Climacteric Health Dictionary

The result of a combination of natural, largely genetically programmed changes occurring in all body systems. Diseases or injuries may in?uence these changes, which impair the body’s homeostatic mechanisms; environment and lifestyle also affect the ageing process.

The effects of ageing include: cessation of MENSTRUATION in females; wrinkling of the skin due to a loss of elastic tissue; failing memory (especially short term) and a reduced ability to learn new skills, along with slowed responses

– changes caused by the loss of or less e?cient working of nerve cells; the senses become less acute; the lungs become less e?cient, as does heart muscle, both causing a fall in exercise tolerance; arteries harden, resulting in a rise in blood pressure and poor blood circulation; joints are less mobile, bones beome more brittle (OSTEOPOROSIS) and muscle bulk and strength are reduced; the lens of the EYE becomes less elastic, resulting in poorer sight, and it may also become opaque (CATARACT).

In developed countries people are living longer, in part because infant and child mortality rates have dropped dramatically over the past 100 years or so. Improved standards of living and more e?ective health care have also contributed to greater longevity: the proportion of people over 65 years of age has greatly increased, and that of the over-75s is still rising. The 2001 census found 336,000 people in the UK aged over 90 and there are 36,000 centenarians in the US. This extreme longevity is attributed to a particular gene (see GENES) slowing the ageing process. Interestingly, those living to 100 often retain the mental faculties of people in their 60s, and examination of centenarians’ brains show that these are similar to those of 60-year-olds. (See MEDICINE OF AGEING; CLIMACTERIC.)

Help and advice can be obtained from Age

Concern and Help the Aged. See www.helpthaged.org.uk www.ageconcern.org.uk... ageing

See CLIMACTERIC; MENOPAUSE.... change of life

(Linn.) Nutt.

Family: Ranunculaceae.

Habitat: Temperate Himalayas from Kashmir to Bhutan up to at 3,000-4,000 m.

English: Black Cohosh Root, Black Snake Root.

Folk: Cohosh, Jiuenti (Punjab).

Action: Sedative, anti-inflammatory, antitussive, diuretic, emmenagogue. Used in homoeopathy for rheumatic diseases of nervous, hysterical women, suffering from uterine affections; also for locomotor ataxia.

Key application: In climacteric (menopausal), neurovegetative ailments, premenstrual discomfort and dysmenorrhoea. (German Commission E, ESCOP.)

The rhizome contains triterpene gly- cosides (including actein, cimigoside, cimifugine and racemoside; isofla- ones (including formononetin; isofer- ulic acid; volatile oil, tannin.

Pharmacological studies have shown that the menthol extract binds to oestrogen receptors in vitro and in rat uteri; this activity is thought to be due to the presence of formononetin. Racemoside exhibited antiulcer activity in mice. Isoferulic acid lowered body temperature in rats.

The rhizome is hypotensive in animals; a central nervous system depressant and antispasmodic in mice; causes peripheral vasodilation in human. Also exhibits anti-inflammatory (The British Herbal Pharmacopoeia) and hy- poglycaemic activity.

Actein has been studied for use in treating peripheral arterial disease. (Expanded Commission E Monographs.)

Clinically, the rhizome and root constituents of Black Cohosh does not seem to affect hormonal levels, such as estradiol, LH, FSH and pro- lactin. (Natural Medicines Comprehensive Database, 2007.)

Cimicifuga foetida L. root is used in bronchial and rheumatic diseases. Aqueous EtOH extract is used in cosmetic preparations for protecting skin; also used for preventing oral diseases and bad breath.

