Modern Homoeopathy

Monthly E-Newsletter May 2008

Menopause & its Homoeopathic Approach

by

Dr. Pawan S. Chandak & Dr. Mrs. Asha P. Chandak

Menopause: Basic Medical Consideration:

Menopause means permanent cessation of menses at the end of reproductive life due to loss of ovarian follicular activity.

The clinical diagnosis is confirmed following stoppage of menstruation for six consecutive months.

Premenopause refers to period prior to menopause.

Postmenopause refers to period after menopause.

Perimenopause refers to period around the menopause (40-55 years).

Climacteric is the physiological period in women's life during which there is regression of ovarian function. This covers a wide period ranging from 5-10 years on either side of menopause.

Age of menopause:

Thinner women have early menopause. Cigarette smoking & malnutrition causes early menopause. The age of menopause ranges from 45-55 years average being 50 years.

Clinical Importance:

Due to increased life expectancy, specially in affluent society about one third of life span will be spent during the period of Oestrogen deprivation stage with long term symptomatic and metabolic complication.

Organ Changes: Ovaries shrink in size, becomes wrinkled and white thinning of cortex with increase in medullary component.

Atrophy of fallopian tube.

Uterus becomes smaller, endometrium becomes thin and atrophied.

Vagina becomes narrower due to gradual loss of elasticity.

Atrophy of vulva, flattened labia, scanty pubic hair, narrowed introitus.

Breast fat is reabsorbed and and glands atrophied, nipple size decreased.

Dysuria, frequency, stress incontinence due to changes in bladder and urethra.

Loss of muscle tone leads to pelvic relaxation, uterine descent and anatomic changes in urethra and neck of bladder.

Bone Metabolism:

Following menopause there is loss of bone mass by around 3-5 % / year due to deficiency of Oestrogen.

Osteoporosis is a condition where there is reduction in bone mass but bone mineral matrix ratio is normal.

Postmenopausal women runs a high risk for fracture of bones due to osteoporosis.

Oestrogen prevents osteoporosis by several mechanism like inhibits osteoclastic activity, increase in absorption of calcium from the gut, stimulates calcium secretion from the (cells of thyroid and increase 1, 25 dihydroxy Vitamin D.

Cardiovascular System:

Risk of cardiovascular disease is high in postmenopausal women due to deficiency of oestrogen. Oestrogen prevents Cardiovascular disease by increasing HDL & decreasing LDL & total cholesterol, inhibit platelet and macrophage aggregation at the vascular intima.

It stimulates release of Nitric oxide (NO) and prostacycline from vascular endothelium to dilated blood vessels. It prevents atherosclerosis by its antioxidant property.

Menstruation Pattern prior to Menopause:

Any of the following pattern observed

i) Sudden cessation of menses

ii) Gradual hypomenorrhoea  (scanty menses) or irregular cycles (oligomenorrhoea).

iii) Irregular with or without excessive bleeding.

Menopausal Symptoms:

It is grouped as follows.

1) Vasomotor:

Hot flushes is sudden onset of feeling of warmth. It is due to low Oestrogen level. It coincides with GnRH pulse secretion. Hot flushes lasts only for 1-2 minutes, associated with profuse sweating.

Sleep may be disturbed due to night sweats. There is peripheral vasodilatation. Hot flushes are due to peripheral vascular permeability. .

Thermoregulatory centre in association with GnRH centre in the hypothalamus is involved in the aetilogy of hot flush. The patient experience palpitation & pulse rise by 20 beats per minute.

2) Genital & Urinary Symptoms:

It includes dyspareunia and features of atrophic vaginitis and endometritis. The urethral symptoms are urinary urgency, dysuria, recurrent UTI and stress incontinence.

3) Psychological Symptoms:

Increased frequency  of anxiety, headachae, insomnia, irritability and depression. Also suffer from dementia, mood swing and inability to concentrate.

Health Hazard:

Osteoporosis and Fracture:

Due to decline in collegenous bone matrix resulting in osteoporotic changes. Both the cortical and trabecular bones are affected lead to back pain, loss of height & Kyphosis, Fracture of bones.

Risk of Ischaemic Heart Disease (IHD) & coronary Heart Disease & Strokes are increased .

Skin collagen content is reduced in menopause.

Diagnosis:

1) Cessation of menstruation for consecutive 6 months during climacteric.

2) Appearance of  menopausal symptoms 'hot flush' and 'night sweat'.

3) Vaginal cytology - showing Maturation index of at least 10/85/5 (Features of low oestrgen).

