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Line 255: − + − + − Investigations+ − • Vaginal cytology: showing maturation index of at least 10/85/5 (features of low estrogen)+ − • Serum estradiol: <20 pg/ml+ − • Serum Follicle Stimulating Hormone (FSH) and Luteinizing hormone (LH) :>40mIU/ml (three values at weeks interval required)+ − + − + + + + + + + + + − • Oral estrogen regime- for those who underwent hysterectomy+ − • Estrogen and cyclic progestin – for those with intact uterus+ − • Continuous estrogen and progestin therapy-prevents endometrial hyperplasia+ − • Transdermal administration+ − • Subdermal implants+ − • Percutaneous estrogen gel+ − • Transdermal patch+ − • Vaginal cream+ − • Progestins- in patients with a history of breast carcinoma or endometrial carcinoma+ − • Levonorgestrel intrauterine system(LNG-IUS)+ − • Tibolone, Testosterone, parathyroid hormone are also used.+ + + + + + + + + + + + + − + + + − + − • Premature menopause: Occurrs before the age of 40 years.+ − • Delayed menopause: Fails to occur even beyond 55 years.+ − • Artificial menopause: Permanent cessation of ovarian functions done by artificial means.+ − + − • Menstruating women with bilateral oophorectomy experience the symptoms of menopause+ − • Post-hysterectomy cases+ − + − • Ovarian functions may get suppressed by external gamma radiation.+ − • Intra cavity introduction of radium can destroy the endometrium and depress ovarian functions.+ + + + + + + + + + + − • The modified Kupperman index, Menopause Rating Scale(MRS), MENQOL Questionnaire, etc. are the most widely used and internationally accepted scales used for research related to menopause and associated conditions. + − • The role of complementary and alternative therapies is well known in managing menopausal symptoms. A systematic review and meta-analysis of randomized controlled clinical trials (RCTs) showed yoga therapy is effective and safe for reducing menopausal symptoms. + − • A clinical trial was conducted to evaluate the efficacy of Shirodhara and Saraswatarishta compared to hormone replacement therapy (HRT) in the management of the menopausal syndrome. The study showed promising results, especially in managing the psychological symptoms related to menopause. + − • Various research studies have shown the efficacy of rejuvenation therapy(rasayana) using the oral administration of different herbal drugs. [Ref?? ]Some studies are being conducted on a combination of procedures like therapeutic enema (basti), nasal administration (nasya) etc. + + + + + + + + − 5. Ajay Sood (2000) : Comparative study between Rasayanakalpavati and Shankhapushpavati in clinical Study on Rajonivrutti, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.+ + + + + + + + + + + + + + + + + + − + − + − + + + + + + + + + − + + + + + + + + +
Menopausal Syndrome (view source)
Revision as of 00:25, 24 September 2021
, 00:25, 24 September 2021→References
==Contemporary approach==
==Contemporary approach==
Diagnosis of menopause:
=== Diagnosis of menopause ===
A woman is noted to have attained menopause only retrospectively. It is diagnosed when there is cessation of menstruation for 12 consecutive months in a woman of the climacteric period.
A woman is noted to have attained menopause only retrospectively. It is diagnosed when there is the cessation of menstruation for 12 consecutive months in a woman of the climacteric period.
'''Investigations'''<ref>D.C Dutta,D.C Dutta’s text book of gynaecology, edited by Hiralal Konar, Menopause, Jaypee brothers medical publishers, New delhi, edition 8, 2015, chapter 6, page no:49.</ref>
Management
*Vaginal cytology: showing maturation index of at least 10/85/5 (features of low estrogen)
Hormone Therapy (HT)
*Serum estradiol: <20 pg/ml
*Serum Follicle Stimulating Hormone (FSH) and Luteinizing hormone (LH) : >40mIU/ml (three values at weeks interval required)
===Management===
'''Hormone Therapy (HT)'''
It is indicated to overcome the short-term and long-term consequences of estrogen deficiency.
It is indicated to overcome the short-term and long-term consequences of estrogen deficiency.
It is administered in different forms like:
It is administered in different forms like:
*Oral estrogen regime- for those who underwent hysterectomy.
*Estrogen and cyclic progestin – for those with intact uterus.
*Continuous estrogen and progestin therapy-prevents endometrial hyperplasia
*Transdermal administration
*Subdermal implants
*Percutaneous estrogen gel
*Transdermal patch
*Vaginal cream
*Progestins- in patients with a history of breast carcinoma or endometrial carcinoma
*Levonorgestrel intrauterine system(LNG-IUS)
*Tibolone, Testosterone, parathyroid hormone are also used.
