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            <h3>Menopause</h3>
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                    <h4>What Is Menopause?</h4>
                    <p>When a woman experience 1 year without menstrual cycle it is called as menopause. Permanent cessaion of menstrual cycle for 12 consecutive months stamps the diagnosis of Menopause.</p>
                    <p>Menopause is a phase which comes in every woman’s life. It is a natural part of aging and typically affects women between the age group of 45 to 55 years. </p>
                    <h4>Why menopause occurs?</h4>
                    <p>As women grow older, their ovarian follicles diminish in number. There is a decline in granulosa cells of the ovary, which were the main producers of estradiol and inhibin. So the estrogen deficiency ultimately leads to menopause and symptoms relted to it.</p>
                    <p><strong>Perimenopause or ‘menopause transition’</strong> is the time when the ovaries will start to decrease the amount of oestrogen they produce and physiological changes first become noticeable, usually beginning on average 3-4 years before the menopause. During menopause, the ovaries no longer release eggs and oestrogen production slows drastically.</p>
                    <h4>What are menopausal symptoms?</h4>
                    <p>Symptoms are typically due to deficiency of estrogen in the body.</p>
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                    <h4>Long term complications of Menopause</h4>
                    <p><strong>Cardiovascular Risk:</strong> Coronary heart disease and Stroke risk is increased 2-3 times after menopause.</p>
                    <p><strong>Osteoporosis:</strong> More than 250,000 menopausal and postmenopausal women are affected by osteoporosis. The characteristic bone loss or decreased bone density in osteoporosis is due to estrogen deficiency in these women.  </p>
                    <h4>What are the treatment options available for women facing perimenopausal symptoms?</h4>
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                        <li>Lifestyle changes</li>
                            <p>● Avoid alcohol, smoking , hot and spicy foods, caffeine intake</p>
                            <p>● Weight loss</p>
                            <p>● Regular exercise , Yoga, Pranayam helps coping up with symptoms</p>
                            <p>● Follow a healthy diet which is high in Protein content . Soybeans contains natural phytoestrogens and helps reducing the symptoms </p>
                        <li>Hormone Replacement Therapy</li>
                            <p>● Estrogen only therapy</p>
                            <p>● Estrogen & Progesterone therapy</p>
                        <li>Non hormonal therapy: it includes SSRI, SNRI, gabapentin.</li>
                        <li>Selective estrogen receptor modulators</li>
                        <li>Osteoporosis specific therapy</li>
                        <li>Alternative medicine: Phytoestrogens, Isoflavones, Omega 3 fatty acids, vitamin E.</li>
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                    <h4>What Is Hormone Replacement Therapy?</h4>
                    <p>HRT is the most efficient treatment for symptoms of acute climacteric syndrome and for efficient prevention of long-term estrogen deficiency. Estrogen-only therapy is labeled as estrogen replacement therapy (ET, ERT). For combination of estrogens and progestogens, the term is estrogen–progestogen therapy (EPT).</p>
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                        <li>Estrogens can be administered orally, transdermally, percutaneously, intramuscularly, intranasally, subcutaneously, or locally (vaginally) with doses and timing tailored to each patient.</li>
                        <li>ET is for women without a uterus. For women with intact uterus, estrogen–progestogen blends are administered, and their application regimen consists of continual administration or cyclic administration for 21 days with a 7-day pause. </li>
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                    <h4>Benifits of Hormone Replacement Therapy</h4>
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                        <li>Relieves hot Flushes and night Sweat</li>
                        <li>Helps you sleep Better</li>
                        <li>Relief from Vaginal dryness and itchiness</li>
                        <li>Makes Sex less Painfull</li>
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                    <h4>What test needs to be done before starting Hormone Replacement Therapy?</h4>
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                        <li>Complete gynec check up and thorough history taking</li>
                        <li>Pap test</li>
                        <li>Renal function test</li>
                        <li>Liver function test</li>
                        <li>Fasting blood sugar</li>
                        <li>Lipid profile</li>
                        <li>Mammography</li>
                        <li>Bone marrow density check test</li>
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                    <h4>Long term complications of HRT?</h4>
                    <p>There is slightly increased chances of Coronary heart disease, Stroke, Venous thromboembolism and breast cancer. Though benefits outweigh the risks HRT is tailored treatment for each patient according to their needs the route of administration is decided. </p>
                    <h4>Osteoporosis specific therapy ?</h4>
                    <p>Post menopausal women are at 5 times higher risk of development of osteoporosis and hence fractures of bone. </p>
                    <p>Osteoporosis related fractures include vertebral fracture, hip joint fratre, wrist bone fracture on fall.</p>
                    <h4>How can we prevent Postmenopausal Osteoporosis?</h4>
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                        <li>Weight bearing exercise</li>
                        <li>Calcium and vitamin D3 supplements</li>
                        <li>Cessation of alcohol. Smoking</li>
                        <li>Hormone replacement therapy </li>
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                    <h4>Non hormonal/ alternative medicines for Menopause?</h4>
                    <ul>
                        <li><strong>Selective serotonin reuptake inhibitors(SSRI):</strong> paroxetine, fluoxetine, citalopram</li>
                        <li><strong>Selective norepinephrine reuptake inhibitors(SNRI):</strong> Venalafexine</li>
                        <li>Gabapentin </li>
                        <li>Clonidine patch </li>
                        <li>Soy isoflavones, black cohosh</li>
                        <li>Yoga and pranayam</li>
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                    <h6 class="customise-heading">For Customized Hormone Replacement Therapy Meet Our Experts At Aarya Women’s Hospital. Never Ignore Your Health.  </h6>
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