Natural menopause is the cessation of menstruation resulting from the loss of ovarian follicular activity and is diagnosed after 12 months of absence of a menstrual period (amenorrhœa). Premature or early menopause occurs before the age of 40 (source - World Health Organisation). It can be both physiological and induced and may contribute to a higher risk of osteoporosis, neurodegenerative diseases and cardiovascular problems. The International Menopause Society guidelines recommend HRT as the best preventive treatment (whether with estrogens alone, for women who have undergone hysterectomy, or combined estrogen and progesterone, or progestins to protect the endometrium in patients with a uterus).
Induced menopause can be determined by surgical removal of both ovaries (with or without hysterectomy) or by the suppression of ovarian function as a side effect of cancer treaments, such as chemotherapy, radiation, tamoxifen (source - World Health Organisation). Around 60% of women who undergo treatment for breast cancer can develop vaginal atrophy.
Premenopause is the period preceding menopause up to the first year after the last mentrual period (source - World Health Organisation). Postmenopause is the period that follows the last menstrual period, regardless of the type of menopause (source - World Health Organisation). To this list established and approved by the WHO in 1990, the International Menopause Society (IMS) has added, in 1999, the definition of climacteric, as a transition from the reproductive phase to the nonreproductive state.
HRT (Hormone Replacement Therapy) is the prescription of estrogens alone (for hysterectomised women) or combined estrogen and progesterone for postmenopausal patients to fight the symptoms related to urogenital atrophy and, more importantly, the negative effects of sudden estrogen deficiency on the cardiovascular, skeletal and autonomic nervous systems.
Specifically, the estrogen alone therapy is called Estrogen Replacement Therapy (ERT). 10–25% of women using systemic hormonal therapy continue to suffer from symptoms related to urogenital atrophy. This, in addition to possible concerns over the long term effect of taking hormones, is why systemic therapy is seldom prescribed to women who suffer only from vaginal symptoms.
Topical therapy is a commonly prescribed treatment for vaginal atrophy which requires the patient to apply a cream containing hormones directly into the vagina. Estrogens are absorbed by the vaginal walls and enter into the circulation, except in the event of preparations designed to prevent their absorption. Potential adverse effects include breast, perineal pain and uterine bleeding (which should be reported immediately to your doctor). The treatment is contraindicated in some cases, such as in presence of vaginal/uterine bleeding of unknown nature or in women with endometrial cancer.
In the event that estrogen preparations are either not indicated or not effective – vaginal lubricants and moisturising preparations, applied locally and consistently, can attenuate symptoms related to vaginal dryness. It is a mixture of soluble aqueous-based protective and restorative agents and nonhormonal substances, which have a beneficial effect on the vaginal epitelium. Nonhormonal therapies are especially indicated in women against hormonal therapies or in subjects at risk due to previous cancers sensitive to hormones.
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