Recently at The Indian Menopause Society, it was unequivocally agreed that around menopause (maybe a few years before, during and until about 7 years after the cessation of menstruation),women tend to experience a conundrum of symptoms that need special attention and careful analysis.
Hormonal imbalance, fluctuations in neurotransmitter levels, deranged metabolic activity and sudden transformation in physical characteristics are amongst the many changes that punctuate this delicate period. Besides outwardly manifesting as abnormal fat distribution (hips and stomach), alteration of skin and hair colour, varicosities in the legs etc, there are other initially subtle and later full blown symptoms, that need to be defined.
The exacerbation of hitherto controlled migraines, increased blood pressure, the association of water retention and consequential bloating accompanying delayed periods and the evaporation of these symptoms on its arrival, are other frequent complaints. Hot flushes comprise a spectrum of symptoms—the classical being the feeling of severe warmth searing through the chest and trunk in a wave form, recurring and passing off in short spells. Husbands reporting the inexplicable use of air conditioners in winter, patient's desire to shed tight garments and a craving for ice, are some variations.
These when associated with palpitations (feeling the heart beat),headache and giddiness, comprise the so called 'Vasomotor Symptoms'. The concomitant presentation of mood swings then leads to a very volatile and trying time for the patient and her family.
It is these very symptoms that harass the patient and send her from pillar to post i.e. from physician to cardiologist and neuro to psychiatrist. The treatment of this relentless suffering during this phase is Hormone Replacement therapy (HRT) and is a matter of much debate. HRT in the younger, menopausal patient with more symptsoms and less co-morbidities (hypertension, diabetes etc) is seen to be safe and beneficial. They are able to tolerate therapy and even shrug off these handicapping tribulations with ease and merge into the fifties with grace. Their chances of developing blood clotting disorders and other complications is less.
Having said that I must add that HRT is NOT for all and can have serious side effects especially when started late or in older women or in women with coexisting medical conditions and obesity. Unsupervised HRT can lead to premalignant changes and complications, so the dictum is - consume only under STRICT medical surveillance.
Antagonists may argue that women over generations have aged effortlessly without medication. Science recommends that in the 'fairness' of things, every member of the 'fairer' sex should be offered the pros and cons of HRT and then allowed to 'fare' well with the decision.
The journey at that crossroad of life does not need a pharmacological prop alone, but a mental bridge, a metabolic boost and a psychological ladder to ascend the transition between the '2 States' with care, cure and comfort.
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