Hormone therapy has many risks like endometrial cancer, breast cancer, venous thromboembolic disease, coronary heart disease, alteration in lipid metabolism etc. So, it is to be used with lowest effective dose and for a short period of time.
Hormone therapy has many risks like endometrial cancer, breast cancer, venous thromboembolic disease, coronary heart disease, alteration in lipid metabolism etc. So, it is to be used with lowest effective dose and for a short period of time.
Non-hormonal Treatment
'''Non-hormonal Treatment'''
It includes a nutritious diet, exercise, lifestyle modification, supplementation of calcium, vitamin D, vitamin E etc.
It includes a nutritious diet, exercise, lifestyle modification, supplementation of calcium, vitamin D, vitamin E etc.
Abnormal Menopause:
===Abnormal Menopause===
*Premature menopause: Occurrs before the age of 40 years.
a) Surgical menopause-
*Delayed menopause: Fails to occur even beyond 55 years.
*Artificial menopause: Permanent cessation of ovarian functions done by artificial means.
b) Radiation menopause-
'''a) Surgical menopause-'''
*Menstruating women with bilateral oophorectomy experience the symptoms of menopause.
*Post-hysterectomy cases
'''b) Radiation menopause-'''
*Ovarian functions may get suppressed by external gamma radiation.
*Intra cavity introduction of radium can destroy the endometrium and depress ovarian functions.
==Current Research==
==Current Research==
*The modified Kupperman index, Menopause Rating Scale(MRS), MENQOL Questionnaire, etc. are the most widely used and internationally accepted scales used for research related to menopause and associated conditions.<ref>MinFang Tao et al, Correlation between the modified Kupperman Index and the Menopause Rating Scale in Chinese women, Patient Preference and Adherence 2013:7 223–229.</ref> <ref>T. Gazibara, N. Kovacevic, S. Nurkovic, I. Kurtagic, S. Radovanovic, B. Rancic, M. Terzic & J. Dotlic (2018): Menopause-specific Quality of Life Questionnaire: factor and Rasch analytic approach, Climacteric, DOI: 10.1080/13697137.2018.1535585</ref>
*The role of complementary and alternative therapies is well known in managing menopausal symptoms. A systematic review and meta-analysis of randomized controlled clinical trials (RCTs) showed yoga therapy is effective and safe for reducing menopausal symptoms.<ref>Cramer H, Peng W, Lauche R. Yoga for menopausal symptoms-A systematic review and meta-analysis. Maturitas. 2018 Mar;109:13-25. doi: 10.1016/j.maturitas.2017.12.005. Epub 2017 Dec 6. PMID: 29452777.</ref>
*A clinical trial was conducted to evaluate the efficacy of Shirodhara and Saraswatarishta compared to hormone replacement therapy (HRT) in the management of menopausal syndrome. The study showed promising results, especially in managing the psychological symptoms related to menopause.<ref>Santwani K, Shukla VD, Santwani MA, Thaker G. An assessment of Manasika Bhavas in menopausal syndrome and its management. Ayu. 2010;31(3):311-318. doi:10.4103/0974-8520.77156</ref>
*Various research studies have shown the efficacy of rejuvenation therapy(rasayana) using the oral administration of different herbal drugs.<ref>Krithika Chaudhary, A clinical study on Menopausal syndrome and its management by Vayasthapanagana Ghana Vati and Rasayanakalpa Vati’, PG Thesis,Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar,2015.</ref> Some studies are being conducted on a combination of procedures like therapeutic enema (basti), nasal administration (nasya) etc.
