gps tracking by cell phone number parental phone tracking iphone 4s spy video app best spy app for rooted android best free undetectable spy software for android

Notes on menopause and its treatment

Natural menopause is the cessation of menstruation resulting from the loss of ovarian follicular activity and is diagnosed after 12 months of absence of a menstrual period (amenorrhœa).

Premature or early menopause occurs before the age of 40 (WHO). It can be both physiological and induced and involve a higher risk of osteoporosis, neurodegenerative diseases and cardiovascular problems. The International Menopause Society guidelines recommend HRT as the best preventive treatment (whether with estrogens alone, for women who have undergone hysterectomy, or combined estrogen and progesterone, or progestins to protect the endometrium in patients with a uterus).

Induced menopause can be determined by surgical removal of both ovaries (with or without hysterectomy) or by the suppression of ovarian function as a side effect of cancer treaments, such as chemotherapy, radiation, tamoxifen (WHO).

Premenopause is the period preceding menopause up to the first year after the last mentrual period (WHO).

Postmenopause is the period that follows the last menstrual period, regardless of the type of menopause (WHO).

To this list established and approved by the WHO in 1990, the International Menopause Society (IMS) has added, in 1999, the definition of climacteric, as a transition from the reproductive phase to the nonreproductive state.

HRT (Hormone Replacement Therapy) HRT (Hormone Replacement Therapy) is the prescription of estrogens alone (for hysterectomised women) or combined estrogen and progesterone for postmenopausal patients to fight the symptoms related to urogenital atrophy and, more importantly, the negative effects of sudden estrogen deficiency on the cardiovascular, skeletal and autonomic nervous systems. Specifically, the estrogen alone therapy is called Estrogen Replacement Therapy (ERT). 10–25% of women using systemic hormonal therapy continue to suffer from symptoms related to urogenital atrophy. This, in addition to fears concerning the safety of taking hormones, is why systemic therapy is seldom prescribed to women who suffer only from vaginal symptoms. Fears concerning the safety of taking hormones are related to cancer risks. The incidence of breast cancer throughout the life of a western woman can reach 10%, and acknowledged risk factors include the extensive use of estrogen or progestin hormonal therapies during menopause (HRT); similarly, estrogen alone therapy (ERT) administered to non-hysterectomised menopausal women is a risk factor for endometrial cancer. Vice-versa, epidemiological studies have shown a substantial reduction in the risk of colorectal cancer in women treated with HRT.

Vaginal or transdermal estrogen therapy – especially due to its beneficial effects on vaginal atrophy and the absence of systemic contraindication related to estrogen intake. Topical therapy is preferred over systemic therapy (in the event the latter is not required for other medical reasons). Estrogens are absorbed by the vaginal walls and enter into the circulation, except in the event of preparations designed to prevent their absorption. Potential adverse effects include breast, perineal pain and uterine bleeding (which should be reported immediately to your doctor). The treatment is contraindicated in some cases, such as in presence of vaginal/uterine bleeding of unknown nature or in women with endometrial cancer. Treatment of gynaecological or breast cancer can lead, in fact, to sexual dysfunctions, such as vaginal atrophy; however, most them are sensitive to hormones. In other cases (such as cervical squamous cell carcinoma), localised radiotherapy can reduce the number of estrogen receptors, making the topical therapy poorly effective. As of yet, there are no guidelines concerning the duration of vaginal estrogen treatments, after which symptoms reappear. Moreover, there is still no reliable data available on the use of this therapy for over 1 year.

Lubricants and moisturisers – In the event that estrogen preparations are either not indicated or not effective – vaginal lubricants and moisturising preparations, applied locally and consistently, can attenuate symptoms related to vaginal dryness. It is a mixture of soluble aqueous-based protective and restorative agents and nonhormonal substances, which have a beneficial effect on the vaginal epitelium. Nonhormonal therapies are especially indicated in women against hormonal therapies or in subjects at risk due to previous cancers sensitive to hormones.

Phytoestrogens. These are non-steroidal molecules of plant origin (soy and clover are the most common sources), which bind to estrogen receptors. Taken as food supplements, their absorption varies from person to person and, even in the same person, according to type of diet, interaction with antibiotics and the state of the gut flora. Hormonal interactions with these molecules are not limited to estrogens, but concern also other hormones, such as androgens and thyroid hormones. Natural products are not necessarily free from contraindications; on the other hand, there are not enough clinical data that demonstrate their effectiveness and safety during menopause. For example, we do not know if they are safe for patients with thyroid problems, since they have inhibitory effects on thyroid function. The risk-benefit ratio of phytoestrogens with respect to breast cancer is still much debated.