Menopause happens start hormone replacement therapy, and for how long mp electricity bill payment paschim kshetra

####

The normally positive, confident environmental engineer found herself overwhelmed at least once a week by sudden feelings of dread and sadness. "If it had just been the hot flashes, I may have toughed it out," said the Odessa woman, 56. "But when the panic attacks started, I was afraid it would hit when I was doing my job."

For most women, hormone production starts declining slowly in the 30s. It becomes more pronounced as women go through their 40s, and usually around age 50, menstrual periods stop. The schedule is of course more dramatic for women who have had a total hysterectomy.

Technically, menopause is said to begin one year after a woman’s last period. For some, the hormonal change is so gradual that it’s hardly noticeable, except for the absence of monthly periods. For others, symptoms range from mild to severe. The most common and bothersome are hot flashes, sleep disturbance, vaginal dryness and mood swings.

Doctors have treated menopausal symptoms with hormone replacement therapy since the 1950s. It has fallen in and out of favor over the years; at its peak popularity, doctors were touting its efficacy for preventing everything from cancer to heart disease to wrinkles.

HRT took a big hit in 2002 when the Women’s Health Initiative, the largest government-sponsored clinical trial to evaluate hormone therapy for disease prevention, found disturbing results. The combination estrogen and progestin therapy given to women who still have a uterus was found to increase the risk of stroke, heart attack, blood clots and breast cancer.

The hormones are combined to prevent endometrial cancer, which is not an issue in women who have no uterus. Women who had a hysterectomy could take estrogen alone, and in this group, the study found an increased risk of stroke and blood clots.

But since the initial data were released, additional research has returned more reassuring results. Taking estrogen alone did not increase breast cancer risk, but neither did it prevent heart disease, as so many women had been led to believe.

Laurel Hall, who is a patient of Dr. Verkauf’s, asked about health risks before she started treatment. Because her heart disease risk is low, she has no family history of breast cancer, and she’d had a partial hysterectomy and would only need estrogen, she decided to give it a try.

If hot flashes are the problem, Parsons may suggest the drug Neurontin (generic name gabapentin, used also for seizures and neuropathic pain), or the plant-based supplement black cohosh. For vaginal dryness, small amounts of an estrogen-based topical cream can alleviate the problem at a lower dose of hormone.

Finding alternatives is important because not all women can take estrogen. Liver disease, recent stroke, heart disease, a personal or family history of abnormal blood clots, and a history of breast and certain gynecological cancers all are conditions that disqualify a patient from HRT.

"There is no reliable, scientific data to support that," Parsons said. It’s much better to protect yourself from the sun and not smoke if you want to improve your skin and prevent wrinkles. Take calcium and vitamin D and do weight-bearing exercise to strengthen your bones, and watch your nutrition to look good outside and inside.

Bioidentical hormones, plant-derived estrogen and progesterone that can be made by a compounding pharmacist or are manufactured like conventional drugs, are a popular alternative to prescription estrogen. They are also heavily marketed to fight natural signs of aging, including thinning hair, wrinkles and diminished sex drive.

"Some women think bioidenticals are safer than prescription hormones, but they aren’t," said Dr. Madelyn Butler, an obstetrician-gynecologist with the Woman’s Group in Tampa. "They are still estrogens. I’m fine if patients want to use them, but they carry the same risks."

Compounded hormones are not FDA regulated and so are not subject to the same oversight as prescription medications. Verkauf says you really have to trust the compounding pharmacist to consistently deliver a pure, high-quality product at the proper dose.