==List of thesis works done==
==List of thesis works done==
1. Deena Raval (1974): Rajonivrutti Ek Adhyayana , Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
1. Deena Raval (1974): Rajonivrutti Ek Adhyayana , Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
2. Kritidevi Gohil(1995): A Clinical Study on Rajonivrutti with special reference to Menopausal syndrome, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
2. Kritidevi Gohil(1995): A Clinical Study on Rajonivrutti with special reference to Menopausal syndrome, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
3. Kritidevi Gohil (1998): A Clinical Study on the management of climacteric stage in women with special reference to Menopausal syndrome by using certain Ayurvedic formulations; Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
3. Kritidevi Gohil (1998): A Clinical Study on the management of climacteric stage in women with special reference to Menopausal syndrome by using certain Ayurvedic formulations; Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
4. Shipra Dhar (1999.): Effect of Vacha, Ashwagandha, Ulatakambala and Jatamansi on Menopausal Syndrome , Department of Prasuti tantra and stree roga,IMS,BHU,Varanasi
4. Shipra Dhar (1999.): Effect of Vacha, Ashwagandha, Ulatakambala and Jatamansi on Menopausal Syndrome , Department of Prasuti tantra and stree roga,IMS,BHU,Varanasi
5. Ajay Sood (2000) : Comparative study between Rasayanakalpavati and Shankhapushpavati in clinical Study on Rajonivrutti, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
6. Ami Modi (2000) : A comparative pharmaco-clinical study of Rasayanakalpavati and Mamsyadivati on Rajonivrutti Avasthajanyalakshana, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
6. Ami Modi (2000) : A comparative pharmaco-clinical study of Rasayanakalpavati and Mamsyadivati on Rajonivrutti Avasthajanyalakshana, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
7. Sunitha (2001) : Study on Ayurvedic concept of pathogenesis of Perimenopausal Syndrome & Evaluation of efficacy of a Rasayana Compound in its Management , Department of Prasuti tantra and stree roga ,NIA, Jaipur.
7. Sunitha (2001) : Study on Ayurvedic concept of pathogenesis of Perimenopausal Syndrome & Evaluation of efficacy of a Rasayana Compound in its Management , Department of Prasuti tantra and stree roga ,NIA, Jaipur.
8. ManjuPateria (2002) : A clinical study on Manasa Bhavas in Menopausal syndrome and its management by Medhyarasayanavati and Shirodhara, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
8. ManjuPateria (2002) : A clinical study on Manasa Bhavas in Menopausal syndrome and its management by Medhyarasayanavati and Shirodhara, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
9. Kaushal kamini (2002); Pharmacological of Varadadi Yoga w.s.r to Post Menopausal Syndrome; Department of Prasuti tantra and stree roga ,NIA, Jaipur.
9. Kaushal kamini (2002); Pharmacological of Varadadi Yoga w.s.r to Post Menopausal Syndrome; Department of Prasuti tantra and stree roga ,NIA, Jaipur.
10. Shaini M Bhaskar (2002): Study on the efficacy of Satavari Gopakanyadi Kwatha in Rajonivruttijanya Lakshana; Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
10. Shaini M Bhaskar (2002): Study on the efficacy of Satavari Gopakanyadi Kwatha in Rajonivruttijanya Lakshana; Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
11. Umesh K Agarwal (2003): .Study on the effect of Satavari in Rajonivrutti Lakshanas, Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
11. Umesh K Agarwal (2003): .Study on the effect of Satavari in Rajonivrutti Lakshanas, Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
12.Devangi Patel (2004) :The role of Nasya (with Medhya drug) in the Rajonivruttijanyalakshana w.s.r to Menopausal syndrome, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
12.Devangi Patel (2004) :The role of Nasya (with Medhya drug) in the Rajonivruttijanyalakshana w.s.r to Menopausal syndrome, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
13. Tellus Kurian (2004.): Clinical trial to evaluate the efficacy of Balasatavari Kwatham and Bala Tailam ointment in vaginal symptoms in women who attained menopause; Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
13. Tellus Kurian (2004.): Clinical trial to evaluate the efficacy of Balasatavari Kwatham and Bala Tailam ointment in vaginal symptoms in women who attained menopause; Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
14. Usha Koli (2005): Pharmacognostic and Pharmacological Evaluation of Gauryadi Yoga w.s.r. to Post Menopausal Syndrome, Department of Prasuti tantra and stree roga ,NIA, Jaipur.
14. Usha Koli (2005): Pharmacognostic and Pharmacological Evaluation of Gauryadi Yoga w.s.r. to Post Menopausal Syndrome, Department of Prasuti tantra and stree roga ,NIA, Jaipur.
15.Jasmine Japee(2006):A clinical study on the role of Satavari in minimizing the risk of post-menopausal osteoporosis; Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
15.Jasmine Japee(2006):A clinical study on the role of Satavari in minimizing the risk of post-menopausal osteoporosis; Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
16. Kavita MB (2006) : Effect of Pranayama on Arthavanivritti W.S.R. to Climatric features; ; Department of Prasuti tantra and stree roga,SDMCA,Hassan , Karnataka.
16. Kavita MB (2006) : Effect of Pranayama on Arthavanivritti W.S.R. to Climatric features; ; Department of Prasuti tantra and stree roga,SDMCA,Hassan , Karnataka.
