MENOPAUSE AND POST MENOPAUSAL OSTEOPOROSIS

Dr. GERALD PAPALI M.D, D.G.O
(Retired Additional D H S)

Menopause is the turning point, where the woman changes from reproductive phase to non-reproductive phase.  There is marked decline in ovarian function, which results in decreased production of Hormones, Oestrogen and Progesterone.  The Oestrogen production comes down by less than 10% of pre Menopausal phase.

This marked reduction of Oestrogen is responsible for most of the symptoms, we call – Menopausal Symptoms.  The main symptoms are hot flashes, night sweats, disturbed sleep, irritability, palpitation, carelessness, tendency for accidents, difficulty in making decisions, suicidal tendencies, quarrelling with family members on minor issues, wrinkling of  skin, sagging of  breasts, loss of  body contour, tendency to get obese, with resultant hypertension, pain in the weight bearing joints like knee joints, genitourinary symptoms like burning micturition, stress incontinence, painful coitus, lack of libido, quarrels with husband, increased tendency for coronary artery disease, increased tendency for fracture of wrist, spine and hip due to Osteoporosis.

Osteoporosis is the result of removal of calcium and minerals from bone, which starts 5-7 years after attaining menopause.  At 55-65 years, nearly 16% go for wrist fractures at 60-65 years about 20% go for spinal fracture, (wedge fracture or crush fracture), at 65-75 years following a fall nearly 16% go for hip fracture.  Over 80 years nearly all go for spinal fracture, following minor activities like coughing, sneezing, lifting some weights etc.

DIAGNOSIS OF OSTEOPOROSIS- is by dual energy x-ray  absordtiometry (DEXA) also called  bone densitometry.  Ordinary x-rays are useless in diagnosis osteoporosis, changes should have gone to 40-50% by this time the woman would have gone for one or two fractures.

MANAGEMENT-   By hormone replacement therapy
(H RT), most of the minor symptoms
can  be relieved by 3-4 months time.  Long term use (5-10 years) reduces the risk of coronary artery disease (C.A.D) and Postmenopausal Osteoporosis .

Those women who cannot take HRT due to some specific contra indication, can be given Oestrogenic anti Oestrogens Roloxifene – Tamoxifene etc.

If the women wants only protection against Osteoporosis, and do not want HRT, they can very well be put on Bisphosphonates for 5-10. This treatment has been shown to increase bone mineral density  considerably along with the above line of treatments,calcium to be supple meter at dose of 1500mg daily.  The other drug that can be used is Phyto Oestrogens.

They have 0.2% Oestrogenic  activity.  But the use of these preparations is not recommended at present, because no authenticated research reports have so far come on the effects and side effects of these preparations.

Contraception

Dr. Sajira Bhasi
Govt. Taluk Hospital, Tripunithura

FOGSI’s theme for the year 2003 is population stabilization through women empowerment.

Only 20% of married women in India use contraception compared to 80% in West, resulting in 78% unplanned and 25% unwanted pregnancies and 12 million abortions annually.

Female condoms are popular in US and Europe since 1970s. Mirena is the latest intra uterine system which serves dual purpose of menorrhagia treatment and contraception. Vaginal contraceptive rings are used in US, Canada and Europe.

Steroidal contraceptions includes OC (IUC) injectables, implants and contraceptive patch.

Though newer OC pills have very few side effects and non-contraceptive benefits in addition to its birth control action, only 6% use them in developing countries compared to 14% in developed countries mainly due to fear of side-effects and carcinoma. ‘Low dose pills’ have least side-effects, but has troublesome break through bleeding. ‘Progesterone only pill’ is the choice in lactating mothers and in whom oestrogen is contra-indicated.

Emergency contraceptive pills uses lemonorgestrel. Injectable contraceptives are available in India over 20 years. However, this is not provided in the National Family Welfare Programme in India. Immune contraceptions are on trial. Norplant and implanon are the popular implants used. The contraceptive patch uses the technology of transdesmal system of constant liberation of hormones.

There is no single contraceptive that is fool proof and absolutely safe, a reason why a variety of methods are available, each one with some specific advantages and certain disadvantages.


Induction of Abortion  – Newer Techniques

Dr. Zareena Khalid, Laxmi Hospital, Aluva

Mifepristone is an antiprogesterene which can be used within 49 days of amenorrhoea, to produce therapeutic abortion. There is a failure rate of 1-2% with high risk of congenital anomaly if pregnancy continues.