1.  MENSTRUATIONMENSTRUATION
 POST MENOPAUSAL SYNDROMEPOST MENOPAUSAL SYNDROME
 TREATMENT OPTIONSTREATMENT OPTIONS
MENO-HRTMENO-HRT
P. K. MITRAP. K. MITRA

2. MENSTRUAL CYCLE
&
HORMONE REPLACEMENT THERAPY

3. BIOLOGY OF MENSTRUATION ?BIOLOGY OF MENSTRUATION ?
 Menstrual cycle is regulated by
fluctuating levels of sex hormones
(FSH, LH )
 These hormones produce certain
changes in the ovaries and uterus
 Humans are nearly unique among
species in having a menstrual cycle
 Other species of mammals have
estrous cycles

4. PHASES OF MENSTRUAL CYCLEPHASES OF MENSTRUAL CYCLE
The menstrual cycle has 4 phases & normal cycle length isormal cycle length is
considered to beconsidered to be 2828 days but varies from female to female:days but varies from female to female:
 Follicular Phase
Maturation of Follicle
 Ovulatory Phase or Ovulation
Release of Matured Ovum inRelease of Matured Ovum in
Fallopian TubeFallopian Tube
 Luteal Phase - Secretory phase
Secretion of Progesterone from Corpus LuteumSecretion of Progesterone from Corpus Luteum
 Menstruation
Clearing of Dead Uterine BedClearing of Dead Uterine Bed

5. Figure: The menstrual cycle
 Follicular phaseFollicular phase
 Egg maturesEgg matures
 OvulationOvulation
 Egg releasedEgg released
 Luteal phaseLuteal phase
 Corpus luteumCorpus luteum
 EndometriumEndometrium
 Prep for blastocystPrep for blastocyst
 No PregnancyNo Pregnancy
 MensesMenses
MENSTRUAL CYCLEMENSTRUAL CYCLE

6. FOLLICULAR PHASEFOLLICULAR PHASE
 Starts in the pituitary gland with the release of FSH (FollicleStarts in the pituitary gland with the release of FSH (Follicle
Stimulating Hormone)Stimulating Hormone)
 Under FSH stimulation one of the ovaries produces theUnder FSH stimulation one of the ovaries produces the
matured follicle ( Ovum )matured follicle ( Ovum )
 When the follicle begins to mature it releases ESTROGENWhen the follicle begins to mature it releases ESTROGEN
hormone.hormone.
 Estrogen causes the uterine lining to thicken in preparationEstrogen causes the uterine lining to thicken in preparation
of the egg ( Ovum )of the egg ( Ovum )

7. OVULATIONOVULATION
 When estrogen levels get high enough they causeWhen estrogen levels get high enough they cause
the release of LH or luteinizing hormonethe release of LH or luteinizing hormone
 LH causes the release of egg from the ovary orLH causes the release of egg from the ovary or
OVULATIONOVULATION
 Follicle pops and the egg comes out causing aFollicle pops and the egg comes out causing a
crater on the side of the ovary, called corpuscrater on the side of the ovary, called corpus
luteum.luteum.

8. LUTEAL PHASELUTEAL PHASE
 The “crater” that is left on the side of the ovaryThe “crater” that is left on the side of the ovary
called Corpus Luteum & oozescalled Corpus Luteum & oozes
PROGESTERONEPROGESTERONE
 Progesterone causes the uterine lining to thickenProgesterone causes the uterine lining to thicken
 If no fertilization occurs in the fallopian tube, theIf no fertilization occurs in the fallopian tube, the
egg deteriorates when it arrives at the ‘horn’ of theegg deteriorates when it arrives at the ‘horn’ of the
uterus.uterus.
 Progesterone & Estrogen levels drop significantlyProgesterone & Estrogen levels drop significantly

9. MENSTRUATIONMENSTRUATION
 The corpus luteum on the side of the ovary healsThe corpus luteum on the side of the ovary heals
into the corpus albacans (white body)into the corpus albacans (white body)
 Cycle starts all over again with the secretion ofCycle starts all over again with the secretion of
FSH by the pituitary glandFSH by the pituitary gland
 The egg meets up with a sperm in the oviduct andThe egg meets up with a sperm in the oviduct and
a zygote is formeda zygote is formed
 Progesterone and Estrogen levels continue toProgesterone and Estrogen levels continue to
increase for another 40 weeksincrease for another 40 weeks
 Corpus luteum does not healCorpus luteum does not heal

10. Other Hormones thatOther Hormones that
Occur after FertilizationOccur after Fertilization
OXYTOCINOXYTOCIN
 Causes the jointsCauses the joints
and ligaments toand ligaments to
loosen starting atloosen starting at
about 4 monthsabout 4 months
 Initiates laborInitiates labor
PROLACTIN
Causes the
production of milk to
start
Takes about 3 days
for the milk to be
formed after birth

