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