Dr Ruqsar Farheen
Every woman faces menopause and many dread its approach fearing the onset of uncomfortable side effects like irregular menses, hot flushes ,mood changes and bladder problems which may have impact on their quality of life. As longevity increases ,we see more and more cases needing treatment. Recently it is found that there is a chance of the development of cardiovascular disease and Alzheimer’s disease due to hormonal replacements. Alternative treatments like homoeopathy are often sought by the women looking for symptomatic relief without the risks and potential side effects of the Hormonal Replacement Therapy.Homoeopathic system of medicine which follows the holistic approach plays a positive role in alleviating the troublesome symptoms of perimenopausal syndrome ,that has effects on subcellular level, organ level and biopsychosocial level.In this article an attempt is made to explain the role of homoeopathy ,in the management of perimenopausal syndrome.
KEYWORDS: Perimenopause, Indian Menopause Society, Irregular periods, hot flushes
Menopause is defined as the permanent cessation of menses for one year and is physiologically correlated with the decline in estrogen secretion resulting from the loss of follicular function. The period of hormonal transition is marked by irregular menses, heat flushes, urinary and sexual disturbances, anxiety and depression, etc when levels of estrogen and progesterone rise & fall unevenly.This period is described as “Perimenopause”.
Women around the world suffer from ailments characteristic for the menopausal period regardless of the ethnic origin, skin color, or sociodemographic factors.
In the present day management of menopause ,the age 45-55years is taken as the limit of normality and those menstruating after 55 years merit investigation to exclude pathology2.
The average age of perimenopause in Indian women is 44.6+/-3.7 years according to the pan India survey conducted by Indian Menopause Society.
The cause of menopause is burning out of the ovaries. Through out life, about 450 primordial follicles grow and ovulate and thousands of ova degenerate. The depletion of the ovarian follicles is secondary to apoptosis or programmed cell death. It leads to no or very little response of ovary to pituitary hormones FSH and LH, which results in cessation of estrogen and progesterone production. The ovarian stroma is unaffected ,so androgen production by the stroma is spared. The effects of perimenopause are related to estrogen deficiency.
- Psychological symptoms-mood swings, depressive mood , anxiety or irritability, difficulty in falling asleep through the night, concentration difficulties and forgetfulness.
- Somatic symptoms-irregular periods , periods that are heavier or lighter than normal, hot flushes ,night sweats, breast tenderness, weight gain, headache ,muscle or joint aches,unusual awareness of heart.
- Urogenital symptoms-difficulty in urinating , increased frequency to urinate, loss of sexual drive.
1.According to the Stages of Reproductive Aging Workshop (STRAW) criteria: Women having increased irregularity of menses without skipping periods experienced after a previously regular cycles or had menstruation during the past 2-12 months but not during the past 2 months are considered under perimenopause.
2.Based on clinical symptoms
- Serum FSH level >30 IU/L.
- Serum estradiol levels will be decreased to 20 pg /ml.
To rule out other associated disorders:
- Hb%, fasting and postprandial blood sugar, liver function tests ,kidney function tests, ECG ,lipid profile, pelvis USG especially for endometrial thickness and ovarian size.
- Cervical pap smear
- Endometrial biopsy is indicated when endometrial thickness (ET) is >5mm on ultrasound
- Bilateral mammography is done especially for those who are on HRT
A.LIFE STYLE MODIFICATION-Active participation of the patient in making lifestyle changes like
- weight bearing exercises
- daily walk for 30 minute
- A suitable natural diet
- Smoking and alcohol intake is discouraged.
- Aroma therapy, Yoga and Meditation also helps.
- Bladder training is a simple and effective treatment.
- Estrogen therapy
- estrogen gel as local application
- vaginal cream 1-2 gm
- implants 25 to 50 mg.
