Perimenopause and its homoeopathic therapeutics

Dr Deekshitha P

ABSTRACT
Perimenopause is a transitional phase preceding menopause, characterized by fluctuating ovarian function and hormonal instability, leading to a wide array of physical, psychological, and urogenital symptoms. With increasing life expectancy, women now spend nearly one-third of their lives in the peri and postmenopausal period, making effective management of this phase essential. Although Hormone Replacement Therapy (HRT) is commonly used for symptomatic relief, its prolonged use is associated with significant adverse effects. Homoeopathy, based on the principles of individualization and dynamic healing, offers a safe and holistic alternative. This article aims to review the physiological basis of perimenopause, its clinical manifestations, and the role of homoeopathic therapeutics in restoring balance and improving quality of life during the perimenopausal transition.

Keywords: Perimenopause, Climacteric, Homoeopathy, Menopausal transition

INTRODUCTION:
The term menopause is derived from the Greek words meno (month) and pausis (cessation), denoting the permanent cessation of menstruation. Menopause represents a natural physiological transition from the reproductive to the non-reproductive phase of a woman’s life. According to the World Health Organization (WHO), menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian follicular activity, occurring naturally or induced by surgery, chemotherapy, or radiation.

Advances in medical science have significantly increased human life expectancy, resulting in women spending nearly one-third of their lives in the peri- and postmenopausal period. It is projected that by 2026, India’s population will reach approximately 1.4 billion, with nearly 103 million women belonging to the menopausal age group. This demographic shift highlights the growing importance of addressing menopausal health as a major public health concern.

Perimenopause is the period immediately preceding menopause and extending up to one year after the final menstrual period.¹This phase may last for three to five years and is marked by progressive endocrine changes. During this time, women commonly experience menstrual irregularities, hot flushes, mood disturbances, sleep disorders, vaginal and bladder symptoms, reduced fertility, and changes in sexual function. These symptoms can significantly interfere with daily activities and negatively impact overall quality of life.

The average age of menopause worldwide ranges between 45 and 55 years. In Indian women, the mean age of menopause is approximately 46.2 years, while perimenopause generally begins around 44.6 ± 3.7 years, as reported by the Pan-India survey conducted by the Indian Menopause Society.¹ Due to distressing symptoms during this phase, many women opt for Hormone Replacement Therapy (HRT).

Although HRT is effective in alleviating short-term symptoms of estrogen deficiency, prolonged use has been associated with serious risks such as endometrial cancer, breast cancer, venous thromboembolic disorders, and adverse lipid profile changes.^1,2 Consequently, there is a growing demand for safer, non-hormonal therapeutic alternatives.

Homoeopathy offers a holistic approach to the management of perimenopausal syndrome by addressing the individual as a whole rather than merely correcting hormonal deficiency. Observational and clinical studies have demonstrated that homoeopathic medicines can significantly reduce menopausal symptoms and improve quality of life without the risks associated with hormonal therapy.

PATHOPHYSIOLOGY OF PERIMENOPAUSE: ^2,3

• Perimenopause results from progressive depletion of ovarian follicles and dysregulation of the hypothalamic-pituitary-gonadal axis.
• Reduced ovarian responsiveness leads to fluctuating estradiol levels
• Loss of negative feedback causes elevation of FSH and LH
• Oestrone becomes the predominant oestrogen through peripheral conversion
• Progesterone deficiency results from anovulatory cycles
• These endocrine changes affect thermoregulation, neurotransmitter balance, bone metabolism, cardiovascular health, and urogenital tissues.

CLINICAL FEATURES: ²

Psychological Symptoms: Moods wings, Anxiety and irritability, Depression, Insomnia, Impaired concentration and memory, Loss of sexual desire.

Somatic Symptoms: Hot flushes and night sweats, Palpitations, Headache, Fatigue, Muscle and joint pains.

Urogenital Symptoms: Irregular or heavy menstrual bleeding, Vaginal dryness and dyspareunia, Urinary urgency and incontinence.

DIAGNOSIS: ^2,3

Diagnosis is primarily clinical and supported by:

• Menstrual irregularities (cycle variation ≥7 days or amenorrhea ≥60 days)
• Vasomotor and psychological symptoms
• Elevated serum FSH (>40 mIU/mL)
• Reduced serum estradiol (<20 pg/mL)

The Menopausal Rating Scale (MRS) is commonly used to assess symptom severity and health-related quality of life.

MANAGEMENT:

The management of menopausal syndrome is individualized and aims to relieve symptoms, prevent complications, and improve quality of life.

1. General Measures:

Reassurance and counselling regarding the physiological nature of menopause. Maintenance of a balanced diet rich in calcium and vitamin D. Regular physical exercise and adequate sleep. Avoidance of smoking, alcohol, and excessive caffeine.

2. Lifestyle and Supportive Therapy

Stress reduction, yoga, meditation, and relaxation techniques. Weight control and regular health screening (breast and pelvic exams).

3. Non-Hormonal Medical Therapy

For vasomotor symptoms: SSRIs, SNRIs, clonidine, or gabapentin.

For vaginal dryness: use of lubricants and vaginal moisturizers.

