Hormone Replacement Therapy
HRT involves administration of estrogen and progesterone hormones to counteract their dipping levels during menopause. Earlier ERT (Estrogen Replacement Therapy) was followed but this is now replaced by combined hormone therapy. HRT provides relief from symptoms such as increased fatigue and irritability and depression. Hormone Replacement Therapy is usually followed for a few months or a couple of years.
HRT is known to prevent or alleviate any bone loss that leads to osteoporosis. Women who have been on HRT experience enhanced sexuality and improved pelvic floor muscles. It may prove beneficial in preventing Alzheimer's disease and macular degeneration. Cyclic hormone therapy involves taking estrogen pills for 25 days, switching to progestin in between 10 - 14 days and then taking a combined pill for the next 25 days. Stopping the HRT for about 4 days brings on the menstrual bleeding.
The other form of adminstering HRT is continous or combined therapy - whereby estrogen and progestin are taken everyday in combined form. Women on HRT complain of a bloated feeling as well as terrible headaches and fluid retention.
HRT Side Effects
Some women experience post-menopausal bleeding when on HRT. Tender and swollen breast are yet another side effect of HRT. Swelling of the legs and increased weight are also noticed by women on HRT. Other associated risks of HRT are increased incidence of venous thrombosis or worsening of any existing liver condition. Long-term use of HRT is associated with breast cancer.
HRT patch
An HRT patch is an alternative to hormone tablets and vaginal creams. When ingested in tablet form, the hormone moves from the stomach and intestines to your liver. This necessitates higher dose of estrogen to be administered. HRT patches allow the skin to absorb estrogen through the bloodstream. HRT patches are worn on any location below your waist.
But it must never be applied on or near the breasts. Women suffering from sore or irritated skin must not use HRT patches. Vaginal creams containing estrogen are yet another method of administering HRT. This reduces the feeling of dryness experienced by most peri-menopausal women.
Surgical menopause
The ovaries produce estrogen, progesterone and androgens to regulate the menstrual cycle. When a hysterectomy occurs, these hormones get suddenly interrupted and their levels fall resulting in symptoms of menopause. This is termed surgical menopause. Although removal of ovaries becomes unavoidable in most hysterectomy surgeries, every effort is made by the surgeon to leave the ovaries intact in order to avoid the sudden absence of hormones. Most often, surgical menopause is caused quite dramatically when there is surgical interference like hysterectomy, bilateral oophorectomy, where both the ovaries are removed. A woman undergoing surgical menopause experiences certain symptoms more profoundly than women going through menopause normally. Since there is abrupt disruption of hormones after hysterectomy, the menopausal symptoms are more severe, more frequent and last longer when compared to natural menopause. The symptoms are triggered by the body's sudden inability to make certain hormones due to the removal of ovaries.
Estrogen is immediately given after surgery to try to prevent the intense changes especially the hot flashes that can occur in woman undergoing hysterectomy. However the use of estrogen is itself controversial and it is not usually recommended for women with existing or high risk of cardiovascular disease. A lowest dose of estrogen for the shortest possible time is recommended.
Surgical menopause risks
- Women with surgical menopause are seven times more prone to cardiovascular disease risks.
- They run the risk of osteoporosis as estrogen plays a vital role in bone formation.
- Gum tissues are affected and regular dental check ups are advised to tide over this problem.
- Women younger than 45 years and who have had their ovaries removed face a mortality risk 170% higher than women who have retained their ovaries after oophorectomy. Hormone replacement therapy is commonly advised as it is believed by many doctors to mitigate the mortality risks.
- There is a definite lowering of sexual desire in women who have undergone surgical menopause. This reduction is greater than that seen in women undergoing natural menopause.
Myxoedema
Lack of thyroid hormones causes hypothyroidism. Prolonged hypothyroidism can lead to myxoedema. Myxoedema is a disorder of the skin and tissue owing to long term hypothyroidism. Hypothyroidism occurs due to surgical removal of thyroid glands, atrophic diseases, etc. Partial myxoedema/myxedema, can affect the lower legs of the person, this condition is referred to as pretibial myxedema. Rarely Grave’s disease can also lead to pretibial myxedema. This condition is very common in women, in particular middle aged women. Myxodema is also known as Gull’s disease. If this condition is left untreated, it can cause myxoedema coma. Myxoedema can be classified into myxoedema and operative myxoedema.
Myxoedema is accompanied by the following symptoms - coarse skin, thickening nose, thickening of the skin, puffiness of the eyes, swollen
lips, mental disturbances, muscle pain abd lethargy. In advanced cases the thyroid gland shrinks and becomes a fibrous mass. Persons suffering from myxoedma might also suffer brittle hair, weight gain and constipation.
Blood tests are done to check for T3, T4, and TSH levels in the blood. Thyroid profile result helps in diagnosing the condition. In few cases nuclear imaging of the gland is done to study the gland. Thyroid biopsy is not required to diagnose this condition. Treating hypothyroidism is the treatment for myxoedema. Hypothyroidism is treated through thyroid hormone replacement therapy. In advanced cases of myxoedema, treatment gets difficult.
Bibliography / Reference
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