Climacteric and Hormonal Replacement Therapy (HRT)

A new stage in women’s lives

It is the period between the immediate previous stage to menopause and the subsequent 5 years.

It represents, in the same way as adolescence and maternity, a key stage in women’s lives.

These stages are characterized by physical facts, such as menarche (first menstruation) during adolescence, the delivery during maternity and menopause (cease of menstruation) during climacteric which takes place around the age of 45 to 50.

Nowadays, the woman spends a third of her life in the post-menopausal stage.
This represents, from the biological point of view, the end of a woman’s reproductive period and it is characterized by ovarian function declination (in charge of producing estrogens, progesterone, and few quantities of androgen during the fertile period).

From that fact on, a series of phenomena are triggered, some of them directly associated with the cease of hormone production and others involved in changes of lifestyle.

Actually, ovarian function declination starts some time earlier than the cease of menstruation. This is shown in irregularities in the menstrual cycles which precede menopause, such as short or too long cycles, the lack of some of them, etc. But it is the gynaecologist who must diagnose whether these symptoms belong to this phenomenon or to affections with similar signs and symptoms which correspond to severe pathologies.

During climacteric, some of the following symptoms may be present:
 

1. Cardiovascular
Suffocation or heat waves, perspiration, palpitations, chokes, arterial pressure volatility and headaches.
 

2. Psychical
Insomnia or sleepiness, anxiety, depression, affective instability and diminution of libido (sexual desire).
 

3. Gynaecological
Dyspareunia (pain during sexual intercourse), vaginal dryness and alterations of secondary sexual characters such as the fall of pubic hair.
 

4. Metabolic
Blood lipids alterations, osseous mass loss, and tendency to obesity.
 

I will analyze them following the same order above:
  

1.   Cardiovascular

The feeling of sudden heat in waves is called suffocation or heat wave, which is the most ostensible and frequent symptom among the ones which may appear during climacteric.

Suffocation appears abruptly, affecting face, arms and thorax. It lasts between 1 to 3 minutes and can be repeated many times a day or even at night. They are accompanied by reddening of the affected zones, sometimes with chokes and palpitations, and are followed by perspiration of variable intensity. They are strongly related to the woman’s previous personality and the influence of environmental factors. The worst thing about this symptom is the subjectivity of suffering from it.

It may also be accompanied by arterial pressure increase and headaches such as migraine (half of the head and face) which are not relieved with usual painkillers.
 

2.   Psychical

These symptoms are generally related to the environmental context or the family. They express a vital crisis. Apparently, the woman starts hating what she loves the most. In general, women who work outside the house endure this stage better than the ones who only work at home.
 

3.   Gynaecological

Vaginitis, directly related to the descent of circulating estrogens, is manifested through vulvar pruritus (itching) and vaginal dryness with pain and heat during sexual intercourses.

As time goes by, some other symptoms appear: repeated urinary infections, urinary incontinence or difficulties in urinary emissions and frequent desire to urinate. Not in the genital apparatus but directly related to feminine sexual characteristics we can also find, skin changes such as dryness, modifications of the voice, and hair increase getting masculine characteristics.
 

4.   Metabolic

4.1. Increase of cardiovascular risk

Risk is defined as the probability of a fact to occur. When we talk about risk factors, circumstances which increase the probability of an illness to develop are analyzed. Many studies have proved an increase of cardiovascular illnesses in women after menopause.

There seems to be a direct relationship between the diminution of estrogens production and the appearance of these kinds of disorders. However, not only estrogenic diminution is associated to the increase of cardiovascular illnesses, but also other risk factors such as arterial hypertension, sedentarism, addiction to tobacco, alcohol consumption, and unhealthy diets are involved.

 
4. 2. Osteoporosis

The bone, unlike it is believed, is a tissue which is permanently renewed. The osseous mass is continuously incremented during childhood and adolescence, reaching its peak around the age of 30 to 35.

