and obese women have them in abundance.
Getting overweight after menopause:
Gaining weight is frequent at climacteric but not always, as is generally supposed. When occurs, it is associated to excessive eating to combat emotional stress, and also to change in metabolism. BMR falls significantly after the menopause, while the lady continues to eat the same amount and starts putting on weight.
Changes in heart and blood vessels after menopause:
Women at menopause may have symptoms like palpitation and occasional chest pain related to heart. But the most important symptom of menopause is 'hot flushes'. Flushing of the face and neck may be accompanied by profuse sweating particularly in the night when she reclines leading to night sweats. The basic reason of hot flushes is a increase in the pituitary hormone levels due to lowered circulating estrogen. The duration of a hot flush may vary from half a minute to several minutes. Too much drinking of alcohol, stress, anxiety, heat, or emotional outbursts may all set off a hot flush, but usually hot flushes take place without any precipitating factor.
The level of uneasiness experienced during hot flushes is variable. In some it may be so severe that pillows and bed linens are soaked due to sweat, others may just feel that they have had a disturbed night, and may vaguely remember feeling uncomfortably hot. Most women fall in between these extreme ranges. Insomnia is a natural result of hot flushes. Even if there is no sleep disturbance, there is a feeling of being neglected, dismay, downhearted and depressed. This fact is due to vasodilatation - dilatation of the peripheral blood vessels as a result of hormonal imbalance.
The frequency of coronary arterial disease is more after menopause. Estrogens have a shielding effect on the heart. At menopause, this protection is lost. Blood pressure also tends to rise.
Bones weaken and joint starts paining after menopause:
At menopause, pain in the joints and weakness of bones is also frequent. Bones become frail with the loss of calcium deposits. Increased intake of calcium containing foods such as milk and some green vegetables, along with regular exercise, can help to avert osteoporosis. It has been undoubtedly proved that bone density diminishes after menopause.
Women who have had an early menopause, whose ovaries are surgically removed during hysterectomy, or who suffers from anorexia are at elevated risk of acquiring osteoporosis. Most women have maximum bone density when they are in their thirties, after which bone mass starts declining. Minor traumas result in fractures. Hip, spine and wrist are the most susceptible. At least 1000 mg of calcium supplement along with Vitamin D is recommended daily.
Digestion problem and menopause:
Dyspepsia, indigestion, constipation and abdominal distension of varying degree may also occur during and after menopause.
Psychological Changes following menopause:
Being a major change from all aspects, menopause is viewed with uneasiness by most women. The fright of losing one's womanliness, appearing unpleasant to one's partner or acquiring cancer are very real at this stage. At menopause, women comprehend that their reproductive capacity is lost. Some wrongly regards this is an end of sexual activity and the herald of old age.
For these facts, variety if neurotic and psychotic changes occurs. Depression, irritability, mood swings, irrational behavior, nervousness, tingling or burning in the hands and feet are all common symptoms. Though some of these symptoms are related to the withdrawal of estrogen too as they sometimes disappear after giving HRT or, hormone replacement therapy. Melancholia, leading to suicidal attempts, though rare but may occur in women who have a background of mental instability.
Menopause is just the reverse of menarche. It can be turbulent and annoying for some women. Others seem to sail through menopause smoothly and gracefully. Mood swings usually last for a year or two, and then taper away gradually.
Depression is seen quite commonly in postmenopausal women, and the reasons are multifarious. A sudden drop in estrogens is probably the major cause of depression. It may also be aided by disturbed sleep, gaining weight, or feeling of chronic fatigue. This phase of life is associated with changes in the family dynamics also. Children grow up and leave home and there may be deaths in the family or extra burdens in the form of ageing parents who need care. All these can cause energy loss and thereby depression.
It is essential for the spouse to understand that menopause itself is not a disease, and the menopausal woman is not a neurotic annoyance. An thoughtful spouse can make this complex phase of changeover very simple and smooth.
This article is also published in India Study Channel
Menopause is the pause of the monthly menstrual flow. It can happen all of a sudden, but it is more usual for menopause to happen gradually. That is to say, the amount of bleeding starts diminishing and the interval between bleeding episodes keeps on rising over the months, till it finally comes to an end.
The average age at which women experience menopause ranges from 45-52 years. There is actually a wide deviation in the age at which menopause occurs, depending on the weather, degree of nutrition, obesity and socio-economic status. Family history also has to be taken into account Women who have menopause in their early or mid-forties find that their mothers had an early menopause too. Obese women often have a late menopause, around the age of 55 years. If menopause occurs before the age of 40, it is diagnosed as premature menopause.