11. MENOPAUSEMENOPAUSE
 Menopause is the permanent cessation of reproductive fertilityMenopause is the permanent cessation of reproductive fertility
some time before the end of the natural lifespan.some time before the end of the natural lifespan.
 In women without a uterus, menopause or postmenopause isIn women without a uterus, menopause or postmenopause is
identified by a very high FSH level.identified by a very high FSH level.
 Perimenopause - Menopause transition years during whichPerimenopause - Menopause transition years during which
maximum Physical & Psychological damage occurs.maximum Physical & Psychological damage occurs.
 In women who have a uterus, perimenopause describes the yearsIn women who have a uterus, perimenopause describes the years
both before and after the final period.both before and after the final period.
 During Perimenopause, production of Estrogen, ProgesteroneDuring Perimenopause, production of Estrogen, Progesterone
Testosterone & fertility diminishes.Testosterone & fertility diminishes.
 But not considered to reach zero until the official date ofBut not considered to reach zero until the official date of
menopause.menopause.
 Actual Menopause is declared 12 months after the lastActual Menopause is declared 12 months after the last
menstruation.menstruation.

12. MENSTRUATIONMENSTRUATION
Hormonal Impact:Hormonal Impact:
In some women, these hormonal imbalances cause
undesirable symptoms (climacteric)
LH/FSH oppose the action of estrogen
If high levels of LH/FSH = low levels of estrogen

13. POST MENOPAUSAL SYMPTOMSPOST MENOPAUSAL SYMPTOMS
PSYCHOLOGICALPSYCHOLOGICAL
 DEPRESSIONDEPRESSION
 IRRITABILITYIRRITABILITY
 TIREDNESS / POORTIREDNESS / POOR
SLEEPSLEEP
 ANXIETYANXIETY
 LOSS OF LIBIDOLOSS OF LIBIDO
 WEEPINESSWEEPINESS
 FORGETFULNESSFORGETFULNESS
 LOSS OFLOSS OF
CONCENTRATIONCONCENTRATION
PHYSICALPHYSICAL
 IRREGULAR PERIODSIRREGULAR PERIODS
 HOT FLUSHESHOT FLUSHES
 NIGHT SWEATSNIGHT SWEATS
 PALPITATIONSPALPITATIONS
 SEXUAL CHANGESSEXUAL CHANGES
 SKIN & HAIRSKIN & HAIR
 JOINT PAINSJOINT PAINS
 URINARY SYMPTOMSURINARY SYMPTOMS
 WEIGHT GAINWEIGHT GAIN
 HEADACHEHEADACHE

14. LONG TERM POST MENOPAUSALLONG TERM POST MENOPAUSAL
EFFECTSEFFECTS
 ATROPHY OF VAGINA/ URETHRA
 OSTEOPOROSIS
 CARDIOVASCULAR DISEASE
 RISK OF STROKE AND PULMONARY EMBOLISMRISK OF STROKE AND PULMONARY EMBOLISM
 INCREASED RATES OF BREAST CANCERINCREASED RATES OF BREAST CANCER
 INCREASED GASTRIC BOWEL DISEASEINCREASED GASTRIC BOWEL DISEASE
 INCREASED RATES OF LUPUSINCREASED RATES OF LUPUS
 VAGINAL BLEEDINGVAGINAL BLEEDING

15. TREATMENT OPTIONS OF PMSTREATMENT OPTIONS OF PMS
 HORMONES:HORMONES:
ESTROGENS, PROGESTOGENS , TIBOLONE , RALOXIFENEESTROGENS, PROGESTOGENS , TIBOLONE , RALOXIFENE
 LIFESTYLE MODIFICATION:LIFESTYLE MODIFICATION:
EXERCISE, DIET-FIBER, REDUCE EXPOSURE TO XENOHORMONESEXERCISE, DIET-FIBER, REDUCE EXPOSURE TO XENOHORMONES
 NUTRITIONAL SUPPLEMENTATIONNUTRITIONAL SUPPLEMENTATION
ADRENAL SUPPORT, LIVER SUPPORT, OMEGA 3FAADRENAL SUPPORT, LIVER SUPPORT, OMEGA 3FA
 HERBAL SUPPLEMENTSHERBAL SUPPLEMENTS
Black Cohosh, Dong Quai, Chaste Berry, Evening Primrose OilBlack Cohosh, Dong Quai, Chaste Berry, Evening Primrose Oil
 BIOIDENTICAL HORMONESBIOIDENTICAL HORMONES

16. HRT/DRUGS IN PMSHRT/DRUGS IN PMS
 NATURAL ESTROGENS & PROGESTERONESNATURAL ESTROGENS & PROGESTERONES
 MEDROXY & HYDROXY PROGESTERONESMEDROXY & HYDROXY PROGESTERONES
 TIBOLONETIBOLONE
 RALOXIFENE ( SERM )RALOXIFENE ( SERM )
 PHYTOESTROGENS ( SOY, BC, )PHYTOESTROGENS ( SOY, BC, )

