Post on 07-May-2015
MENSTRUATION MENSTRUATION
POST MENOPAUSAL POST MENOPAUSAL SYNDROMESYNDROME
TREATMENT OPTIONSTREATMENT OPTIONS
MENO-HRTMENO-HRT
P. K. P. K. MITRAMITRA
MENSTRUAL CYCLE&
HORMONE REPLACEMENT THERAPY
BIOLOGY OF MENSTRUATION ?BIOLOGY OF MENSTRUATION ?
Menstrual cycle is regulated by fluctuating levels of sex hormones (FSH, LH )
These hormones produce certain changes in the ovaries and uterus
Humans are nearly unique among species in having a menstrual cycle
Other species of mammals have estrous cycles
PHASES OF MENSTRUAL CYCLEPHASES OF MENSTRUAL CYCLEThe menstrual cycle has 4 phases & normal cycle ormal cycle
length islength isconsidered to be considered to be 2828 days but varies from female to days but varies from female to
female:female:
Follicular Phase Maturation of Follicle
Ovulatory Phase or Ovulation Release of Matured Ovum in Release of Matured Ovum in Fallopian TubeFallopian Tube
Luteal Phase - Secretory phase Secretion of Progesterone from Corpus Luteum Secretion of Progesterone from Corpus Luteum
Menstruation Clearing of Dead Uterine BedClearing of Dead Uterine Bed
Figure: The menstrual cycle
Follicular Follicular phasephase Egg Egg
maturesmatures
OvulationOvulation Egg releasedEgg released
Luteal phaseLuteal phase Corpus luteumCorpus luteum Endometrium Endometrium Prep for Prep for
blastocystblastocyst
No No PregnancyPregnancy MensesMenses
MENSTRUAL CYCLEMENSTRUAL CYCLE
FOLLICULAR PHASEFOLLICULAR PHASE
Starts in the pituitary gland with the release of FSH Starts in the pituitary gland with the release of FSH (Follicle Stimulating Hormone)(Follicle Stimulating Hormone)
Under FSH stimulation one of the ovaries produces Under FSH stimulation one of the ovaries produces the matured follicle ( Ovum )the matured follicle ( Ovum )
When the follicle begins to mature it releases When the follicle begins to mature it releases ESTROGEN hormone.ESTROGEN hormone.
Estrogen causes the uterine lining to thicken in Estrogen causes the uterine lining to thicken in preparation of the egg ( Ovum )preparation of the egg ( Ovum )
OVULATIONOVULATION
When estrogen levels get high enough they When estrogen levels get high enough they cause the release of LH or luteinizing cause the release of LH or luteinizing hormonehormone
LH causes the release of egg from the ovary LH causes the release of egg from the ovary or OVULATIONor OVULATION
Follicle pops and the egg comes out causing Follicle pops and the egg comes out causing a crater on the side of the ovary, called a crater on the side of the ovary, called corpus luteum.corpus luteum.
LUTEAL PHASELUTEAL PHASE
The “crater” that is left on the side of the ovary The “crater” that is left on the side of the ovary called Corpus Luteum & oozes PROGESTERONEcalled Corpus Luteum & oozes PROGESTERONE
Progesterone causes the uterine lining to Progesterone causes the uterine lining to thickenthicken
If no fertilization occurs in the fallopian tube, If no fertilization occurs in the fallopian tube, the egg deteriorates when it arrives at the the egg deteriorates when it arrives at the ‘horn’ of the uterus.‘horn’ of the uterus.
Progesterone & Estrogen levels drop Progesterone & Estrogen levels drop significantlysignificantly
MENSTRUATIONMENSTRUATION
The corpus luteum on the side of the ovary The corpus luteum on the side of the ovary heals into the corpus albacans (white body)heals into the corpus albacans (white body)
Cycle starts all over again with the secretion Cycle starts all over again with the secretion of FSH by the pituitary glandof FSH by the pituitary gland
The egg meets up with a sperm in the The egg meets up with a sperm in the oviduct and a zygote is formedoviduct and a zygote is formed
Progesterone and Estrogen levels continue Progesterone and Estrogen levels continue to increase for another 40 weeksto increase for another 40 weeks
Corpus luteum does not healCorpus luteum does not heal
Other Hormones that Other Hormones that Occur after FertilizationOccur after Fertilization
OXYTOCINOXYTOCIN
Causes the joints Causes the joints and ligaments to and ligaments to loosen starting at loosen starting at about 4 monthsabout 4 months
Initiates laborInitiates labor
PROLACTIN
Causes the production of milk to start
Takes about 3 days for the milk to be formed after birth
MENOPAUSEMENOPAUSE Menopause is the permanent cessation of reproductive fertility Menopause is the permanent cessation of reproductive fertility
some time before the end of the natural lifespan. some time before the end of the natural lifespan.
In women without a uterus, menopause or postmenopause is In women without a uterus, menopause or postmenopause is identified by a very high FSH level. identified by a very high FSH level.
