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Journalism of Courage
Before menopause, the female sex hormones, estrogen and progesterone, produced in the ovaries control the menstrual cycle. Dr. Kala Vashisht, Professor at the Department of Obstetrics and Gynecology, PGI, explains, 8220;As menopause approaches, the production of estrogen and progesterone gradually stops. Monthly periods become irregular until they finally cease.8221;
Menopause brings various changes in the body due to the depleted levels of these hormones. While for some women the transition is smooth, others experience hot flushes, night sweats, palpitations, joint and muscle pain, insomnia, and in some cases, even fatigue and depression. An increased incidence of heart attacks, strokes and osteoporosis also figures among the manifestations of menopause. 8220;The presence of estrogen in pre-menopausal women provides some protection against cardiovascular disorders. At menopause, women lose the natural protection and develop cardiovascular problems,8221; says Dr. Vashisht. Calcium depletion of the bones is also commonly associated with lack of estrogen and is often identified by the increasing incidence of fractures.
Hormone Replacement Therapy HRT is prescribed to alleviate these effects by restoring the requisite levels of the depleted hormones in women entering or already experiencing menopause.
8220;However, if estrogen alone is replaced Estrogen Replacement Therapy there is an increase in the risk of cancer of the uterus and endometrium lining of the uterus. Adding progestin, a synthetic form of progesterone to the treatment brings the risk of these cancers down,8221; reveals Dr. Vashisht.
HRT8217;s combined tablet treatment simply involves one tablet a day regime. 8220;By restoring estrogen through oral HRT, studies have shown that the risk of heart disease is reduced by 50 per cent,8221; says Dr. Vashisht. Most women feel that their fitness, energy levels and skin improve with HRT. Sushmita Malik who was recommended ERT after she underwent a hysterectomy says, 8220;Not only did the post-operative symptoms like hot flushes and insomnia disappear, the treatment proved to be an effective mood-elevator.8221;
However, HRT is not without risks and not recommended for all women. 8220;There has been some concern about the possible risk of breast cancer with HRT. The studies, however, are inconclusive,8221; says Dr. Vashisht.
8220;Tests are conducted to check before HRT can be safely administered. Some women do have side effects such as headaches, nausea or weight gain due to HRT.
But does HRT recommence the menstrual cycle? 8220;Taking estrogen for the first part of the cycle and progestin during the latter part may cause bleeding every month, much like a menstrual period. However, taking both the hormones everyday, throughout the month solves this problem.
Another option is Estraderm patches that are attached to the abdomen and deliver estrogen directly through the skin into the blood. 8220;Estrogen delivered this way bypasses the liver and reduces the aggravating effect HRT can have on the liver and gallbladder,8221; says Dr Dipika Loganey, a practicing obstetrician and gynecologist. 8220;The potential pros and cons of HRT need to be carefully weighed as there are some controversies attached with it,8221; counsels Dr. Vashisht.
HRT finds support in the view that replacing hormones delays some of the diseases associated with ageing. Conventional opinion holds that menopause is a natural event and should not be treated as a hormone deficiency disease.
