Hormone replacement therapy (HRT) delays the ageing process and improves the quality of life. Womenbecome more active, enthusiastic and the full of life.....
Presently there are 30 million women, above 60 years of age in India. It is estimated that by 2020, the elderly population over 60 years will be 200 million of which 50 percent will be women.
It is essential to protect this vulnerable group of women from increased risk of cardiac diseases, strokes,fractures,etc. In addition they must be relieved of the distressing symptoms and problems of menopause which includes emotional, psychological,physical,sexual and vasomotor disturbances like hot flushes, sweating and sleep disturbances. They also suffer from the demoralizing effects of lack of ability to control urine.
In order to to prevent and relieve these problems,most women can and will benefit by hormone replacement therapy, and supplementation with calcium and vitamins.
The prescribing of hormones has to be done only after a proper physical, medical and specialist Gynecological examination, which includes a "Pap" smear to detect very earlier change in the mouth of uterus (the cervix) for any possible malignancy.
The female hormone, estrogen, is what maintain female sexuality and well being and prevents the last risk of menopause. HRT is the replacement of sex hormones. It can be estrogen alone are in combination with progesterone.
Estrogen can be administered orally or through the skin by using skin patches. The Trans dermal patch is indicated in persons who have liver problems or varicose veins. The addition of progesterone and androgens is to reduce the inconvenience of having the bleeding and certain possible risks for the breast and the uterine (endometrial) cancer.
These two oppose and minimize the risk of over-activity of the cells lining the uterus and estrogen sensitive breast cells. Estrogen alone, can be safely taken by women who have their uterus removed for various reasons.
In recent years, there has been further development in the drugs that help to prevent or treat post menopausal osteoporosis. These are non hormonal and are called SERMS (Selective Estrogen Receptor Modulators). They can act on the estrogen receptors in blood vessels, especially of the heart and the brain and improves blood flow. They have a selective action on bone cells to prevent bone calcium loss and improve calcium deposition in bones.
When osteoporosis is already established,biphosphonates (Allendronates) has been useful to prevent bone loss as well as build new bone...
Osteoporosis causes backache, pain all over the body, osteoarthritis of the knee joints causing severe pain and disability in walking. Osteoporosis may lead to stress fractures or collapse of the spine bone and causes a hunchback deformity. Fractures of the hip may result in the person becoming bedridden Nowadays hip replacement is also done by which is a expensive procedure...
In addition to HRT, supplementation with calcium, Vit D and Multivitamins with minerals and antioxidants is essential. To prevent aging, certain mineral like Selenium, Magnesium, Boron are also required.....
Alzheimer's Disease, a degenerative condition of the brain the brain which affects more Women than women over the age of 65 or 70 is due to the diminished blood flow to the brain. It is adistressing condition especially for the caretakers of the aged. In Westem Countries, administration of the HRT,
especially estrogen has helped to prevent as well as cure Alzheimer’s disease. Estrogen has been used to relieve this condition even in men.
With the administration of HRT, the skin does not Wrinkle, fat deposition is reduced and blood pressure, if raised is reduced. Risk of Ischemic heart disease and stroke is also considerably reduced.
Exercise and diet play a very important part throughout one’s life, particularly at and after menopause. Restriction of fats and sugar, help in maintaining weight and also in prevention of diabetes and Hypertension.
Exercise, regular Walking for 20 to 30 minutes at least 5 days in a week helps to maintain proper weight and prevent diabetes. It is also helps to built muscle strength and maintain proper balance in the order to prevent falls, resulting in fractures. Most important,it boosts morale and helps a person to remain charming and grow old gracefully.
It has been observed in advanced countries where HRT has been in vogue since more than 30 years that there is slightly increased risk of breast and endometrial cancer if HRT is taken for more than 10 years. This risk can be reduced by using the recently developed SERMS, particularly where HRT is needed 10 to 15 years after menopause, Fortunately these drugs are now freely available in India.
Regular Self- examination of breasts, examination by the gynecologist and a regular mammography once a year reduces
the risk of breast cancer. Care has to be taken in women who have a history of breast cancer in the family. Monitoring of the inner lining of the uterus (Endometrium) by Pelvic Ultrasonography, is an essential part ofthe initial
examination as well as in follow up to detect any possible endometrial overactivity.
To conclude, HRT should be tailored to the needs of each individual and should be prescribed by specialists who are experienced in the management of menopause............
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