Vayasthapana Gana Ksheerapaka in Perimenopausal Symptoms - A Case Report

Perimenopause is the transition period from reproductive to non-reproductive phase. It usually begins with menstrual cycle irregularity and extends to one year after permanent cessation of menstruation. There is manifestation of varied physical, psychological and somatic symptoms. Menopause may be correlated to Rajakshaya. It usually occurs as part of the ageing process and is the period of transition from Pitta predominant middle age to vata predominant old age. Treatment in modern medicine includes hormone replacement therapy and use of anti-depressants etc. Acharyas mention Jara among Swabhavabala pravritta Vyadhi, and its management is to be done with drugs having Rasayana property. Here we present a 48-year-old lady who presented with complaints of hot flushes, severe sweating especially during night hours, reduced sleep, irritability, multiple joint pain, loss of interest in most daily activities and stress incontinence. Vayasthapana gana was administered as Ksheerapaka. Vayasthapana gana include ten drugs which are Rasayana, Medhya, Tridosha samana and possess anti-oxidant, free radical scavenging and anti-stress activity. Ksheera is Vata pitta samana, Rasayana, and Jeevaneeya. Vayasthapana gana ksheerapaka is given in the dose of 48ml twice daily one hour before food for thirty days. After treatment intensity of these symptoms were reduced. Follow up was done thirty days after stopping the medication, here also intensity of these symptoms remained less when compared to before treatment. Here we reviewed the probable role of Vayasthapana gana ksheerapaka in alleviating perimenopausal symptoms.

A Case of Excessive Sweating and Hot Flushes Successfully Treated with Yokukansan / 日本東洋医学雑誌

We report a case of a 49-year-old woman who presented with 6-month period menopausal syndrome including excessive sweating and hot flushes in her face, chest and back. She was also frustrated with her sons, but she reflected on her own anger and wondered why she got so irritated with them. We prescribed yokukansan to her and her all symptoms improved one month later. We need to differentiate between yokukansan and kamishoyosan in the treatment of menopausal syndrome and irritation, and it may be useful to evaluate the detail of irritation in selecting formula.

Hindi translated version of menopausal rating score questionnaire: a method to evaluate post menopausal symptoms in India

Background: There are large number of post menopausal patients in India deserving more care and attention than is given at present.MRS questionnaire in Hindi (MRS-H), a translated and validated version of original MRS Scale (MRS-E), self assessed by patients in their own native language. This tool can be used to assess and document current quality of life as well as improvement with treatment of severe post menopausal symptoms, in Indian population.Methods: 30 bilingual English and Hindi speaking postmenopausal patients were recruited for this study.MRS Questionnaire has 11 questions covering somatic, pschycological and genitourinary symptoms of menopause. The scoring system is simple. Hindi translation of MRS Questionare was done from English (MRS-E) to Hindi (MRS-H) by 4 independent translations using standard protocol. The MRS-H was tested for internal validity and also compared with MRS - E.Results: Quality of life is a subjective perception modified by the cultural habitat in which one lives. MRS-H showed high validity and good co-relation with MRS-E. The MRS-H possessed good convergent and discriminant validity. MRS-H showed anICC (Intraclass coefficient) was more than 0.5 and cronbach alpha more than0.5. There was found to be strong correlation between MRS-E and MRS-H questionnaire with all correlation value above 0.7.Conclusions: The authors recommend the use of the self assessed MRS-H in Hindi should be used to assess menopausal complaints and relief with treatment in India.

Estrategias no farmacológicas para el manejo de los síntomas vasomotores en la menopausia