Climacteric is the period just prior to menopause, when symptoms first start to emerge, and it continues till the postmenopausal period, i.e. when one has completed a full year without having another period. It is just the reverse of puberty changes, just as menopause is the reverse of menarche changes. Basically, climacteric is the intermediary phase of 1-5 years during which the genital organs involute as a result of stoppage of ovarian activity. Menopause is only a expression of climacteric, and precedes complete stoppage of ovarian functions by a few months to a few years.
In 50 per cent of all women, the changes of climacteric are for the time being deferred by a slight amount of oestrogen from the adrenal gland.
Ultimately the following changes are seen:
Changes of climacteric, which can be seen outside (Physical Changes)
Changes seen in the skin during climacteric / menopause:
Slowly the skin becomes drier than earlier. There is also a loss of tissue from below the skin ensuing in a loss of elasticity and leading to the emergence of wrinkles. Greater than before facial hair is another indication of menopause.
Urge for sex or, libido diminishes after menopause:
The urge for sex declines as vaginal dryness causes painful penetration. Psychological alterations caused by menopause also influence the sex drive. Women may feel unloved, unattractive and surplus, and may pull out into themselves rather than face rejection. Menopause is the time when it is of utmost importance for both partners to be truthful and unrestrained with each other.
From the medical point of view, the decrease in sex drive is due to a decline in the circulating testosterone levels. Testosterone is the male hormone, and though readers will find it amazing, all women have testosterones circulating in their blood stream! This testosterone is responsible for the sex drive. Menopause with its associated decline in ovarian activity results in a fall in the testosterone level as well. This to a great extent affects the sex urge.
The sex organs atrophy with the menopause:
The vulval skin becomes slender and shiny, and prone to trauma. Subcutaneous fat of the vulva diminishes in amount. Both the labia minora reduce in size and be inclined to disappear. The opening of the vagina gets smaller and loses its elasticity. Later on, pubic hair becomes meager and scarce.
The vagina becomes 'tent shaped' and undergoes contracture in length and width. But those continue sexual activities these chane may not appear. The uterus and cervix become small. The ovaries become atrophied and dried-up in appearance. Breasts get shriveled and tend to become flat, with the exception of in obese women, where they remain large and pendulous. This is because shrinkage is due to the glandular tissue only; fats in the breast and obese women have them in abundance.
Getting overweight after menopause:
Gaining weight is frequent at climacteric but not always, as is generally supposed. When occurs, it is associated to excessive eating to combat emotional stress, and also to change in metabolism. BMR falls significantly after the menopause, while the lady continues to eat the same amount and starts putting on weight.
Changes in heart and blood vessels after menopause:
Women at menopause may have symptoms like palpitation and occasional chest pain related to heart. But the most important symptom of menopause is 'hot flushes'. Flushing of the face and neck may be accompanied by profuse sweating particularly in the night when she reclines leading to night sweats. The basic reason of hot flushes is a increase in the pituitary hormone levels due to lowered circulating estrogen. The duration of a hot flush may vary from half a minute to several minutes. Too much drinking of alcohol, stress, anxiety, heat, or emotional outbursts may all set off a hot flush, but usually hot flushes take place without any precipitating factor.
The level of uneasiness experienced during hot flushes is variable. In some it may be so severe that pillows and bed linens are soaked due to sweat, others may just feel that they have had a disturbed night, and may vaguely remember feeling uncomfortably hot. Most women fall in between these extreme ranges. Insomnia is a natural result of hot flushes. Even if there is no sleep disturbance, there is a feeling of being neglected, dismay, downhearted and depressed. This fact is due to vasodilatation - dilatation of the peripheral blood vessels as a result of hormonal imbalance.
The frequency of coronary arterial disease is more after menopause. Estrogens have a shielding effect on the heart. At menopause, this protection is lost. Blood pressure also tends to rise.
Bones weaken and joint starts paining after menopause:
At menopause, pain in the joints and weakness of bones is also frequent. Bones become frail with the loss of calcium deposits. Increased intake of calcium containing foods such as milk and some green vegetables, along with regular exercise, can help to avert osteoporosis. It has been undoubtedly proved that bone density diminishes after menopause.
Women who have had an early menopause, whose ovaries are surgically removed during hysterectomy, or who suffers from anorexia are at elevated risk of acquiring osteoporosis. Most women have maximum bone density when they are in their thirties, after which bone mass starts declining. Minor traumas result in fractures. Hip, spine and wrist are the most susceptible. At least 1000 mg of calcium supplement along with Vitamin D is recommended daily.
Digestion problem and menopause:
Dyspepsia, indigestion, constipation and abdominal distension of varying degree may also occur during and after menopause.