17.Khyati Santavani (2009) :An assessment of Manasikabhavas in Menopausal syndrome and its management, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
17.Khyati Santavani (2009) :An assessment of Manasikabhavas in Menopausal syndrome and its management, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
18. Rituja Trivedi (2009): A clinical–Experimental study of Shatavaryadi Vati on Menopausal Syndrome (Rajonivruttijanyalakshana), I.P.G.T & R.A G.A.U Jamnagar.
18. Rituja Trivedi (2009): A clinical–Experimental study of Shatavaryadi Vati on Menopausal Syndrome (Rajonivruttijanyalakshana), I.P.G.T & R.A G.A.U Jamnagar.
19. Bharathi (2009): Evaluation of “AVA” Formula in the Management of Rajonivrutti Lakshana (Post-Menopausal Syndrome), Department of Prasuti tantra and stree roga ,NIA, Jaipur.
19. Bharathi (2009): Evaluation of “AVA” Formula in the Management of Rajonivrutti Lakshana (Post-Menopausal Syndrome), Department of Prasuti tantra and stree roga ,NIA, Jaipur.
20. Meera Ravindran (2009): A clinical trial to assess the combined effect of Sukumara Kashayam and Shasthika Taila in Menopausal Vaginal symptoms, Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
20. Meera Ravindran (2009): A clinical trial to assess the combined effect of Sukumara Kashayam and Shasthika Taila in Menopausal Vaginal symptoms, Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
21. Mamatha Rani (2011): Clinical Study on the Role of Menosol Compound in the Management of Menopausal Syndrome, Department of Prasuti tantra and stree roga ,NIA, Jaipur.
21. Mamatha Rani (2011): Clinical Study on the Role of Menosol Compound in the Management of Menopausal Syndrome, Department of Prasuti tantra and stree roga ,NIA, Jaipur.
22.Mansi Modi (2012): Clinical evaluation of Ashokarishta, Ashwagandhachurna and Pravalpishti in the management of Menopausal syndrome, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
23. Neeta Kumari(2012) :Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval pishti in the management of Menopausal Syndrome, Department of Prasuti tantra and stree roga ,NIA, Jaipur.
22.Mansi Modi (2012): Clinical evaluation of Ashokarishta, Ashwagandhachurna and Pravalpishti in the management of Menopausal syndrome, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar, Multi centric trial by C.C.R.A.S.,New Delhi.
24. Charulata (2012) : Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the management of Menopausal Syndrome; RGGPGAYC, Paprola.
23. Neeta Kumari(2012) :Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval pishti in the management of Menopausal Syndrome, Department of Prasuti tantra and stree roga ,NIA, Jaipur,Multi centric trial by C.C.R.A.S.,New Delhi.
24. Charulata (2012) : Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the management of Menopausal Syndrome; RGGPGAYC, Paprol, Multi centric trial by C.C.R.A.S.,New Delhi.
25.Dipika Gupta (2013) : Role of Ashwagandha Arjuna Ksheerapaka and Soya Seeds in the management of Vata predominant features of Menopausal Syndrome; Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
25.Dipika Gupta (2013) : Role of Ashwagandha Arjuna Ksheerapaka and Soya Seeds in the management of Vata predominant features of Menopausal Syndrome; Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
26. Shrawan N Kamble (2014) : Study on Pitta predominant Menopausal syndrome and its management with Sodhana and Shamana therapy, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
26. Shrawan N Kamble (2014) : Study on Pitta predominant Menopausal syndrome and its management with Sodhana and Shamana therapy, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
27. Krithika Chaudhary (2015.): “A clinical study on Menopausal syndrome and its management by Vayasthapanagana Ghana Vati and Rasayanakalpa Vati’, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
27. Krithika Chaudhary (2015.): “A clinical study on Menopausal syndrome and its management by Vayasthapanagana Ghana Vati and Rasayanakalpa Vati’, Department of Prasuti tantra and stree roga, IPGT &RA, Jamnagar.
28. T. R. Thanga selva kumara (2016): Comparative clinical study between Lashuna and Shatavari in minimizing the risk of postmenopausal osteoporosis, Department of Prasuti tantra and stree roga, Parul institute of Ayurveda, Gujarat.
28. T. R. Thanga selva kumara (2016): Comparative clinical study between Lashuna and Shatavari in minimizing the risk of postmenopausal osteoporosis, Department of Prasuti tantra and stree roga, Parul institute of Ayurveda, Gujarat.
29. Anusree K M (2017): Effect of Yashtimadhu Churna with Ksheera in Perimenopausal Symptoms, Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
29. Anusree K M (2017): Effect of Yashtimadhu Churna with Ksheera in Perimenopausal Symptoms, Department of Prasuti tantra and stree roga, Govt. Ayurveda College, Thiruvananthapuram.
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