Los síntomas vasomotores afectan a gran número de mujeres en la peri y posmenopausia, impactando notablemente en la calidad de vida; por otro lado, su duración en el tiempo es incierta y muchas veces prolongada. Si bien la terapia hormonal de la menopausia (THM) constituye el tratamiento más efectivo para los síntomas climatéricos en su conjunto, en algunos casos existen contraindicaciones para su uso. Por lo tanto, ofrecer estrategias de tratamiento en las mujeres con contraindicación al tratamiento hormonal resulta mandatorio. Contamos con una amplia gama de opciones no hormonales, tanto farmacológicas como no farmacológicas. Dentro de estas últimas se incluyen las terapias alternativas o naturales (isoflavonas y cimicifuga racemosa), las modificaciones sobre el estilo de vida y las terapias complementarias. Las terapias alternativas presentaron resultados controvertidos en cuanto a la efectividad sobre los síntomas climatéricos y, por otro lado, debido a que su mecanismo de acción involucra a los receptores estrogénicos, están contraindicadas en las pacientes con antecedentes personales de cánceres hormonodependientes. Las modificaciones del estilo de vida impactan positivamente la salud general de la mujer, más allá de los síntomas climatéricos. En cuanto a las terapias complementarias, las únicas recomendadas son la terapia cognitiva conductual y la hipnosis. Se debe individualizar en cada caso la mejor opción terapéutica, teniendo en cuenta los antecedentes, interacciones medicamentosas, estado cognitivo, entre otros, ya que el objetivo final es mejorar la calidad de vida de nuestras pacientes.

Vasomotor symptoms affect a large number of women in the peri and post menopause with significant impact on quality of life; the duration of these symptoms is uncertain and often prolonged. Although menopausal hormone therapy is the most effective treatment for climacteric symptoms, there are some contraindications for its use. Therefore, it is mandatory to offer other treatment strategies for women with contraindication to hormonal treatment. We have a wide range of non-hormonal options available, both pharmacological and non-pharmacological. Among the latter, we include alternative or natural therapies (isoflavones and cimicifuga racemosa), lifestyle changes, and complementary therapies. Alternative therapies show controversial results regarding effectiveness on climacteric symptoms, and their mechanism of action involves estrogen receptors; they are contraindicated in patients with a personal history of hormone-dependent cancers. Lifestyle modifications have a positive impact on women's general health, beyond the climacteric symptoms. The only complementary therapies recommended are cognitive behavioral therapy and hypnosis. In each case, the best therapeutic option should be individualized, taking into account the patient's clinical history, drug interactions and cognitive status, since the ultimate goal is to improve quality of life.

Hot flushes and night sweats in midlife: why do some women have them and others do not? / Afrontamentos e suores noturnos na meia-idade: porque é que algumas mulheres os têm e outras não?

This study investigated what predicts the occurrence of hot flushes (HF) and night sweats (NS). A community sample of 992 women (42-60 years) answered a questionnaire to collect socio-demographic, health and menopause-related, as well as lifestyle information. Depressive mood and stress, as well as HF and NS (in terms of presence, frequency and intensity), were also assessed. Structural equation modelling was used to build a structural model to predict the occurrence of both vasomotor symptoms. Results: Stress predicted NS (ß =.154; p =.006), whereas depressive mood was linked to the occurrence of HF's (ß =.149; p =.006). Being peri-menopausal and post-menopausal, among several other characteristics, were also significant predictors of the occurrence of both HF and NS. This study supports a distinguished influence of stress and depressive mood in NS and HF respectively, probably due to the nature of psychological symptoms. Moreover, significant associations between vasomotor symptoms and socio-demographic, health and menopause-related characteristics, and alcohol were confirmed. (AU)

Este estudo investigou os preditores da ocorrência de afrontamentos (Af) e de suores noturnos (SN). Foi utilizada uma amostra comunitária de 992 mulheres (42-60 anos), que respondeu a um questionário para a recolha de informação sociodemográfica, de estado de saúde e menopausa, e sobre o estilo de vida. Os níveis de humor deprimido e estresse, tal como a ocorrência, frequência e intensidade dos Af e SN, foram avaliados. Modelos de equações estruturais foram utilizados para construir o modelo estrutural para predizer a ocorrência de ambos os sintomas vasomotores. Os resultados indicaram que estresse predisse os SN (ß =0,154; p =0,006), enquanto o humor deprimido associou-se à ocorrência de Af (ß =0,149; p =0,006). Estar na peri-menopausa ou na pós-menopausa, entre outras características, associou-se igualmente à ocorrência de Af e SN. Este estudo suporta uma influência diferenciada do estresse e do humor deprimido na ocorrência de SN e Af, respetivamente, provavelmente devido à natureza dos sintomas psicológicos. Adicionalmente confirmou-se uma associação significativa entre os sintomas vasomotores e características sociodemográficas, de saúde, de menopausa e consumo de álcool. (AU)