Perimenopause - Menopause transition years during which Perimenopause - Menopause transition years during which maximum Physical & Psychological damage occurs.maximum Physical & Psychological damage occurs.
In women who have a uterus, perimenopause describes the In women who have a uterus, perimenopause describes the years both before and after the final period.years both before and after the final period.
During Perimenopause, production of Estrogen, Progesterone During Perimenopause, production of Estrogen, Progesterone Testosterone & fertility diminishes.Testosterone & fertility diminishes.
But not considered to reach zero until the official date of But not considered to reach zero until the official date of menopause. menopause.
Actual Menopause is declared 12 months after the last Actual Menopause is declared 12 months after the last menstruation.menstruation.
MENSTRUATIONMENSTRUATIONHormonal Impact:Hormonal Impact:
In some women, these hormonal imbalances cause undesirable symptoms (climacteric)
LH/FSH oppose the action of estrogen
If high levels of LH/FSH = low levels of estrogen
POST MENOPAUSAL SYMPTOMSPOST MENOPAUSAL SYMPTOMS
PSYCHOLOGICALPSYCHOLOGICAL DEPRESSIONDEPRESSION IRRITABILITYIRRITABILITY TIREDNESS / TIREDNESS /
POOR SLEEPPOOR SLEEP ANXIETYANXIETY LOSS OF LIBIDOLOSS OF LIBIDO WEEPINESSWEEPINESS FORGETFULNESS FORGETFULNESS LOSS OF LOSS OF
CONCENTRATIONCONCENTRATION
PHYSICALPHYSICAL IRREGULAR IRREGULAR
PERIODSPERIODS HOT FLUSHESHOT FLUSHES NIGHT SWEATSNIGHT SWEATS PALPITATIONSPALPITATIONS SEXUAL CHANGESSEXUAL CHANGES SKIN & HAIRSKIN & HAIR JOINT PAINSJOINT PAINS URINARY URINARY
SYMPTOMSSYMPTOMS WEIGHT GAINWEIGHT GAIN HEADACHEHEADACHE
LONG TERM POST MENOPAUSAL LONG TERM POST MENOPAUSAL EFFECTSEFFECTS
ATROPHY OF VAGINA/ URETHRA
OSTEOPOROSIS
CARDIOVASCULAR DISEASE
RISK OF STROKE AND PULMONARY EMBOLISMRISK OF STROKE AND PULMONARY EMBOLISM
INCREASED RATES OF BREAST CANCERINCREASED RATES OF BREAST CANCER
INCREASED GASTRIC BOWEL DISEASEINCREASED GASTRIC BOWEL DISEASE
INCREASED RATES OF LUPUSINCREASED RATES OF LUPUS
VAGINAL BLEEDINGVAGINAL BLEEDING
TREATMENT OPTIONS OF PMSTREATMENT OPTIONS OF PMS
HORMONES:HORMONES:ESTROGENS, PROGESTOGENS , TIBOLONE , RALOXIFENEESTROGENS, PROGESTOGENS , TIBOLONE , RALOXIFENE
LIFESTYLE MODIFICATION:LIFESTYLE MODIFICATION:EXERCISE, DIET-FIBER, REDUCE EXPOSURE TO EXERCISE, DIET-FIBER, REDUCE EXPOSURE TO
XENOHORMONESXENOHORMONES
NUTRITIONAL SUPPLEMENTATIONNUTRITIONAL SUPPLEMENTATIONADRENAL SUPPORT, LIVER SUPPORT, OMEGA 3FAADRENAL SUPPORT, LIVER SUPPORT, OMEGA 3FA
HERBAL SUPPLEMENTSHERBAL SUPPLEMENTSBlack Cohosh, Dong Quai, Chaste Berry, Evening Black Cohosh, Dong Quai, Chaste Berry, Evening
Primrose OilPrimrose Oil
BIOIDENTICAL HORMONESBIOIDENTICAL HORMONES
HRT / DRUGS IN PMSHRT / DRUGS IN PMS
NATURAL ESTROGENS & PROGESTERONESNATURAL ESTROGENS & PROGESTERONES
MEDROXY & HYDROXY PROGESTERONESMEDROXY & HYDROXY PROGESTERONES
TIBOLONE TIBOLONE
RALOXIFENE ( SERM )RALOXIFENE ( SERM )
PHYTOESTROGENS ( SOY, BC, )PHYTOESTROGENS ( SOY, BC, )
RISKS OF HRTRISKS OF HRT
• INCREASED RISK OF BREAST CANCERINCREASED RISK OF BREAST CANCER
• ENDOMETRIAL HYPERPLASIAENDOMETRIAL HYPERPLASIA
• FIBROIDS & ENDOMETRIOSISFIBROIDS & ENDOMETRIOSIS
• ADENOCARCINOMA ( Cancer of Glands )ADENOCARCINOMA ( Cancer of Glands )
• 2 - 4 FOLD INCREASED RISK OF 2 - 4 FOLD INCREASED RISK OF
DEVELOPING THROMBOLIC DISEASEDEVELOPING THROMBOLIC DISEASE
• DEPRESSION, WEIGHT GAIN, BLOATINGDEPRESSION, WEIGHT GAIN, BLOATING
• IMPAIRED LIVER DISEASEIMPAIRED LIVER DISEASE
HYPERTENTION, DIABETES, CADHYPERTENTION, DIABETES, CAD
Alternative remedies forAlternative remedies forsymptoms of Menopusesymptoms of Menopuse