4) Serum oestradiol: < 20 pg/ ml.

5) Serum FSH and LH: . 40 mIU / ml (three values at weeks interval required).

Treatment:

Nutritional diet: balanced with Calcium and protein helpful.

Supplementation Calcium: daily intake of 800 - 1000 mg can reduce osteoporosis and fracture.

Exercise: walking and Jogging.

Vitamin D: supplementation of vitamin D3 (400 IU/ day) along with calcium can reduce  osteoporosis and fractures.

Biophosphonates prevent osteoclastic bone resorption.

Fluorides prevents osteoporosis and increase bone matrix.

Homoeopathic Treatment:

Repertorial Approach:

Following rubrics covers menopausal Complaints from Synthesis Repertory 8.0

MIND - ANXIETY - fear; with - menopause; during
MIND - ANXIETY - health; about - own health; his - menopause; during
MIND - ANGER - delusions during menopause; with
MIND - COMPLAINING - menopause; during
MIND - DOUBTFUL - recovery, of - menopause; during
MIND - EXCITEMENT - menopause; during
MIND - FEAR - insanity - menopause; during
MIND - FEAR - open spaces; fear of - menopause; during
MIND - FEAR - recover, he will not - menopause; during
MIND - FORGETFUL - menopause; during
MIND - HYSTERIA - menopause; at
MIND - INDIFFERENCE, apathy - menopause; in
MIND - INSANITY, madness - menopause, during
MIND - IRRITABILITY - menopause; during
MIND - LAUGHING - menopause; during
MIND - LAUGHING - weeping - same time; weeping and laughing at the - menopause; during
MIND - LOQUACITY - menopause; during
MIND - MENOPAUSE agg.
MIND - MOROSE - menopause; at
MIND - NYMPHOMANIA - menopause; at
MIND - RESTLESSNESS - menopause; at
MIND - SADNESS - menopause, during
MIND - SIGHING - menopause; during
MIND - SUSPICIOUS - menopause; during
MIND - WEEPING - menopause; at
VERTIGO - MENOPAUSE
HEAD - HAIR - falling - menopause
HEAD - HEAT - flushes of - menopause; during
HEAD - HEAT - menopause, at
HEAD - HEAT - Vertex - menopause, during
HEAD - PAIN - violent pains - menopause; during
HEAD - PAIN - burning - menopause; during
HEAD - PAIN - burning - Vertex - menopause, during
STOMACH - APPETITE - ravenous - menopause, at
STOMACH - NAUSEA - menopause, during
ABDOMEN - PAIN - menopause, with sadness; during
RECTUM - HEMORRHAGE from anus - menopause; at
URETHRA - PAIN - menopause, during
URINE - ODOR - putrid - menopause, during
FEMALE GENITALIA/SEX - COITION - aversion to - menopause, during: con
FEMALE GENITALIA/SEX - LEUKORRHEA - acrid, excoriating - menopause, during
FEMALE GENITALIA/SEX - LEUKORRHEA - itching - menopause, in
FEMALE GENITALIA/SEX - LEUKORRHEA - menopause, at
FEMALE GENITALIA/SEX - LEUKORRHEA - offensive - menopause, in
FEMALE GENITALIA/SEX - LEUKORRHEA - yellow - menopause, at
FEMALE GENITALIA/SEX - MENOPAUSE
FEMALE GENITALIA/SEX - MENSES - copious - menopause, during
FEMALE GENITALIA/SEX - MENSES - frequent, too - fourteen days, every - menopause, at
FEMALE GENITALIA/SEX - MENSES - frequent, too - menopause, in
FEMALE GENITALIA/SEX - MENSES - painful, dysmenorrhea - menopause, near the
FEMALE GENITALIA/SEX - MENSES - return - menopause, after
FEMALE GENITALIA/SEX - METRORRHAGIA - menopause
FEMALE GENITALIA/SEX - SEXUAL DESIRE - increased - menopause, at

- Female Genitals - Atrophy of

                                        - Uterus

                                        - Ovaries

- Female Genitals - Inflammation of - ovaries, Uteris, Vagina
CHEST - PALPITATION of heart - menopause
SLEEP - SLEEPLESSNESS - menopause; during
PERSPIRATION - CLAMMY - menopause; during
GENERALS - CHOREA - menopause; during
GENERALS - CONVULSIONS - menopause; during
GENERALS - FAINTNESS - menopause; during
GENERALS - FOOD and DRINKS - coffee - agg. - smell of coffee - sensitive to the - menopause; during
GENERALS - HEAT - flushes of - menopause, during:

- General - Heat Flushes of - perspiration with

- General - Heat Flushes of - perspiration without

GENERALS - HEAT - lack of vital heat - menopause; during
GENERALS - HEMORRHAGE - menopause; in
GENERALS - NUMBNESS - externally - menopause; during
GENERALS - OBESITY - menopause; during
GENERALS - REACTION - lack of - menopause; during
GENERALS - SEXUAL - desire; suppression of sexual - menopause; during
GENERALS - TREMBLING - externally - menopause; during
GENERALS - TREMBLING - internally - menopause, during
GENERALS - WEAKNESS - menopause; during
GENERALS - WEARINESS - menopause; during

- Generals - Osteoporosis

Homoeopathic Materia Medica:

Folliculinum:  A female remedy, affecting primarily the female hormonal system.

Foll. in a homeopathic dilution could be indicated in premenstrual syndrome, as well as for all the functional symptoms present in a patient. Weight gain without excessive eating, worse before menses or during ovulation. Premenstrual migraines. Congestive headaches, either with redness of the face or the opposite with pallor, but still with the sensation of chilliness at the limbs.
Frequent ecchymosis, bruises very easily. Acne on the face and seborrhea of the nostrils.

"Folliculinum is a really brilliant remedy around menopause. It pretty well covers the whole range of physical and mental symptoms we might find at this time." [Assilem]. Cycle irregularities. Flooding. Hot flushes. Hyperactive worse rest [hot and bothered].
Night sweats. Air hunger. Dizziness and faintness. Abdominal heaviness. Fibroids. Vaginal dryness. Slow movement and spacey thinking. Hypersensitive to noise, heat and touch.
 

Amyl Nitrosum: It causes dilatation of all arterioles and capillaries. Useful for climacteric flushing, with headachae, anxiety and palpitation. Useful for Uterine haemorrhages with facial flushing. There is surging of blood to head with fiery red face < slightest emotion. Flushing heat followed by drenching night sweat.

Amyl nitrosum in 3x is an excellent drainer and circulatory regulator in menopausal women.

< climaxis, slight causes, emotions, heat, close room.

> open air, exercise, in cold water.

Glonoine: Glonoine is the most important remedy for congestive headaches in people suffering from hypertension. Especially indicated in menopausal women of the Lachesis or Sulphur constitution. It acts upon the circulation where it causes violent pulsation, ebullitions and irregular congestions. Blood rushes upwards. There is waves of terrible, bursting, pounding, headachae with feeling as if standing on head with expanding and contracting sensation or as if blood were surging back and forth in head from carotids to heart < sunshine. Headachae before, during, after or in place of menses. Indicated for climacteric flushing. There is sudden cessation of menses with congestion to head.

< heat on head, heat of sun, overheated, hot weather, motion, jarring, shaking, bending head back, injury, suppressed menses, fruits, weight of hat, wine.

> open air, elevating head, cold things, cold applications.

Lachesis: It is indicated specially for Hormonal disturbances, Menopause. Faintness during climacteric. There is Flushes of heat, from below upwards. There is intense left sided throbbing headache; in waves (Sep) worse during Menopause, on waking, before menses, sun better by Onset of menses (Meli), discharges (coryza), pressure.  Sensitive to clothing. Also indicated for premenstrual syndrome. All complaints worse before menses. Ailments from suppressed menses (Climacteric). Palpitation during sleep worse by lying on left side.

< during sleep, before menses, lying on left side, tight clothing,

> discharges, onset of menses, open air.

Sepia: Patient has indifference to everything. Depression < menses. All symptoms worse by hormonal changes, during menopause.  Flashes of heat. Easy fainting. Left sided headachae < menopause. Hair fall < hormonal changes. Aversion to sex < hormonal changes. Indicated also for premenstrual syndrome. Metrorrhagia at the time of climaxis. Hot hand with cold feet or vice versa. Anxious, hot flushes preceded by sudden weakness.
< cold air, sexual excess, before menses, morning, evening,

> violent motion, pressure, hot application.

Sulphur: Best medicine for Menopausal complaints like Hot flushes, offensive & profuse perspiration, headachae with burning pain < heat, feet hot and burning, uncovers them at night. All complaints worse during climacteric age. periodicity of complaints every 7 days, Burning pains, Complaints worse after suppressed discharges or eruptions, sleeplessness.

< Heat, heat of bed, 11 am