CLIMACTERIC AILMENTS

Abstract: Climacteric is a common phenomenon of women. It is a physiological process but, lots of women suffer very seriously. This article is an attempt to explore its aetiology, symptoms, diagnosis, management, conventional treatment & its side effect and Homoeopathic approach.
Keywords: Climacteric, Menopause, Menstruation, Aromatisation, Hormone Replacement Therapy, Homoeopathy.
Introduction
Adjustment and compromise are the two components to survive in nature. Our internal body constantly adjust to combat a situation called as homoeostasis. The best example of adjustment in a female life is transition from the active to inactive reproductive life. Adjustment involves three basic levels: Physical, Mental & Sexual. This change of life period is called climacteric period. It begins around three years before final stoppage of menstruation and continues for two- five years after it. ⁽¹⁾
Stoppage of menstruation is called menopause. It may be defined as cessation of ovarian function around the age of 47 years⁽¹⁾; resulting in permanent stoppage of menstruation. ⁽²⁾ Menstruation means crying of uterus during the period of reproductive life of a female where blood and bits of endrometrium is coming for failure of giving birth to a new life (funeral of the unfertilised ovum).
Demography:
60 million women in India are above age of 55 years ⁽¹⁾. Majority of women spend 1/3 of their life in post menopausal period. ⁽²⁾
Aetiology:
Climacteric is a natural process. But millions of women suffer a lot due to:
A.   Fundamental cause: As per Homoeopathic philosophy, latent miasms are responsible for manifestation of symptoms. History of past illness, family history and present manifestation of symptoms give the miasmatic diagnosis which is essential for the treatment of a particular patient.
B.   Organic Causes:
·        Deficiency of Oestrogen.
·        Surgical removal of ovary.
·        Hypopituitarism leads to deficient secretion of FSH & LH.
Premature menopause ⁽¹⁾– Below the age of 40yrs. is caused by
·        Genetic factors.
·        Tuberculosis of genital tract.
·        Autosomal diseases.
·        Smoking
·        Chemotherapy
·        Hystectomy
·        Prolong GnRH (Gonadotropin-Releasing Hormone) therapy.
·        17α hydrolase deficiency.
Delayed menopause ⁽¹⁾: Above 50 years of age, causes:
Physiological:
·        Good  nutrition
·        Good health
·        Mental peace.
Pathological:
·        Uterine fibroid
·        Endometrial carcinoma
·        Vulva trauma
·        DUB( Dysfunctional Uterine Bleeding)
Pathophysiology
Oestrogen and Progesterone are the fundamental hormones for a female reproductive life. Oestrogen comes mainly from graafian follicle and a small amount from corpus luteum; progesterone comes from corpus luteum of the ovary. Graafian follicles originate from primordial follicles, 60 lakh⁽³⁾ in number during intra-uterine life, but only 450 to 500 primordial follicles mature to form graafian follicles. Around the age of 40years primordial follicles decrease in number, leading to decrease in the production of these two hormones. When all the primordial follicles are atrophied oestrogen secretion from ovary stops completely. But, F.S.H & L.H from anterior Pituitary is secreted continuously due to negative feedback mechanism. The symptoms start to appear soon after the stoppage of ovarian function.
Age: 45 -50 years; average 47years. ⁽¹⁾
Anatomical changes ⁽¹⁾during climacteric period:
·        Genital organ: atrophied
·        Ovaries: Shrinks
·        Uterus: Small
·        Cervix: Small in size
·        Breast: Pendulous due to less amount of glandular tissue but more amount of fat.
·        Skin: Wrinkles.
·        Hair: Abnormal hair grows around the chin and lips.
Symptoms ^(1,2):
·        Stoppage of menstruation either suddenly or gradually.
·        Hot flushes < Night.
·        Sweating.
·        Headache
·        Palpitation
·        Sleeplessness
·        Depression
·        Irritability
·        Lack of concentration
·        Pseudocyesis
·        Cancer phobia
·        Pin mania.
·        Sexual desire usually decreased but sometimes may be increased.