Psychological Changes following menopause:
Being a major change from all aspects, menopause is viewed with uneasiness by most women. The fright of losing one's womanliness, appearing unpleasant to one's partner or acquiring cancer are very real at this stage. At menopause, women comprehend that their reproductive capacity is lost. Some wrongly regards this is an end of sexual activity and the herald of old age.
For these facts, variety if neurotic and psychotic changes occurs. Depression, irritability, mood swings, irrational behavior, nervousness, tingling or burning in the hands and feet are all common symptoms. Though some of these symptoms are related to the withdrawal of estrogen too as they sometimes disappear after giving HRT or, hormone replacement therapy. Melancholia, leading to suicidal attempts, though rare but may occur in women who have a background of mental instability.
Menopause is just the reverse of menarche. It can be turbulent and annoying for some women. Others seem to sail through menopause smoothly and gracefully. Mood swings usually last for a year or two, and then taper away gradually.
Depression is seen quite commonly in postmenopausal women, and the reasons are multifarious. A sudden drop in estrogens is probably the major cause of depression. It may also be aided by disturbed sleep, gaining weight, or feeling of chronic fatigue. This phase of life is associated with changes in the family dynamics also. Children grow up and leave home and there may be deaths in the family or extra burdens in the form of ageing parents who need care. All these can cause energy loss and thereby depression.
It is essential for the spouse to understand that menopause itself is not a disease, and the menopausal woman is not a neurotic annoyance. An thoughtful spouse can make this complex phase of changeover very simple and smooth.
This article is also published in India Study Channel
Tuesday, January 20, 2009
Premenstrual Syndrome (PMS)
What is Premenstrual syndrome? or, PMS?
A very common condition affecting the women mostly in their 30s and 40s. They notice premenstrual worsening of their physical wellbeing and mood. The symptom may vary month to month; being minimal in one month severe in other and moderate discomfort in some months. Some women also notice that the symptoms are less when they are on combined contraceptive pills. 3% of the affected women get these symptoms regularly and they may be so severe, that it cause major disruption to their lives. This syndrome is also known as Premenstrual tension or. PMT
What are the symptoms of PMS or PMT?
Tension, irritability, depression, bloating sensation, heaviness and tenderness in the breasts, headache, craving for carbohydrates, lack of sexual drive or, libido are the common symptoms. Many other bizarre symptoms may appear. To know whether one has PMS or, not it is essential to keep a diary of events. This diary will help the treating doctor to differentiate PMS with other disorders and will be helpful to find any psychological disturbance, she may be having. If she is having her symptoms worst premenstrual, she will have at least one week symptom free period after her menstruation.
How to treat Premenstrual syndrome (PMS)?
Reassurance is very important and she must understand this is not going to produce any serious disease or, cancer in future. Cooperation from the spouse and children is required to cope up with life. Find self help group support in the area. Improvement of diet, proper exercising, Yoga and rest, avoiding tobacco and alcohol will help. Herbal remedies though not tested properly some find them helpful. Try sage and fennel for irritability. Pyridoxine (Vitamin B6) 10 mg orally daily, either continuously or during the discomfort may help to elevate the mood and relive headache.
For severe cyclical pain in the breasts, cyclical mastalgia:
Avoid eating saturated fats as they increases the affinity of the oestrogen receptors for oestrogen.
Gamolenic Acid 160 mg orally 12 hourly
Bromcryptine 2.5 mg orally twice daily from 10th to 26th day of the cycle ( prescribed even when the prolactin level is within normal limit)
Danazol 100 – 200 mg 12 hourly orally for 7 days prior to menstruation.
Suppression of ovulation help in relieving symptoms in PMS
Yasmin a new entrant in combination pill is specially helpful to alleviate symptoms of PMS by suppressing ovulation.
Oestrogen Implants with cyclical progesterone is also used.
Danazol can also be given to suppress ovulation, but has other side effects like pimple, hair fall, weight gain etc.
Diuretics Spironolactone 25mg orally 6 hourly is also prescribed from 16th to 26th day of the cycle ( 1st day being the first day of menstruation) when there is excessive fluid retention.
Other than these alprazolam, mefenamic acid and other analgesics are used to treat PMS.
In intractable patients removal of uterus and ovaries may be done and results are 96% satisfactory. These women should receive oestrogen replacement (HRT) following their operation.
This article is also republished at India Study Channel
Saturday, December 13, 2008
Cyclical Pain Abdomen Related With Menstruation – Dysmenorrhoea
The commonest complain in my Out Patient Department I encounter from all age group of patients is cyclical pain associated with menstruation. The medical term for this condition is dysmenorrhoea. The condition is very common and most of the time, not always, it is nothing serious. In this article you will have some idea how and why such cyclical pain occurs and what one should do?