Prevalencia de insomnio y deterioro de la calidad de vida en posmenopáusicas que presentan oleadas de calor residentes en el Caribe Colombiano / Prevalence of insomnia and quality of life for post-menopausal women suffering hot flushes living in the Colombian Caribbean region

Objetivo: comparar la prevalencia subjetiva de insomnio y del deterioro severo de la calidad de vida en un grupo de mujeres posmenopáusicas que presentan oleadas de calor, con la obtenida en otro grupo con ausencia de las mismas. Materiales y métodos: estudio transversal en 589 mujeres posmenopáusicas, 40-59 años de edad, que hacen parte del estudio Calidad de vida en la menopausia y etnias colombianas (Cavimec). Se compararon mujeres que referían oleadas de calor con otras que no tenían dicha sintomatología. Para evaluar la calidad de vida se utilizó la Menopause Rating Scale, y para el insomnio la Athens Insomnia Scale. Resultados: el 49,2% (290/589) de las mujeres manifestaron experimentar oleadas de calor y la prevalencia de insomnio para todo el grupo fue del 34,8% (IC 95%: 31,0-38,8%). En el grupo de mujeres menopáusicas con oleadas de calor la prevalencia de insomnio fue del 45,5% (IC 95%: 37,9-51,4%) mientras en el grupos sin oleadas de calor fue del 24,4% (IC 95%: 19,7-29,7%). Las oleadas de calor aumentan 2,07 veces el riesgo de insomnio. La prevalencia de deterioro severo de la calidad de vida fue del 17,2% (IC 95%: 13,1-22,1%) en las mujeres con oleadas de calor y del 1,7% (IC 95%: 0,5-3,9%) en las mujeres sin oleadas de calor. Conclusiones: fue más prevalente el insomnio y el deterioro severo de la calidad de vida en mujeres con oleadas de calor, que entre aquellas libres de dicha manifestación.

Objective: Comparing the prevalence of subjective insomnia and severe deterioration in the quality of life in a group of postmenopausal women suffering from hot flushes to that obtained in another group not suffering from hot flushes. Materials and methods: This was a cross-sectional study of 589 40-59-year-old postmenopausal women forming part of a quality of life study covering menopause and Colombian ethnic groups (Cavimec). Women suffering hot flushes were compared to others who were not suffering such symtomatology. The menopause rating scale was used for evaluating the quality of life and the Athens insomnia scale for insomnia. Results: 49.2% (290/589) of the women stated that they had suffered from hot flushes and the prevalence of insomnia for the whole group was 34.8% (31.0-38.8 95%CI). The prevalence of insomnia was 45.5% (37.9-51.4 95%CI) in the group of menopausal women suffering hot flushes whilst prevalence in groups in which hot flushes had not occurred was 24.4% (19.7-29.7 95%CI). Hot flushes increased the risk of insomnia 2.07 times. The prevalence of severe deterioration in the quality of life was 17.2% (13.1-22.1 95%CI) in women suffering hot flushes and 1.7% (0.5-3.9 95%CI) in women without them. Conclusions: Insomnia and severe deterioration in the quality of life was more prevalent in women suffering hot flushes than in women free from such manifestation.

<b>Four Patients with Various Symptoms of Non-Gastrointestinal </b><b>Disorder Successfully Treated with Rikkunshito </b> / 日本東洋医学雑誌

Rikkunshito is known as a drug used for recovery from epigastric distress and loss of appetite. However, here we report four patients with symptoms involving non-gastrointestinal disorders successfully treated with rikkunshito. In Case 1 there was a complaint of erythema around the right eye, in Case 2 of hot flushes, in Case 3 of gonarthrosis, and in Case 4 of urticaria. After taking rikkunshito, these symptoms improved. The four cases were instances of <i>hikyo</i>, because in Cases 1, 3, 4 their disorders of the stomach were so severe that they couldn't take shishihakuhito, boiogito, jumihaidokuto and inchingoreisan, and in Case 2 there was poor appetite in summer. Thus we believe it is important to improve gastrointestinal symptoms with rikkunshito when various <i>hikyo </i>disorders arise.