AS PER THE PERUSAL OF DIFFERENT REPERTORIES THE FOLLOWING RUBRICS ARE FOUND TO BE RELEVANT FOR THE MANAGEMENT OF PERIMENOPAUSAL SYNDROME:
A.KENT’S REPERTORY OF HOMOEOPATHIC MATERIA MEDICA:
- GENITALIA FEMALE-Menopause
- GENITALIA FEMALE-Menses-copious-menopause-during
- MIND-Anxiety-health about-especially during climacteric period
- MIND-Insanity-climacteric period-during
B.BOGER BOENNINGHAUSEN’S CHARACTERISTICS & REPERTORY:
- FEMALE ORGANS-Female organs-bleeding ,hemorrhage, etc., uterus-climacteric
- SEXUAL IMPULSE-Sexual desire-strong too-in women-at climacteric
C.POCKET MANUAL OF HOMOEOPATHIC MATERIA MEDICA & REPERTORY:
- FEMALE SEXUAL SYSTEM-LEUKORRHEA-Occurrence-Climaxis, At
- FEMALE SEXUAL SYSTEM-LEUKORRHEA-Modalities-Climaxis, At
- GENERALITIES-DROPSY-CAUSES-Menstrual disorder at puberty, or Menopause
D.HOMOEOPATHIC MEDICAL REPERTORY:
- Female – MENOPAUSE, general – agg.
- Female – MENOPAUSE, general – heat, with, in vertex of head
- Female – MENOPAUSE, general – hot flashes, with, perspiration
Under chapter FEMALE GENITALIA-
- COITION-aversion to-menopause; during
- ITCHING-leukorrhea; from- menopause; during
- LEUKORRHEA- acrid, excoriating -menopause ;during
- LEUKORRHEA-offensive-menopause; during
- LEUKORRHEA- yellow- menopause ;during
- MENOPAUSE-never well since
- MENOPAUSE-obese women; in
- MENOPAUSE- sadness ;with
- MENOPAUSE- servants; in
- MENSES-Early ;too-Menopause-during
- MENSES-Frequent, too-Menopause ,in
- MENSES- Frequent, too-week-two weeks; every -menopause ;at
- MENSES-Painful- Menopause , near the
- MENSES- Protracted – Menopause; during
- MENSES-Suppressed- Menopause; during
- PAIN-Uterus- Menopause; during
- SEXUAL DESIRE- Increased- Menopause; during
- GENERALS-MENOPAUSE-Ailments from
MINTON’S UTERINE THERAPEUTICS:
Under the chapter MENSTRUATION-Time & quantity of the menstrual discharge
- Premature during the menopause
- Profuse and short duration during menopause
- Suppressed (amenorrhea)-during the menopause
Under the chapter DURING MENSTRUATION
- Menopause, during the, flushes of heat to the face:
-great commotion in the abdomen
-during the, swelling of the feet
- Perspiration-after midnight
- Perspiration-least exertion
- Reappearance of the flow after it has once ceased
Under the chapter METRORHAGIA
- Menopause, at the
- Menopause, when approaching the
- At the climacteric Lachesis lady complains of profound prostration with palpitation.
- Flushes of heat.
- Sensation as if all the blood in the body is running to the head.
- Abdomen is so sensitive that she cannot bear any clothing around the abdomen.
- Pain in the left ovarian region or extending from left to right.
- The menopausal symptoms are violent before and after flow. They are relieved during the flow.
- <before and after sleep, left side, warm room, morning
- >cold in general, flow of discharges.
- Suitable for the women of climacteric age group where there is tendency to gain weight and deposition of fat on thighs, buttocks and around the breasts.
- Aversion to coition because of dryness of vagina.
- Great tenderness in the uterine region and both the fornices.
- Cauliflower like growth on cervix, uterus and vagina.
- Menses are irregular, scanty, pale or mixed with dark and small clots and are of short duration.
- <warmth, at night, during and after menstruation
- >in dark, from wrapping up.
- Natrum mur lady during menopause is very much emaciated and hysterical.
- Nervous affection tremble the whole body and also there is fluttering of heart.
- Sensation as if limbs were falling asleep.
- Oversensitiveness to minute incidences.
- She has unquenchable thirst for cold water.
- Dislikes consolation ,because consolation aggravates her complaints.
- <sunrise to sunset, between 10-11am, heat of sun, at the sea shore, mental excitement ,warmth in general, consolation.
- >open air, lying on hard surface, moderate exertion in cold air.
- Inability to digest or assimilate the lime present in her food .Thus this lack of extraction of lime from food and assimilation causes lot of disturbances during menopause.
- During menopause tendency of putting up weight and excessive fat.
- Increased sweating in various parts of the body even though the patient is very chilly.
