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Menopause Clinic PDF Print E-mail

 

Associate Professor Irene Lambrinoudaki                                 

 

 

 

upadate

 

 The aim of the Menopause Clinic is to provide information, to prevent or to treat symptoms and diseases associated with menopause. Clinical and laboratory tests are performed in  all women attending the menopause clinic in order to assess the individual risk of these diseases. Furthermore, an electronic file is created with the medical history and test results of every woman, which is updated at each visit. In this way, we ensure a long-term follow-up, during which preventive or therapeutic interventions may take place according to individual needs.

 

 

 

The World Health Organization estimates that in 2030 more than 1.5 billion women will be over the age of 50 years. When a woman becomes menopausal, she still has a life expectancy of at least 30 years of healthy and productive life, which is, however, characterized by the lack of estrogen. Nowadays women are active not only within the family but also at professional, social and political areas, and therefore they need to have a high quality of life.  They should also have access to the various options that are offered by Medicine for maintaining the quality of their lives.

        Theclimacteric syndrome is the major direct impact of menopause. The hot flushesare the most characteristic and most bothersome symptom. In many women, hot flushes last for many years after the menopause, causing sleep problems and leading to chronic fatigue. Emotional instability, irritability, and the loss of interest in daily activities are the main psychological consequences of menopause. Chronic headaches andjoint pains are psychosomatic components of the syndrome. Finally, vaginal dryness, recurrent urogenital infections,pain during sexual intercourse and the lack of sexual interest are for many women a serious problem.

         Hormone therapy(HT) refers to the replacement of the hormones produced by the human ovary before menopause. HT effectively replaces estrogens that cannot be produced by the ovary anymore but at a much lower level. HT is divided into two categories: estrogen alone, which is given to women who have undergone hysterectomy (removal of uterus) and combination therapy with estrogen and progestin, which is given to women who have their uterus in place. The progestin protects the uterus from the stimulatory action of estrogen, thus the combination therapy is absolutely safe for the endometrium. In contrary to previous years, currently we use very low doses of hormones that are effective in reducing climacteric symptoms and preventing osteoporosis, but at the same time they do not increase estrogen levels above the normal postmenopausal reference range, so that long term safety is ensured.

         Hormone therapy is a very effective treatment of the climacteric syndrome, relieving women from hot flushes, improving sleep and restoring mental well-being and libido.  Furthermore, HT prevents and treats urogenital atrophy and its disturbing consequences, such as recurrent cystitis, vaginitis, itching and burning as well as painful intercourse. As far as metabolism is concerned, HT inhibits the accumulation of fat in the abdomen, a phenomenon that usually occurs after menopause. Finally, HT prevents skin dehydration and collagen atrophy and the appearance of wrinkles.

          Beyond its effects on menopausal symptoms, HT inhibits the rapid bone loss that is observed during the first years after menopause. Furthermore, if a woman starts treatment within the first years after her last menstrual period, she has a lot of benefits as far as cardiovascular risk is concerned since the hormonal treatment before the age of 60 years has beneficial effects on the heart and blood vessels.

           The fear of possible side effects is the main reason why many women avoid HT. Long-term use of standard doses, usually over five years without interruption, may slightly increase the risk of breast cancer. In absolute numbers, however, the extra risk of breast cancer attributed to HT is extremely low: 2-4 extra cases per 1,000 women. Using the lowest effective dose of hormones and choosing the appropriate progestin practically minimizes the risk in the clinical setting. Regarding venous thrombosis, the risk is associated with pills, and it is mainly related to women who are obese or who have a personal or family history of venous thromboembolism. The problem of venous thrombosis can be bypassed using transdermal treatment (adhesive patches on the skin or gel applied daily on the skin), which according to recent data does not increase the risk of venous thrombosis.

          In some women, menopause comes much earlier than the normal age. This condition is calledpremature ovarian failure, if it is diagnosed at an age earlier than 40 years and early menopause, if it diagnosed under the age of 45. The causes in most cases remain unclear. A significant number of women become “iatrogenically” menopaused, due to surgical removal of the genital organs, chemotherapy or irradiation. Premature ovarian failure is considered a disease, due to the fact that it increases the risk of osteoporosis and premature heart disease by 3-6 times. Therefore, all women with premature ovarian failure or early menopause should receive hormone replacement therapy, regardless of the presence of climacteric symptoms. The duration of the treatment is usually until the normal age of menopause, between 50-52 years old.

            Osteoporosis is now a global epidemic. One out of two women around the world will sustain an osteoporotic fracture.  The menopausal woman has an increased rate of bone loss and therefore an increased risk of sustaining an osteoporotic fracture. In a study conducted in our Clinic we demonstrated that 1 out of 10 healthy postmenopausal women has an asymptomatic osteoporotic fracture.Since osteoporosis is not associated with symptoms until an advanced stage, prevention is essential.  The first evaluation should take place at the beginning of menopause.  Currently, there are many medical options to prevent osteoporosis. These vary according to age, the years since menopause and the coexisting risk factors.

 

           Cardiovascular diseaseis the leading cause of death in menopausal women worldwide. It is an established knowledge that women of reproductive age have much lower risk of heart disease compared to men of the same age. This is attributed mainly to the protective effects of estrogens. Estrogen loss in the menopause is associated with an increase in cholesterol and triglycerides, a decrease in the protective HDL cholesterol, an increase in blood glucose and blood pressure and finally with weight gain, particularly in the abdomen, which confers the highest cardiovascular risk. The result of these changes is that the cardiovascular risk of women 10 years after menopause becomes equal to that of men. In a survey conducted in our Clinic in collaboration with the Vascular Laboratory of the Department of Therapeutics in Athens University, we found that 1 out of 3 women have evidence of carotid atherosclerotic plaques within 10 years after menopause. Recent data indicate that hormone therapy, when started soon after menopause, can prevent these changes in the cardiometabolic risk factors and thus can decrease the risk of cardiovascular disease. In our Clinic we try to identify and eventually treat risk factors of cardiovascular disease in every woman as early as possible.

 

 

 " Medical Days, Naxos 2008 "

upadate

 

 

 

Contact: Tel +30-2107286284 Monday to Thursday 9:00-12:00 a.m

 

 

Web site: www.emmino.gr

 
 
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