Uso de antidepresivos para el tratamiento de los síntomas climatéricos: [revisión] / Using antidepressant drugs for treating menopausal symptoms: [review]

Introducción: los síntomas vasomotores se reportan con frecuencia durante la peri y posmenopausia, y afectan de forma importante la calidad de vida de las mujeres que los sufren. Los estrógenos continúan siendo el tratamiento de elección para estos síntomas, sin embargo, en algunas mujeres este tipo de tratamiento está contraindicado, mientras que otras mujeres simplemente no aceptan usarlo. El objetivo del presente trabajo es hacer una revisión de estudios clínicos que evalúan la eficacia de los antidepresivos en el tratamiento de los síntomas vasomotores. Materiales y métodos: se realizó una revisión en las bases de datos Medline vía PubMed, EBSCO y Ovid. Se incluyeron artículos, publicados entre 2002 y 2011, de ensayos clínicos aleatorizados, meta-análisis y revisiones sistemáticas que evaluaron la eficacia de fármacos antidepresivos en el tratamiento de síntomas vasomotores. Resultados: se observa que los antidepresivos ayudan a aliviar los síntomas vasomotores e inciden favorablemente en los síntomas neuropsiquiátricos propios del climaterio, tales como la irritabilidad, las alteraciones del sueño y la labilidad emocional. Los estudios en relación a la fisiopatología de los bochornos soportan la hipótesis de que los antidepresivos pueden ser útiles para su tratamiento. Dentro del grupo de medicamentos antidepresivos existe evidencia para el uso de sertralina, fluoxetina, citalopram y venlafaxina. Conclusión: el uso de antidepresivos puede ser útil en el tratamiento de los síntomas vasomotores relacionados con la menopausia. Debemos considerar aquellos que tengan un perfil farmacológico noradrenérgico y serotoninérgico...

Introduction: vasomotor symptoms are frequently reported during the peri and postmenopausal periods and drastically affect the quality of life of those women who suffer them. Estrogens continue being the treatment of choice for such symptoms; however, this type of treatment is contraindicated in some women, whilst other women simply refuse to use them. The present work was aimed at reviewing clinical studies which have evaluated antidepressant drugs’ effectiveness regarding the treatment of vasomotor symptoms. Materials and methods: Medline / PubMed, EBSCO, and Ovid databases were reviewed. Articles published between 2002 and 2011 were included, as were randomized clinical assays, metaanalyses and systematic reviews which evaluated antidepressant drugs’ effectiveness in treating vasomotor symptoms. Results: it was observed that antidepressants helped to alleviate vasomotor symptoms and had a favorable effect on neuropsychiatric symptoms related to the menopause, such as irritability, alterations in sleeping patterns and emotional ability. Studies regarding hot flushes’ physiopathology supported the hypothesis that antidepressants could be useful for treating them. Evidence regarding the group of antidepressant medicines suggested using sertraline, fluoxetine, citalopram and venlafaxine. Conclusion: antidepressant drugs could be useful in treating menopause-related vasomotor symptoms; those having a noradrenergic and serotoninergic pharmacological profile should be considered...

Terapia não-hormonal no manejo das ondas de calor no climatério / Non-hormonal therapy in the management of hot flushes in climateric

A menopausa, ponto máximo do climatério, é um evento acompanhado frequentemente por sintomas vasomotores, podendo ter um impacto significativo na qualidade de vida da mulher. A maioria das mulheres experimentará fogachos em algum momento de suas vidas com frequência e intensidade variáveis. Apesar das inúmeras teorias, a fisiopatologia exata dos fogachos ainda não é conhecida. Existem muitas opções de terapias farmacológicas hormonais e não-hormonais, até intervenções não-farmacológicas, e escolher a melhor opção de tratamento para cada mulher envolve o conhecimento dos possíveis riscos e benefícios de cada tratamento, necessitando de individualização na conduta. O tratamento hormonal (estrogênio e/ou progesterona) ainda é a opção mais utilizada, o qual se tem mais estudos realizados com esta modalidade de tratamento, resultando em uma redução de 80 a 90% dos fogachos, entretanto, cada vez mais são procuradas terapias alternativas. O manejo não-hormonal com melhores resultados tem sido conseguido com a classe dos antidepressivos mais recentes, a qual compreende vários inibidores seletivos da recaptação da serotonina, alguns fornecendo redução de cerca de 60% dos fogachos. Este artigo procurou avaliar as opções de terapias não-hormonais disponíveis para o controle dos sintomas climatéricos, seus efeitos colaterais e mecanismos de ação.