White Cohosh, used for urinogen- ital disorders, is equated with Actea pachypoda, synonym A. alba, A. rubra. Blue Cohosh has been identified as Caulophyllum thalictroides. It is toxic and abortifacient.... cimicifuga racemosa

A periodic change occurring in (female) human beings and the higher apes, consisting chie?y in a ?ow of blood from the cavity of the womb (UTERUS) and associated with various slight constitutional disturbances. It begins between the ages of 12 and 15, as a rule – although its onset may be delayed until as late as 20, or it may begin as early as ten or 11. Along with its ?rst appearance, the body develops the secondary sex characteristics: for example, enlargement of the BREASTS, and characteristic hair distribution. The duration of each menstrual period varies in di?erent persons from 2– 8 days. It recurs in the great majority of cases with regularity, most commonly at intervals of 28 or 30 days, less often with intervals of 21 or 27 days, and ceasing only during pregnancy and lactation, until the age of 45 or 50 arrives, when it stops altogether – as a rule ceasing early if it has begun early, and vice versa. The ?nal stoppage is known as the MENOPAUSE or the CLIMACTERIC.

Menstruation depends upon a functioning ovary (see OVARIES) and this upon a healthy PITUITARY GLAND. The regular rhythm may depend upon a centre in the HYPOTHALAMUS, which is in close connection with the pituitary. After menstruation, the denuded uterine ENDOMETRIUM is regenerated under the in?uence of the follicular hormone, oestradiol. The epithelium of the endometrium proliferates, and about a fortnight after the beginning of menstruation great development of the endometrial glands takes place under the in?uence of progesterone, the hormone secreted by the CORPUS LUTEUM. These changes are made for the reception of the fertilised OVUM. In the absence of fertilisation the uterine endometrium breaks down in the subsequent menstrual discharge.

Disorders of menstruation In most healthy women, menstruation proceeds regularly for 30 years or more, with the exceptions connected with childbirth. In many women, however, menstruation may be absent, excessive or painful. The term amenorrhoea is applied to the condition of absent menstruation; the terms menorrhagia and metrorrhagia describe excessive menstrual loss – the former if the excess occurs at the regular periods, and the latter if it is irregular. Dysmenorrhoea is the name given to painful menstruation. AMENORRHOEA If menstruation has never occurred, the amenorrhoea is termed primary; if it ceases after having once become established it is known as secondary amenorrhoea. The only value of these terms is that some patients with either chromosomal abnormalities (see CHROMOSOMES) or malformations of the genital tract fall into the primary category. Otherwise, the age of onset of symptoms is more important.

The causes of amenorrhoea are numerous and treatment requires dealing with the primary cause. The commonest cause is pregnancy; psychological stress or eating disorders can cause amenorrhoea, as can poor nutrition or loss of weight by dieting, and any serious underlying disease such as TUBERCULOSIS or MALARIA. The excess secretion of PROLACTIN, whether this is the result of a micro-adenoma of the pituitary gland or whether it is drug induced, will cause amenorrhoea and possibly GALACTORRHOEA as well. Malfunction of the pituitary gland will result in a failure to produce the gonadotrophic hormones (see GONADOTROPHINS) with consequent amenorrhoea. Excessive production of cortisol, as in CUSHING’S SYNDROME, or of androgens (see ANDROGEN) – as in the adreno-genital syndrome or the polycystic ovary syndrome – will result in amenorrhoea. Amenorrhoea occasionally follows use of the oral contraceptive pill and may be associated with both hypothyroidism (see under THYROID GLAND, DISEASES OF) and OBESITY.

Patients should be reassured that amenorrhoea can often be successfully treated and does not necessarily affect their ability to have normal sexual relations and to conceive. When weight loss is the cause of amenorrhoea, restoration of body weight alone can result in spontaneous menstruation (see also EATING DISORDERS – Anorexia nervosa). Patients with raised concentration of serum gonadotrophin hormones have primary ovarian failure, and this is not amenable to treatment. Cyclical oestrogen/progestogen therapy will usually establish withdrawal bleeding. If the amenorrhoea is due to mild pituitary failure, menstruation may return after treatment with clomiphene, a nonsteroidal agent which competes for oestrogen receptors in the hypothalamus. The patients who are most likely to respond to clomiphene are those who have some evidence of endogenous oestrogen and gonadotrophin production. IRREGULAR MENSTRUATION This is a change from the normal monthly cycle of menstruation, the duration of bleeding or the amount of blood lost (see menorrhagia, below). Such changes may be the result of an upset in the balance of oestrogen and progesterone hormones which between them control the cycle. Cycles may be irregular after the MENARCHE and before the menopause. Unsuspected pregnancy may manifest itself as an ‘irregularity’, as can an early miscarriage (see ABORTION). Disorders of the uterus, ovaries or organs in the pelvic cavity can also cause irregular menstruation. Women with the condition should seek medical advice. MENORRHAGIA Abnormal bleeding from the uterus during menstruation. A woman loses on average about 60 ml of blood during her period; in menorrhagia this can rise to 100 ml. Some women have this problem occasionally, some quite frequently and others never. One cause is an imbalance of progesterone and oestrogen hormones which between them control menstruation: the result is an abnormal increase in the lining (endometrium) of the uterus, which increases the amount of ‘bleeding’ tissue. Other causes include ?broids, polyps, pelvic infection or an intrauterine contraceptive device (IUD – see under CONTRACEPTION). Sometimes no physical reason for menorrhagia can be identi?ed.

