MANAGEMENT FOR MENOPAUSAL HEALTH
Family Support to Women during Menopause
Family support during menopause involves active listening, emotional validation, and practical help, such
as sharing responsibilities and encouraging a healthy lifestyle.
Open communication is key to understanding individual needs as menopause affects everyone differently.
This support can help reduce stress and improve a woman's overall well-being and coping abilities during
this life transition.
Practical and Emotional Support
Communicate and listen
Help with responsibilities
Encourage a healthy lifestyle
Consider practical assistance
Provide words of encouragement
Involve them in activities; invite them to social activities to help them feel connected and good about
themselves.
UNDERSTANDING THE TRANSITION
Recognize the Stress: Understand that menopause often occurs during a stressful "sandwich" period,
where women may be balancing their careers, caring for children, and looking after aging parents.
Be Patient: Recognize that physical symptoms like hot flashes and emotional changes like mood swings
can be difficult and may impact daily life.
Respect the Individual Experience: Avoid making assumptions about what they are going through.
Symptoms and their severity vary significantly from person to person.
Support Sexual Well-being: Be supportive regarding sexual health, understanding that changes in desire
or satisfaction can be a common complaint due to hormonal shifts.
HORMONE THERAPY
The Hormone Therapy (HT) is indicated in menopausal women to overcome the short-term and long-term
consequences of estrogen deficiency.
Indications of Hormone Therapy
Relief of menopausal symptoms
Relief of vasomotor symptoms
Prevention of osteoporosis
To maintain the quality of life in menopausal years
Special Group of women to whom HT should be prescribed:
Premature ovarian failure
Gonadal dysgenesis
Surgical or radiation menopause
Benefits of Hormone Therapy
Improvement of Vasomotor Symptoms
Improvement urogenital atrophy
Increase in bone mineral density (2-5\%)
Decreased risk in vertebral and hip fractures (25-50\%)
Reduction in colorectal cancer (20\%)
Possibly cardioprotection
RISK OF HORMONE THERAPY
Endometrial Cancer: When estrogen is given alone to a woman with an intact uterus, it causes
endometrial proliferation, hyperplasia, and carcinoma. It is therefore advised that a progestin should be
added to Estrogen Replacement Therapy (ERT) to counterbalance such risks.
Breast Cancer: Combined estrogen and progestin Replacement Therapy for a long-term increases the risk
of breast cancer slightly (RR 1.26). Adverse effects of Hormone Therapy are related to the dose and
duration of therapy.
Venous Thromboembolic (VTE) disease: Has been found to be increased with the use of Combined oral
estrogen and progestin. Transdermal estrogen use does not have the same risk compared to oral estrogen.
Coronary Heart Disease (CHD): Combined HT therapy shows a Relative Hazard (RR 1.29) of CHD.
Hypertension has not been observed to be a side effect of HT.
CONTRAINDICATIONS TO HORMONE THERAPY
Known, suspected, or history of breast cancer
Undiagnosed genital tract bleeding
Estrogen-dependent neoplasm in the body
History of venous thromboembolism or active deep vein thrombosis (DVT)
Active liver disease
Prior cholestatic jaundice (Caution)
Gallbladder disease
Prior endometriosis (Caution)
AVAILABLE PREPARATIONS FOR HORMONE THERAPY
The principal hormone used in HRT (Hormone Replacement Therapy) is estrogen.
This is ideal for a woman who has had her uterus removed (hysterectomy) already. But in a woman with
an intact uterus, only estrogen therapy leads to endometrial hyperplasia and even endometrial carcinoma.
Addition of progestin for the last 12-14 days each month can prevent this problem.
HORMONE THERAPY DETAILS AND DURATION
Commonly used estrogens are Conjugated estrogen (C 0.625 - 1.25 \text{ mg}/\text{day}) or micronized
estradiol (1-2 \text{ mg}).
Progestins used are medroxyprogesterone acetate (\text{MPA}) (2.5 - 5 \text{ mg}/\text{day}),
micronized progesterone (100 - 300 \text{ mg}/\text{day}) or dydrogesterone (5 - 10
\text{ mg}/\text{day}).
\rightarrow Considering the risks, Hormone Therapy should be used with the lowest effective dose and for
a shortest period of time. Low-dose oral conjugated estrogen 0.3 \text{ mg} daily is effective and has got
minimal side effects. Dose interval may be modified as daily for initial 2-3 months, then it may be
changed to every other day for another 2-3 months, and then every third day for the next 2-3 months.
\rightarrow It may be stopped thereafter if symptoms are controlled.
DURATION OF HT USE
Generally, use of HT for a shortest period as long as the benefits outweigh the risks. Individual women
need counselling with annual or semi-annual review. Reduction of dosage should be done as soon as
possible. Menopausal women should maintain optimum nutrition, ideal body weight, and perform regular
exercises.
MONITORING HORMONE THERAPY
Individual women should be informed with updated knowledge as regards the relative merits and possible
risks of continuing HT (Hormone Therapy).
MONITORING PRIOR TO AND DURING HORMONE THERAPY
A base level parameter of the following and their subsequent checkup (at least annually) are mandatory:
Physical examination including pelvic examination.
Blood pressure recording.
Breast examination and Mammography (\text{CP} \cdot 475).
Cervical cytology (\text{CP} \cdot 87).
Pelvic ultrasonography (TVS) to measure endometrial thickness (Normal \le 5 \text{ mm}).
\rightarrow Any irregular bleeding should be investigated thoroughly (Endometrial biopsy, hysteroscopy).
\rightarrow The ideal serum level of estradiol should be 100 \text{ pg}/\text{ml} during HT therapy.
Serum level of estradiol is useful to monitor the HT therapy rather than that of serum FSH.