For bone health: calcium + vitamin D supplements; bisphosphonates if osteoporosis present.

4. Hormone Replacement Therapy (HRT)

Indication: Moderate to severe vasomotor and urogenital symptoms.

Estrogen alone – for women after hysterectomy.

Combined estrogen + progestogen – for women with intact uterus (to prevent endometrial hyperplasia)

HOMOEOPATHIC THERAPEUTICS IN PERIMENOPAUSE:

AMYLENUM NITROSUM
Suited to nervous, sensitive, plethoric women, during or after the menopause. Indicated in sudden, intense vasomotor symptoms with facial flushing, anxiety, palpitations, and throbbing headaches. Symptoms are aggravated by slightest emotional excitement and relieved by fresh air.

CAPSICUM ANNUM
It seems suitable to those persons who are of lax fibres, weak, lazy, indolent, fat, red, clumsy, awkward and of unclean habits. Climacteric disturbances with burning of tip of tongue. Uterine haemorrhage near the menopause, with nausea

CARBO VEGETABILIS
The patient is slow, obese, and lethargic, with a tendency toward chronic ailments. Weakness of memory and slowness of thought. Anxiety, especially in the evening (4-6 p.m.)  Debility from defective circulation and imperfect oxidation of the blood, vital forces nearly exhausted, cold surface, especially from knees to feet. Menses too pale and scanty, or too copious and premature, with a varicose condition of sexual organs and abdominal spasm. Burning in hands and soles during menstruation. All complaints are relieved by being fanned.

CIMICIFUGA RACEMOSA
Cimicifuga is particularly indicated in perimenopausal women suffering from marked mental depression, apprehension, and fear of impending evil. It is useful in cases presenting with irregular, profuse, dark menstrual flow accompanied by severe backache, uterine congestion, neuralgic pains, and rheumatic symptoms. Vasomotor disturbances such as heat flashes followed by chills and perspiration are characteristic indications

CROTALUS CASCAVELLA
Metrorrhagia during climaxis. Hot flushes -Sensation as if a red-hot iron were stuck into the vertex. Insomnia, dreams about the dead when she falls asleep. Mania alternating with metrorrhagia. Great sadness and dwell on death continually, especially when alone. All the complaints < during menopause, sleep

GLONOINUM
Suited to women of nervous temperament who are plethoric, florid, and sensitive. At climaxis, flushes of heat, violent headache, nausea, loss of senses, vertigo, swelling of feet. Flushes of heat at the climacteric with the catamenia. Headache < from the heat of the sun; > in the open air and from pressure.  Cerebral congestion, or alternate congestion of the head and heart.

GRAPHITES
Graphites is suited to chilly, sluggish women with a tendency to weight gain, constipation. Menses – delayed or scanty menstruation. Mental symptoms include sadness, melancholy, and weeping disposition. Characteristic features include fissures of skin and muco-cutaneous junctions, aversion to coitus, and flushes of heat with numbness of the head.

LACHESIS
It suited women who have not recovered from the change of life, “have never felt well since that time. Great sadness in the morning on waking, no desire to mix with the world. Restless and uneasy, does not wish to attend to business, wants to be off somewhere all the time. Hot flushes and hot perspiration and burning vertex headache, especially at or after the menopause. Palpitation, with fainting spells, especially during climacteric. Menses at regular time, too short, scanty, suppressed or irregular menses. All symptoms < after sleep, or the aggravation wakes him from sleep > by the appearance of discharges

MAGNESIUM CARBONICUM.
Menses too late and scanty, thick, dark, like pitch.  Anxious, with perspiration all day. Sad mood with an indisposition to talk.  Heat on the vertex and Sore throat before menses appear.  Heat in the head and hands with redness of face, alternating with paleness of face.  Rush of blood to the head. Headache in bed at night, also during sleep, > by sitting up.  Unrefreshing sleep, with fatigue < in the morning and before going to bed, in the evening.

MUREX
It adapted to nervous, lively, affectionate women and persons of a melancholy temperament. Great depression of spirit, she considers herself hopelessly ill, goes to bed and remains there; great debility of the muscles, sinking of the stomach, constriction of uterus during the climacteric period. Menses- irregular, early, profuse, protracted, flowing in large clots with intense pain, like something pressing in the pelvis, worse from sitting. Sleeplessness -awakes early with a headache; sleep is prevented by cold extremities and crowding of ideas or nervousness. Urine is frequent at night, watery, and bloody.

NATRUM MURIATICUM
It is indicated in emotionally sensitive women with a tendency to silent grief, weeping, and aversion to consolation. Perimenopausal symptoms include hot flushes, vaginal dryness, palpitations, headaches, and urinary disturbances. Menstrual irregularities may present as scanty or profuse flow with dark blood.

PULSATILLA
Pulsatilla is useful in mild, yielding women with changeable moods and emotional sensitivity. Menstrual flow is often irregular, delayed, or scanty, accompanied by chilliness and sadness. Vasomotor symptoms, rheumatic pains, and sleep disturbances are common indications during Perimenopause.