- Brain fag, soon becomes tired mentally.
- <cold in general, wet weather, mental or physical work
- >dry weather, lying on painful side.
- Various dreams which makes the sleep disturbed.
- Ignatia lady is very afraid to go to bed when she passes the course of climacteric stage as there is jerking of limbs when she goes to sleep.
- Severe spasmodic pain during menses ,and bleeding is black.
- <in the cold, grief, anger, emotions ,mental excitement ,excess of stimulations.
- >warmth in general, walking in the open air ,after pressure.
- Sick headache associated with nausea and even sometimes vomiting during climacteric period is the characteristic symptom of silicea patient.
- Headache commences in the occipital region, extends forward in the afternoon and settles at the supra-orbital region in the early night hours.
- Profuse sweat which is cold, clammy ,offensive ,especially on forehead.
- Ailments from suppression of discharges ,suppressed sweat.
- Disturbed by extremes of heat and cold.
- Leucorrhoea is profuse ,acrid ,corroding ,milky ,preceded by cutting around the navel ,causing biting pains.
- <morning, after washing the parts, uncovering, ling down, damp wet weather.
- >warmth in general, tight bandages around the head, summer season, humid atmosphere.
- Suited for lean, thin and stoop shouldered subjects who walks stooping.
- She has intense burning everywhere in the body accompanied with itching.
- Menses are irregular, short and troublesome.
- Discharges are acrid and makes the parts excoriated.
- Nocturnal offensive sweating especially of single parts as face, nape of neck or genitalia.
- <warmth of bed, standing, in the morning(11am), at rest, after eating.
- >lying on right side, dry warm weather, open air.
Hence, homoeopathy is proficient in the management of perimenopausal syndrome and the safest unlike the other harmful treatments. Although homoeopathy has good success but there is need for further research studies to develop evidence-based clinical recommendations.
1.Sharma, B., 2008. Menopause:a bane for women. Indian Journal Of Research in Homoeopathy, [online] 2,NO . 3.1. Available at: <http://www.ijrh.org> (accessed on 9/5/2022)
2.Gupta J, Kulshreshtha D, Lamba CD, Gupta P, Shinde V, Wadhwa B and et al. Homoeopathic medicine–Sepia for the management of menopausal symptoms: A multicentric, randomised, double-blind placebo-controlled clinical trial. Indian Journal of Research in Homoeopathy. 2019 Oct 1;13(4):219.Available from:https://www.ijrh.org/article.asp?issn=0974-7168;year=2019;volume=13;issue=4;spage=219;epage=228;aulast=Gupta(accessed on 9/5/2022)
3.Ahuja M. Age of menopause and determinants of menopause age: A PAN India survey by IMS. Journal of mid-life health. 2016 Jul;7(3):126. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051232/(accessed on 12/6/2022)
4. Salhan S.Textbook of Gynecology. JP Medical Ltd,New Delhi; 2011;147 -150.
5.Kent JT. Lectures on homoeopathic Materia Medica: together with Kent’s” New Remedies” Incorporated and arranged in one alphabetical order.2/e, B. Jain Publishers. New Delhi; 2012. 7 ,57 ,724 ,725 ,
6.Boger C M .Boger Boenninghausen’s Characteristics and Repertory .1/e .B. Jain Publishers . New Delhi;2002 .673,677.
7. Boericke William, Pocket manual of Homoeopathic Materia Medica and Repertory, 9/e.B Jain Publishers. New Delhi. 2012 , 389.
8.Murphy R. Homoeopathic Medical Repertory . 3/e ,B. Jain Publishers. New Delhi; 2004.777,778.
9.Schroyens F. Repertorium homeopathicum syntheticum. 8/e , B. Jain Publishers. New Delhi; 2009. 880 ,886 ,890 ,891 ,894 ,895 ,897 ,898 ,901 ,902 ,905 ,907 ,909 ,923 ,1630.
10.Minton H. Uterine therapeutics. B Jain Publishers. New Delhi;2005.339 ,340 ,344 , 405, 415 ,416 ,484.
Dr Ruqsar Farheen MD Part 1
Department of case taking and repertory
Under the guidance of Dr Munir Ahmed R
Government Homoeopathic Medical College and Hospital, Bengaluru