During the previous years to menopause the woman experiments a process of diminution of the corporal osseous tissue, directly related to the fewer amount of estrogens produced, which have a protective effect on bones. This diminution of corporal osseous tissue predisposes to the development of fractures whose risk factors are:

a) Antecedents of osteoporosis in the family

b) Thin physical constitution

c) Precocious menopause (before the age of 40) or surgical menopause (due to ovary extirpation)

d) Sedentarism (not much physical activity)

e) Little calcium ingestion in the diet

f) Addiction to tobacco

g) Illnesses such as hyperthyroidism and renal insufficiency

h) Treatments with corticoids, insulin, some antiepileptic medicines, etc

i)  Alcohol, caffeine or cola soft drinks consumption

In this group of women, the inquiry should be precocious but prudent since menopause is not = osteoporosis.

The most common clinical expressions of osteoporosis are:

o        Back-lumbar pain due to vertebral flattening
o        Wrist fracture
o        Femur fracture (after the age of 60)

We frequently meet 60 year-old people or older who have suffered hip fracture, but we also see very often ladies who suffer spine curving progressing with time. This is a direct consequence of vertebral flattening which can and must be prevented.

4.3. Obesity

Post menopausal obesity is due to the increase of estrogens production (masculine hormone) by the ovary, which increases corporal mass and promotes the appearance of hair in places where it didn’t exist before, with similar characteristic to the masculine one.
In some occasions, there is a clear increase in food consumption, attributed in many cases to psychical stress: anxiety because of changes taking place which are unknown by women beforehand.
 

HORMONAL REPLACEMENT THERAPY (HRT)
 

Medical consultation is generally important at this stage to get information about what is happening to us, among other reasons.

This consultation must be constituted by:

The Hormonal Replacement Therapy can be administered in two ways. Using progestogen cyclically (estrogens first and then progesterone), case in which menstruation is produced, or continuously (estrogens and progesterone during the whole month), case in which there wouldn’t be endometrial desquamation and therefore either menstruation.

In both cases the endometrium is protected, for this reason it is difficult to say which one is the best, having both the same therapeutic aim.

Uninterrupted and regular physical exercise, the sun at convenient hours and a rich diet in calcium and D vitamin, are menopausal women best allies.

Another good alternative is Homeopathic medicine since it will help the woman not only improve the specific symptoms of menopause but also equilibrate the physical, mental and emotional functions of her own organism.

I consider that after receiving appropriate and complete information from the doctor, it is the patient who has to decide how to go through this stage, either in a natural way according to the time approaching or by receiving HRT.

However, there are some cases in which the HRT cannot depend on the patient’s will because it is medically prescribed.

The cases in which HRT is prescribed are:

• Precocious, spontaneous or natural menopause

• Artificial precocious menopause (chemical or surgical)

• Preventive menopause: in patients with high cardiac risk or osteoporosis due to severe antecedents.

There are some other cases in which beyond the patient’s election, HRT is contraindicated. Those cases are:
 

• Mammary pathology: fibrocystic illness.

• Breast cancer antecedents

• Breast cancer.

• Endometrial cancer antecedents

• Endometrial cancer

• Endometrium in activity

• Pathology of endometrium

• Metrorrhagia with unknown reasons

• Antecedents of Thrombophlebitis

• Circulatory pathology

• Hepatopathies

• Melanoma

• Myoma or fibroid in progress

• Addiction to tobacco

Normally, menopause appears at a woman’s age in which her body is naturally ready not to continue being influenced by the hormonal stimulus as it used to be during reproductive periods.

I think that we shouldn’t forget the harm we may produce in certain tissues such as the mammary glands or the endometrium, when demanding them to keep suffering cellular transformations month after month, in a period of life in which they should rest.

Besides, the Hormonal Replacement Therapy is a therapeutic prescribed during 5 years until more than 10.
Perhaps, a more respectful election with the own body and nature are other more natural methods and the acceptance of this stage of life when it comes at the right time…neither precocious nor late.
 

Life and eating habits (see article on Menopause)

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