PHYTOESTROGENSPHYTOESTROGENS
Plant-derived compounds weak estrogenic Plant-derived compounds weak estrogenic activity - similar in structure to estrogenactivity - similar in structure to estrogen
Isoflavones, lignans, coumestans, Black-Isoflavones, lignans, coumestans, Black-cohoshcohosh
Found in legumes, soybeans, vegetables, Found in legumes, soybeans, vegetables, cerealscereals
ISOFLAVONESISOFLAVONES
Found in soyFound in soy
Genistein, Daidzein (most studied)Genistein, Daidzein (most studied)
Can bind to estrogen receptorsCan bind to estrogen receptors
May enhance estrogen’s May enhance estrogen’s beneficial effects, or block beneficial effects, or block negative effectsnegative effects
BLACK COHOSHBLACK COHOSH
Suppresses secretion of luteinizing hormone
Most effective in relieving symptoms in early climacteric women
Has beneficial effects on climacteric symptoms - beneficial bone remodeling and weak estrogenic-like effects on the vaginal mucosa
Relatively safe/effective alternative to HR therapy
BENEFITS OF PHYTOESTROGENSBENEFITS OF PHYTOESTROGENS Plant source derived, least chance of side Plant source derived, least chance of side
effectseffects
Mimic the functions of Physiological Mimic the functions of Physiological EstrogensEstrogens
Do not alter the levels of circulating Do not alter the levels of circulating hormones in the bodyhormones in the body
Avoids the risk of Breast & Uterine CancersAvoids the risk of Breast & Uterine Cancers
Eliminates the Adverse effects of HRTEliminates the Adverse effects of HRT
Protects from CVD, Brain function Protects from CVD, Brain function disorders disorders
Well tolerated & high safety profileWell tolerated & high safety profile
MENO-HRTMENO-HRT Each Tablet Contains:Each Tablet Contains:
• Blackcohosh – 40 mgBlackcohosh – 40 mg• Isoflavones - 60 mgIsoflavones - 60 mg• Glucosamine sulphate – 300 mgGlucosamine sulphate – 300 mg• Milk Calcium – 250 mgMilk Calcium – 250 mg• Vitamin E - 200 IUVitamin E - 200 IU• VitaminD3 – 200 IUVitaminD3 – 200 IU• Magnesium – 40 mgMagnesium – 40 mg
BlackCohosh & Soya Isoflavones mimic the estrogenic action and relief physical & psychological symptoms:
Black Cohosh & Soya Isoflavones show synergistic effect in reducing Hot flush, Night Sweats, Calcium resorption & Anxiety.
Prevents future risk of Rheumatoid Arthritis, Premenstrual Syndrome, Muscle Spasms, Sleep Disorders & Depression.
Milk Calcium & Vit D3 help in prevention of Osteoporosis, future risk and supplement Calcium need of the body, Glucosamine & Magnesium strengthen bone matrix prevent risk of Fractures, Osteoarthritis.
MENO-HRT : BENEFITSMENO-HRT : BENEFITS
MENO-HRT : BENEFITSMENO-HRT : BENEFITS
Devoid of Estrogenic side effects & prevents Devoid of Estrogenic side effects & prevents risk of Coronary Artery Disease risk of Coronary Artery Disease (CAD)(CAD)
Improves Metabolic & Enzymatic FunctionsImproves Metabolic & Enzymatic Functions
Offers anti-oxidant benefits and protect Offers anti-oxidant benefits and protect against FRDagainst FRD
Avoids the risk & ADR of HRT …. The Natural Avoids the risk & ADR of HRT …. The Natural Alternative.Alternative.
MENO-HRT TABLETSMENO-HRT TABLETS
PACKING : PACKING : 3 x 10’s3 x 10’s
STRIPING : STRIPING : Blister FoilBlister Foil
PUNCH LINE : PUNCH LINE : The Natural Alternative to The Natural Alternative to HRTHRT
M’FACTURER M’FACTURER : : Star Healthcare IncorporationStar Healthcare Incorporation, , USAUSA
INDICATIONS : INDICATIONS : Post-Menopausal Syndromme Post-Menopausal Syndromme
TAB COLOUR : TAB COLOUR : Soft Green ColourSoft Green Colour
THAN QTHAN Q
P. K. MitraP. K. Mitra
Mars Therapeutics & Chemicals Mars Therapeutics & Chemicals LtdLtd