Menopause, the highest point of climateric, is frequently followed by vasomotor symptoms and may case a large impact in women's quality of life. The majority of women will experience episodes of hot flushes at various frequencies and intensities during their lives. Despite many theories about the physiopathology of hot flushes, the exact cause is still unknown. Different treatments for climacteric symptoms are available, such as hormonal and non-hormonal therapies, and non-pharmacological intervention also becomes an option. Choosing the best treatment requires ample knowledge of each therapy risks and benefits, and it is necessary to individualize the treatment for each woman. The hormonal therapy (estrogens and/or progestins) is still the most applied option. Accomplished studies about this kind of treatment demonstrated that it can reduce the intensity of hot flushes from 80 up to 90%; however, more and more women are searching for alternative therapies. The non-hormonal therapy with the best result involves the most recent class of antidepressant drugs, which includes many selective serotonin reuptake inhibitors, some of them reducing hot flushes up to 60%. This article aimed at evaluating non-hormonal therapy options available to control climacteric symptoms, their side effects and mechanism of action.

Effect of the levels of serum gonadal hormone and plasma calcitonin gene-related peptide on the hot flushes symptom of perimenopausal women / 中国综合临床

Objective To study the effect of the levels of serum gonadal hormone and plasma calcitonin gene-related peptide(CGRP) on the hot flushes symptom of perimenopausal women. Methods 65 perimenopausal women (35 with hot flushes and 30 without hot flushes) and 25 healthy fertile women were enrolled. The subjects were analyzed for serum estradiol (E2), follicle-stimulating hormone (FSH) ,luteinizing hormone (LH) and plasma calcitonin gene-related peptide (CGRP). Results. ① There were no significant differences of the E2 levels between the perimenopausal women with and without hot flushes (P>0.05). The levels of FSH and LH were significantly higher in the women with hot flushes than women without hot flushes and fertile women(P<0.05),② The levels of plasma CGRP were significantly higher in the women with hot flushes than women without hot flushes (P<0.05), and significantly lower than fertile women,③The levels of plasma CGRP were significantly higher in severe hot flu-shes group than that in the mild hot flushes group and moderate hot flushes group(P<0.05), the severity of hot flu-shes was positively related to the level of plasma CGRP(rs=0.823, P<0.01), but there was no relationship be-tween serum E2 and the severity of hot flushes (P>0.05). Conclusion The occurrence of perimenopansal hot flu-shes might be closely related to the decline and fluctuation of serum E2,increase of FSH and LH and the concentra-tion variety of plasma CGRP.

Inhibitory Effect of Keishi-bukuryo-gan on CGRP-induced Elevation of Skin Temperature in GnRH Analogue-treated Male Rats / 日本東洋医学雑誌

The gonadotropin-releasing hormone (GnRH) analogue (Leuplin/^®1.0mg/kg, s. c.) induced not only a decrease in the serum concentration of testosterone but also potentiation of calcitonin gene-related peptide (CGRP: 10μg/kg, i. v.)-induced elevation of skin temperature in male rats. Keishi-bukuryo-gan (1, 000mg/kg, p. o.) and 17β-estradiol (0.010mg/kg, s. c.) significantly inhibited the elevation of skin temperature as well as teststerone (1.0mg/kg, s. c.) replacement. However, Keishi-bukuryo-gan and 17β-estradiol did not affect the low concentration of serum testosterone, although the hormone replacement of testosterone restored the plasma level. These results suggest that Keishi-bukuryo-gan, which does not have testosterone activity to serum, may be useful for the treatment of hot flushes due to testosterone deficiency after GnRH therapy in men with prostatic carcinoma, as well as 17β-estradiol.

Reproductive Psychiatry: Perimenopause and Menopause / 신경정신의학

The most troublesome symptoms of perimenopause and menopause are hot flushes, insomnia, depression, sexual dysfunction and cognitive decline. The suggested mechanism is the hormonal changes of estrogen, progesterone and androgen as well as neuromodulating effect of estrogen, which enhances activity of 5-HT and norepinephrine, inhibiting monoamine oxidase and dopamine. Though testosterone deficiency is not analogous to female menopause, male climacteric has become a clinical issue in current psychiatry.