·        Parasthenia
·        Dysuria
·        Recurrent infection
·        Stress incontinence
·        Vaginal bleeding
·        Dry vagina leads to dyspareunia.
Late symptoms:
·        Osteoporosis.
·        Arthritis.
·        Stroke.
·        Alzheimer disease.
·        Tooth decay.
·        Prolapsed.
·        Cataract.
Investigation:
·        History of the patient & general examination.
·        Hormonal assay
·        Endometrial biopsy
·        U.S.G
·        Mammography
·        X-ray.
Managements:
·        Assurance
·        Counselling
Conventional treatment: Hormone Replacement Therapy (H.R.T). ⁽²⁾
Adverse side effects of HRT:
·        Endometrial carcinoma.
·        Breast Cancer.
·        Venous thrombo-embolic disease.
·        Gallbladder disease.
·        Hypercholesterolemia
·        Dementia.
·        Heart disease.
·        Alzheimer disease.
Homoeopathic treatment:
Climacteric period is a physiological process and 60- 70% women have no complaints because “following menopause, the predominant oestrogen is oestrone and to lesser extent oestradiols. The major source of oestrone is peripheral conversion (aromatisation) of androgen from adrenal and ovaries. The aromatisation occurs at the level of muscle and adipose tissue.” ⁽²⁾ No medicinal treatment is needed, only counselling is sufficient. Homoeopathic treatment is required when sufferings are intolerable and women become sick. It is a border line to differentiate physiological and sick condition and only experienced person can do it. Homoeopathic treatment is based on individualisation, law of similia, law of minimi and theory of miasm. It is my experience that climacteric ailments may be treated successfully if we follow the Homoeopathic law. Homoeopathic medicines act on vital principal. It has no evidence, but my understanding of the knowledge of physiology and Homoeopathy concludes that: vital principal probably acts on adrenal gland to secrete oestrogen to make the minimum fulfilment of body demand. “The adrenal glands, perched on top the kidneys, produce small quantities of both male and female hormones. At the menopause, the adrenal glands should produce adequate oestrogens, progesterone and other needed hormones in the correct balance and amounts to avoid symptoms that can occur when ovarian hormone production of these hormones diminishes.” ⁽⁴⁾
Therapeutics:
According to  “§153”, “more  striking, singular, uncommon and peculiar(characteristic) signs and symptoms of the case of disease are chiefly and most solely to be kept in view” ⁽⁵⁾ in the search of a Homoeopathic remedy. So any medicine from A to Z may be effective.
Repertorial approach:
In different repertories we find lots of medicine under rubric MENOPAUSE, ailment, from, example: In J.T.Kent Repertory: Chapter- GENITALIA -FEMALE – MENOPAUSE. ⁽⁶⁾ In Robin Murphy’s Repertory: Chapter Female, MENOPAUSE, period, ailments, from ⁽⁷⁾; etc.
Case study–
O.P.D ticket no: 42777 of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital.
Name- xxx
Religion: Hindu. Sex: Female. Age: 47 years.
Date of first Visit: 29/07/2015.
Chief Complaints:
Hot flashes < night.
Associates Complaints:
·        Loss of sleep since last 2 yrs.
·        Headache < night.
·        Falling of hair
Past History– Repeated U.T.I, Appendicectomy at the age of 39 yrs. Eczema treated by ointment at the age of 40 yrs. Stoppage of menstruation 2 years back.
Family History:
Mother: Rectal Ca
Father: Hypertension.
Physical generals:
Thermal Reaction: Hot patient.
Appetite: decreased.
Craving: Sweet, warm food.
Thirst: Increased at night.
Prespiration: Profuse during day.
Sleep: Sleeplessness at evening.
Sexual Desire: absent.
Mentals:  Irritable. Depressed. Suppressed anger. Forgetfulness.
Totality of Symptoms:
·        Irritable.
·        Sadness.
·        Suppressed anger
·        Forgetfulness
·        Hot flashes.
·        Headache at night.
·        Falling of hair.
·        Profuse perspiration at day time.
·        Desires warm food.
·        Desires sweet.
·        Thirst more at night.
·        Menopause.