Treatment of the disorder will depend on how severe the loss of blood is (some women will become anaemic – see ANAEMIA – and require iron-replacement therapy); the woman’s age; the cause of heavy bleeding; and whether or not she wants children. An increase in menstrual bleeding may occur in the months before the menopause, in which case time may produce a cure. Medical or surgical treatments are available. Non-steroidal anti-in?ammatory drugs may help, as may tranexamic acid, which prevents the breakdown of blood clots in the circulation (FIBRINOLYSIS): this drug can be helpful if an IUD is causing bleeding. Hormones such as dydrogesterone (by mouth) may cure the condition, as may an IUD that releases small quantities of a PROGESTOGEN into the lining of the womb.

Traditionally, surgical intervention was either dilatation and curettage of the womb lining (D & C) or removal of the whole uterus (HYSTERECTOMY). Most surgery is now done using minimally invasive techniques. These do not require the abdomen to be cut open, as an ENDOSCOPE is passed via the vagina into the uterus. Using DIATHERMY or a laser, the surgeon then removes the whole lining of the womb. DYSMENORRHOEA This varies from discomfort to serious pain, and sometimes includes vomiting and general malaise. Anaemia is sometimes a cause of painful menstruation as well as of stoppage of this function.

In?ammation of the uterus, ovaries or FALLOPIAN TUBES is a common cause of dysmenorrhoea which comes on for the ?rst time late in life, especially when the trouble follows the birth of a child. In this case the pain exists more or less at all times, but is aggravated at the periods. Treatment with analgesics and remedying the underlying cause is called for.

Many cases of dysmenorrhoea appear with the beginning of menstrual life, and accompany every period. It has been estimated that 5–10 per cent of girls in their late teens or early 20s are severely incapacitated by dysmenorrhoea for several hours each month. Various causes have been suggested for the pain, one being an excessive production of PROSTAGLANDINS. There may be a psychological factor in some sufferers and, whether this is the result of inadequate sex instruction, fear, family, school or work problems, it is important to o?er advice and support, which in itself may resolve the dysmenorrhoea. Symptomatic relief is of value.... menstruation

(climacteric) n. the time in a woman’s life when the ovaries cease to produce an egg cell every four weeks: menstruation ceases and the woman is no longer able to bear children. The menopause can occur at any age between the middle thirties and the middle fifties, most commonly between 45 and 55 (the median age is 51). Natural menopause can only be established in retrospect after 12 consecutive months of *amenorrhoea. Around the time of the menopause (the perimenopause) there are marked changes in the menstrual cycle. Menstruation may decrease gradually in successive periods or the intervals between the periods may lengthen; alternatively there may be a sudden and complete stoppage of the periods. There is a change in the balance of sex hormones in the body, which sometimes leads to hot flushes and other *vasomotor symptoms, palpitations, and dryness of the mucous membrane lining the vagina. Some women may also experience emotional disturbances. Some of these symptoms may be alleviated by *hormone replacement therapy. The term ‘menopause’ is also used for the postmenopausal period. See also postmenopausal bleeding. —menopausal adj.... menopause