More than 90% of women some time or other, in their life experience pain during her menstruation. In clinical terms we have two types of dysmenorrhoea.
a) Primary dysmenorrhoea
b) Secondary dysmenorrhoea
Primary dysmenorrhoea : It is a condition where the girl/ woman having cyclical pain at menstruation, and on investigation no disease is found in the genital organs. This is the commonest form of dysmenorrhoea see in young adults. These usually appears within one to two years after girls starts menstruating and usually lasts for few years and in most cases subside after having a baby. Sometimes it may also continue up to 40 years of age.
Typically the pain starts few hours before or, at the onset of menstruation and last for 48 to 72 hours. The main is similar to labor pain to some extent. The affected girl have cramps in lower abdomen along with backache . Most girls can tolerate this very easily and none of their daily activities are hampered due to this. In few others, it is severe enough to detain her from normal activities and may be associated with nausea, vomiting, dizziness, headache and even fainting attack in severe cases.
Pain sensitivity varies with the individuals. Some can tolerate pain better than others. This may be one of the causes for such condition in some girls. The intensity of the process of pain may also be greater in few of them. Whatever may be the reason, be assured that this is not any dangerous condition and in no way it is going to affect her future sex life or child bearing.
Why pain during menstruation happens?
Prostaglandin, a chemical is produced while a girl is menstruating is the culprit for these symptoms. It produces contractions in the uterine muscles and affect the other organs to produce different kind of symptoms. Girls who are having increased sensitivity to prostaglandins get more symptoms.
What to do when I am in pain during my period (menstruation)?
If this problem is bearable and not detaining you from any activity of yours, don’t worry at all. Have nutritious food and do regular exercises and enjoy your life. In case, you are incapacitated for few days each month, you should visit a gynaecologist. He will probably order a ultrasonography to exclude any other problem in your genital organ. If nothing found abnormal, which is true for most cases, nothing to worry about.
Treatment of Primary dysmenorrhoea:
Analgesics work by inhibiting the prostaglandins, the culprit chemical causing this. Any nonsteroidal anti-inflammatory drug (NSAID) for 2 – 3 days (deliberately I am not writing the name – get it prescribed by your doctor) will relieve the symptoms. The common mistake done by many general practitioners, medicine shops, and the patient is they prescribe or take antispasmodics like Buscopan. This will not help alone. You have to take NSAID along with it.
Know about Secondary dysmenorrhoea here.
More than 90% of women some time or other, in their life experience pain during her menstruation. In clinical terms we have two types of dysmenorrhoea.
a) Primary dysmenorrhoea
b) Secondary dysmenorrhoea
Primary dysmenorrhoea : It is a condition where the girl/ woman having cyclical pain at menstruation, and on investigation no disease is found in the genital organs. This is the commonest form of dysmenorrhoea see in young adults. These usually appears within one to two years after girls starts menstruating and usually lasts for few years and in most cases subside after having a baby. Sometimes it may also continue up to 40 years of age.
Typically the pain starts few hours before or, at the onset of menstruation and last for 48 to 72 hours. The main is similar to labor pain to some extent. The affected girl have cramps in lower abdomen along with backache . Most girls can tolerate this very easily and none of their daily activities are hampered due to this. In few others, it is severe enough to detain her from normal activities and may be associated with nausea, vomiting, dizziness, headache and even fainting attack in severe cases.
Pain sensitivity varies with the individuals. Some can tolerate pain better than others. This may be one of the causes for such condition in some girls. The intensity of the process of pain may also be greater in few of them. Whatever may be the reason, be assured that this is not any dangerous condition and in no way it is going to affect her future sex life or child bearing.
Why pain during menstruation happens?
Prostaglandin, a chemical is produced while a girl is menstruating is the culprit for these symptoms. It produces contractions in the uterine muscles and affect the other organs to produce different kind of symptoms. Girls who are having increased sensitivity to prostaglandins get more symptoms.
What to do when I am in pain during my period (menstruation)?
If this problem is bearable and not detaining you from any activity of yours, don’t worry at all. Have nutritious food and do regular exercises and enjoy your life. In case, you are incapacitated for few days each month, you should visit a gynaecologist. He will probably order a ultrasonography to exclude any other problem in your genital organ. If nothing found abnormal, which is true for most cases, nothing to worry about.
Treatment of Primary dysmenorrhoea:
Analgesics work by inhibiting the prostaglandins, the culprit chemical causing this. Any nonsteroidal anti-inflammatory drug (NSAID) for 2 – 3 days (deliberately I am not writing the name – get it prescribed by your doctor) will relieve the symptoms. The common mistake done by many general practitioners, medicine shops, and the patient is they prescribe or take antispasmodics like Buscopan. This will not help alone. You have to take NSAID along with it.
Know about Secondary dysmenorrhoea here.
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