PSORINUM
Anxious -full of fears and evil forebodings; every moral emotion causes trembling. Despondent: fears he will die; that he will fail in business; during climaxis. Great weakness and debility. The whole body is painful, as if sprained and injured. Mammae swollen and painful. Sleepless at night from intolerable itching, vivid dreams continue after waking or cannot get rid of the one persistent idea.

OVININUM
It indicated after excision of the ovaries and in climacteric sufferings, especially those characterized by skin disorders, such as acne, prurigo. Anxiety in an evening in bed, from violent exercise. Confusion of mind, diminished power to think. All conditions agg. Thinking about them.

SULPHUR
Sulphur is indicated in perimenopausal women with marked vasomotor instability, manifested as flushes of heat, burning vertex, hot head with cold feet, and profuse perspiration. Mental symptoms include weakness of memory, irritability, and indifference. It is particularly useful in cases with irregular circulation and constitutional weakness during the climacteric period.

SANGUINARIA CANADENSIS
Sangunaria is useful in perimenopausal syndrome marked by severe vasomotor symptoms such as circumscribed redness of cheeks, flashes of heat, burning in palms and soles, and distension of temporal veins. It is also indicated in climacteric headaches, painful breast enlargement, and offensive uterine bleeding associated with heat flushes and weakness.

SEPIA OFFICINALIS
It is effective in hot flushes with weakness, perspiration, emotional indifference, irritability, vaginal dryness, and dyspareunia. Irregular menses of nearly every form – early, late, scanty, profuse, amenorrhoea or menorrhagia. Flushes of heat from least motion; with anxiety and faintness, followed by perspiration over whole body.

SULPHURIC ACID
Adapted to the light-haired old people, especially women. Prostration of mind and body with extreme sadness and weeps continuously. Flushes of heat in climacteric years. Hot flushes, followed by perspiration, with trembling. Menses -Too early, too copious and too long and climacteric bleeding or spotting of blood, uterine diseases in elderly women. Leucorrhoea -milky, acrid, burning, frequent discharge of corrosive mucus from the vagina accompanied with uterine prolapse and menopausal symptoms.

USTILAGO MAYDIS
Great irritability, very sad, cries frequently, mental weakness and depression. Congestion to various parts, especially at climacteric. Nervous headache from menstrual irregularities.  Menorrhagia during and after climaxis with vertigo, active and constant flow with frequent clots.  Heat flushes and circulatory disturbances like those at menopause or after early menstrual suppression.

ZINCUM VALERIANICUM
Neuralgic pains, with nervousness and sleeplessness, aggravated during menses. Hysterical symptoms- frequently, at the same time < climacteric period. Severe neuralgic occipital headache with sensation as if parts would be pressed asunder.

CONCLUSION:
Perimenopause is a natural yet challenging phase that significantly affects a woman’s physical, emotional, and social well-being. While conventional hormonal therapies provide symptomatic relief, their long-term risks necessitate the exploration of safer alternatives. Homoeopathy, through its holistic and individualized approach, offers effective management of perimenopausal syndrome without adverse effects. The above remedies highlight the breadth of homoeopathic therapeutics available for managing perimenopausal syndrome. Individualization based on mental, emotional, physical, and miasmatic considerations remains essential. The remedies documented in classical literature and clinical studies reinforce the role of homoeopathy as a safe, effective, and holistic alternative to hormonal therapy in perimenopausal women.

Reference:

1. Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical Practice Guidelines on Menopause: An Executive Summary and Recommendations: Indian Menopause Society 2019-2020. J Midlife Health: 2020 Apr-Jun;11(2),55-95
2. Konar H.D C Dutta’s Textbook of Gynecology including Contraception.7th ed ,J P Medical Ltd, New Delhi,2016 ,46-527.
3. Pathophysiology of Menopause https://www.pathophys.org/menopause/
4. Hormonal fluctuation during Menopause https://www.herstasis.com/menopause-primer/
5. Verma P N , Vaid I. Encyclopaedia of Homoeopathic Pharmacopeia and Drug Index.4th ed, Volume 1&2 ,B Jain Publishers, New Delhi,2007,253-254,2251-2252.
6. Clarke JH.A Dictionary of Practical Material Medica.1/e ,B Jain Publishers, New Delhi, 2014, 1158-1174,98-100.
7. Hering C. The Guiding Symptoms of Our Materia Medica.1/e,Vol 1& 9 ,B Jain Publishers, New Delhi,1986, 238-250,308-320.
8. Boericke W. Pocket Manual of Homoeopathic Materia Medica and Repertory. 9/e, Indians Books and Periodicals Publishers, New Delhi ,2015,586-589,47-48,833-834.
9. Phatak SR. Materia Medica of Homoeopathic Medicines,2/e Jain Publishers. New Delhi; 2012.
10. Farrington EA. Lectures on Clinical Materia Medica. Jain Publishers. New Delhi; 1999.

Dr Deekshitha P
PG Part II, Department of Homoeopathic Materia Medica.
Under the Guidance of Dr.Ashok Kumar Dantkale
Professor and PG guide, Department of Homoeopathic Materia Medica,
Government Homoeopathic Medical College and Hospital, Bangalore.
Email id: deekshithapnaik@gmail.com