·        Sleeplessness at evening.
R_x Staphisagria 200/ 1dose; on the basis of suppressed anger, sadness, past history of Appendicectomy, repeated U.T.I.
Follow up:
After one month no change was observed. Prescribed Staphisagria 1M/ 1dose as higher dose sometimes work. There was no improvement even after two months. Then, went through the totality of the symptoms and repertorized the case from J.T. Kent Repertory.

 
Repertorial Sheet
 
After Repertorization and cross cheeking the remedies from J.T. Kent’s Materia Medica prescribed:
R_x Sulphur 200 / 1dose.
Improvement started very slowly for one month. It continued for two months. Then case came to a standstill condition, neither any improvement nor any new symptoms arise.
Improvement continued for three months and symptoms relieved: Headache subsided, flushes of heat diminished, perspiration became normal, and no desire for sweet and warm food. Patient is now very much talkative. Again repertorized the case from J.T.Kent Repertory and cross checked the medicine from Materia Medica and prescribed: Lachesis ⁽⁸⁾ 200/1 dose.
After 2 month Lachesis 1M/1dose.
Now patient was free from all the suffering. Continued with placebo.
Conclusion:
Climacteric ailments are a complex of endocrine, somatic, and psychic changes occurring in the transition to menopause. Treatment is needed when women suffers from intolerable signs and symptoms. At first counselling is needed, then treatment. Conventional treatment recommends Hormone Replacement Therapy. Lots of hazards may start after use of H.R.T. To avoid it, Homoeopathic treatment is the best choice. It has no adverse side effects. Treatment of Climacteric ailments is not a big challenge for Homoeopathy.  Homoeopaths treat thousands of patients in their day to day practice with great success.
References:
1. Howkins    &   Bourne.   “Shaw’      Textbook      of Gynaecology” 15^th   edition; edited by VG Padubidri; Shirish N Daftary; Elsevier, New Delhi, 2011.
2. Dutta, D.C., “Text Book of Gynaecology including contraception” 4^th edition; edited by Hiralal Konar; New Central Book Agency (P) LTD. Kolkata 2007.
3. Sembulingam, K.; Sembulingam, Prema. “Essentials of Medical Physiology” 6^th edition; Jaypee Brothers Medical Publisher (P) LTD. New Delhi, 2013.
4. http://drlwilson.com/Articles/MENOPAUSE.htm          (visited on 18/05/2016)
5. Hahnemann, Samuel., “Organon of Medicine”, Translated from 5^th edition with an appendix by R.E. Dudgeon; with Additions and Alterations as per Sixth edition translated by William Boericke, B. Jain Publishers Pvt.Ltd, New Delhi,2003.
6. Kent, J.T., “Repertory of the Homoeopathic Materia Medica and a word index”; enriched Indian edition; reprinted from 6^thAmerican edition; B. Jain Publishers Pvt. Ltd, New Delhi, 2003.(P-724)
7. Murphy, Rabin. “Homoeopathic Medical Repertory”; 3^rd revised edition; B. Jain Publishers Pvt. Ltd, New Delhi, 2011. (P-777)
8.Kent, J.T., “Lecture on Homoeopathic Materia Medica” B. Jain Publishers Pvt. Ltd, New Delhi,2003.
9. Hahnemann, Samuel. “The chronic Diseases-Their Peculiar Nature and Their Homoeopathic cure”, Translated from 2^ndEnlarged German edition by Prof. Louis H. Tafel; B.Jain Publishers Pvt. Ltd, New Delhi,1977.
About the author: Dr Sanjoy Kumar Roy is M.D (Hom) Materia Medica from National Institute of Homoeopathy (Govt. of India). He was Ex. Lecturer at Rajkot Homoeopathic Medical College, Gujarat. At Present, he is working as a Homoeopathic Medical Officer in West Bengal Homoeopathic Health Service, Detailed as Lecturer in the Dept. of Physiology including Biochemistry, Mahesh Bhattacharyya Homoeopathic Medical College & Hospital, Howrah, Govt. of West Bengal.  Histwo articles has been published in Homoeotimes.