17. RISKS OFHRTRISKS OFHRT
• INCREASED RISK OF BREAST CANCERINCREASED RISK OF BREAST CANCER
• ENDOMETRIAL HYPERPLASIAENDOMETRIAL HYPERPLASIA
• FIBROIDS & ENDOMETRIOSISFIBROIDS & ENDOMETRIOSIS
• ADENOCARCINOMA ( Cancer of Glands )ADENOCARCINOMA ( Cancer of Glands )
• 2 - 4 FOLD INCREASED RISK OF2 - 4 FOLD INCREASED RISK OF
DEVELOPING THROMBOLIC DISEASEDEVELOPING THROMBOLIC DISEASE
• DEPRESSION, WEIGHT GAIN, BLOATINGDEPRESSION, WEIGHT GAIN, BLOATING
• IMPAIRED LIVER DISEASEIMPAIRED LIVER DISEASE


18. Alternative remedies forAlternative remedies for
symptoms of Menopusesymptoms of Menopuse

19. PHYTOESTROGENSPHYTOESTROGENS
Plant-derived compounds weak estrogenic activity -Plant-derived compounds weak estrogenic activity -
similar in structure to estrogensimilar in structure to estrogen
Isoflavones, lignans, coumestans, Black-cohoshIsoflavones, lignans, coumestans, Black-cohosh
Found in legumes, soybeans, vegetables, cerealsFound in legumes, soybeans, vegetables, cereals

20. ISOFLAVONESISOFLAVONES
 Found in soyFound in soy
 Genistein, Daidzein (most studied)Genistein, Daidzein (most studied)
 Can bind to estrogen receptorsCan bind to estrogen receptors
 May enhance estrogen’s beneficial effects,May enhance estrogen’s beneficial effects,
or block negative effectsor block negative effects

21. BLACK COHOSHBLACK COHOSH
 Suppresses secretion of luteinizing hormone
 Most effective in relieving symptoms in early climacteric
women
 Has beneficial effects on climacteric symptoms -
beneficial bone remodeling and weak estrogenic-like
effects on the vaginal mucosa
 Relatively safe/effective alternative to HR therapy

22. BENEFITS OFPHYTOESTROGENSBENEFITS OFPHYTOESTROGENS
 Plant source derived, least chance of side effectsPlant source derived, least chance of side effects
 Mimic the functions of Physiological EstrogensMimic the functions of Physiological Estrogens
 Do not alter the levels of circulating hormonesDo not alter the levels of circulating hormones
in the bodyin the body
 Avoids the risk of Breast & Uterine CancersAvoids the risk of Breast & Uterine Cancers
 Eliminates the Adverse effects of HRTEliminates the Adverse effects of HRT
 Protects from CVD, Brain function disordersProtects from CVD, Brain function disorders
 Well tolerated & high safety profileWell tolerated & high safety profile

23. MENO-HRTMENO-HRT
Each Tablet Contains:Each Tablet Contains:
• Blackcohosh – 40 mgBlackcohosh – 40 mg
• Isoflavones - 60 mgIsoflavones - 60 mg
• Glucosamine sulphate – 300 mgGlucosamine sulphate – 300 mg
• Milk Calcium – 250 mgMilk Calcium – 250 mg
• Vitamin E - 200 IUVitamin E - 200 IU
• VitaminD3 – 200 IUVitaminD3 – 200 IU
• Magnesium – 40 mgMagnesium – 40 mg

24.  BlackCohosh & Soya Isoflavones mimic the estrogenic action
and relief physical & psychological symptoms:
 Black Cohosh & Soya Isoflavones show synergistic effect in
reducing Hot flush, Night Sweats, Calcium resorption &
Anxiety.
 Prevents future risk of Rheumatoid Arthritis, Premenstrual
Syndrome, Muscle Spasms, Sleep Disorders & Depression.
 Milk Calcium & Vit D3 help in prevention of Osteoporosis,
future risk and supplement Calcium need of the body,
Glucosamine & Magnesium strengthen bone matrix prevent
risk of Fractures, Osteoarthritis.
MENO-HRT : BENEFITSMENO-HRT : BENEFITS

25. MENO-HRT : BENEFITSMENO-HRT : BENEFITS
 Devoid of Estrogenic side effects & preventsDevoid of Estrogenic side effects & prevents
risk of Coronary Artery Disease (CAD)risk of Coronary Artery Disease (CAD)
 Improves Metabolic & Enzymatic FunctionsImproves Metabolic & Enzymatic Functions
 Offers anti-oxidant benefits and protect against FRDOffers anti-oxidant benefits and protect against FRD
 Avoids the risk & ADR of HRT …. The NaturalAvoids the risk & ADR of HRT …. The Natural
Alternative.Alternative.

26. MENO-HRT TABLETSMENO-HRT TABLETS
 PACKING :PACKING : 3 x 10’s3 x 10’s
 STRIPING :STRIPING : Blister FoilBlister Foil
 PUNCH LINE :PUNCH LINE : The Natural Alternative to HRTThe Natural Alternative to HRT
 M’FACTURERM’FACTURER :: Star Healthcare IncorporationStar Healthcare Incorporation,, USAUSA
 INDICATIONS :INDICATIONS : Post-Menopausal SyndrommePost-Menopausal Syndromme
 TAB COLOUR :TAB COLOUR : Soft Green ColourSoft Green Colour

27. THAN QTHAN Q
P. K. MitraP. K. Mitra
Mars Therapeutics & Chemicals LtdMars Therapeutics & Chemicals Ltd