Articles on hormone replacement therapy

Sex Therapy

Dr. Ramesh Maheshwari, Sexologist
Sex therapy is based on behavior therapy. It is a type of re-educative therapy. The fundamental of behavior therapy is that all the behaviors are learned, even the maladaptive behaviors. The behavior therapist helps the client to unlearn the unadaptive behavior and replaces it with newly learned adaptive behavior. The aims of behavior therapy are primarily educational and techniques facilitate improved self control.From amongst several techniques that are used in behavior therapy, ‘systematic desensitization technique’ is used in sex therapy. Prior to 1970, sexual dysfunctions were managed by psychiatrists. After  1970, the masters and Johnson model of sex therapy made it possible to treat sexual dysfunction by psychologists, social workers, nurses, counsellors, and medical doctors.Their approach included :Instead of treating the affected individual, the couple is treated. It is the relationship that is affected. This strategy provides an opportunity to gain  the co-operation and understanding of both the partners in overcoming the problem.Two therapist-a man and a woman work together as a team. This gives each partner a same sex therapist to whom he or she can relate more easily.Masters and Jonson recognized that it was important to identify organic conditions that might require medical or surgical treatment instead of sex therapy.They also found that explanining the anatomy and physiology of sexual response to the clients often had important therapeutic benefits.To individualize the therapy so as to meet the specific needs of each couple.The therapist must avoid imposing his own values on the client.The fear of performance and ‘spectatoring’ are often central to the cases of sexual dysfunction. The pressure of performance is removed initially by banning sexual contact. Couples are then helped to rediscover the sensual pleasures of touching and being touched without the goal of particular sexual response (Sensate Focus Exercise).Blaming each other for the sexual problem is discouraged.When a couple’s relationship improves outside the bedroom, it is apt to have positive results in the bedroom too.Basis : Sexual response is the function of Autonomic nervous system and is a physiological change when effective sexual stimuli are present , and a person is psychologically prepared to respond to them. All the sense organs are to be used to create a situation conducive to sexual response . (touch is most important).Systematic Desensitization : A mode of psychotherapy where all the anxiety provoking stimuli are arranged in an ascending level, and the client is exposed to, one by one, both the partners are to be involvedRelaxation: Deep breathing, deep muscle relaxation and plesant imagery are incorporated.Reassurance.Stages :Sensate focusWoman superior positionLateral positionMen superior positionFormat: No rigid format Variations in time, frequency and structure depending upon the dysfunction, the patient and the therapist.Results: Not as definite as in pharmacotherapy.As you shall sow and water, so you shall reap: A skilled and knowledgeable therapist is like a good seed. Client’s receptive mind is like fertile soil. Compliance and co-operation by wife is like watering by gardner. When all the three factors combine, the results are good. When sex therapy works, it does wonders and results are unparalleled for that particular couple.Contraindications:Severe DepressionActive psychopathologySubstance abuseIIInessHostility in couple-interaction

8 Ways To Avoid Knee Replacement

Dr. Brijbhushan Mahajan, Orthopedist
Undergoing a knee replacement for knee arthritis can be a very effective quality-of-life decision. Patients are able to get back to recreational activities and a severely reduced painful lifestyle.  Methods of avoiding the replacement with the arthritis.Weight loss – Over 65% of Americans & over 30% of Indians are either overweight or obese. The problem with this is that a lot of stress goes through the joint during ambulation. This excess weight can lead to increased pain and/or increased arthritis. Losing weight allows the patient to decrease joint pain by decreasing stress over joint, and an increased ability to perform activities of daily living, along with other substantial health benefits such as lower blood sugars and lowered blood pressure.Benign neglect – The patient is able to do most of the things that he or she wants to do, the most appropriate answer at that point may be to simply ignore the problem. One additional aspect to consider may be to modify one’s activities. This may include switching from jogging to fast walking, or shifting from skiing to an activity that is less stressful on the joints such as swimming. Physical therapy – Physical  therapy may have significant benefits. Therapy can strengthen up the muscles around the knee joint, which has  beneficial effect of unloading the pressure from the knee joint and dissipating it into the surrounding musculature. This can reduce pain.Acetaminophen and NSAIDS – These medications are predominantly available without prescription and they can be extremely beneficial for alleviating the pain. They have a low risk profile, as long as patients stick to the manufacturers dosing on the box, and don’t combine those medications that can have an additive effect and lead to a bleeding ulcer.Knee injections – Injections into arthritic knee can help substantially relieve the pain. Presently the bulk of these injections consist of cortisone, which is a hefty anti-inflammatory substance, but not one that is going to alter the course of the disease. There are some newer medications consisting of regenerative substances, which contain components such as stem cells, hyaluronic acid, and cytokines. These may in fact alter the course of the arthritis.Bracing  – Off-loading braces take pressure off of the arthritic area of the knee joint and promote pain relief. These braces are typically custom fit after seeing your doctor, and should be worn whenever the patient is up and about when the pain would typically be felt. Narcotic medications – These should not be used on a chronic basis. They should be utilized only for an acute type of situation where patients are having an exacerbation of their arthritis pain. Narcotic medication on a chronic basis has the risk of tolerance, addiction, constipation, etc. So it should be avoided. Utilizing them for exacerbations can however be very effective.Non-narcotic medications – Medications that are non-addictive such as Tramadol can be very effective for knee pain. In addition there are modulating medications such as gabapentin that can help a lot with decreasing the pain that is coming into the arthritic knee joint from the surrounding nerve endings.

Nutrients and Hormonal Imbalance in Men

Dr. Priyam Sharma, Dietitian/Nutritionist
Do you feel tired and irritated, suffer from a low libido and low testosterone levels, and seem to be losing hair along with your temper? Often people confuse these symptoms with signs of aging, but they can also be the cause of a hormonal imbalance in men.Though aging is a known trigger of hormonal imbalance, a poor diet, lack of exercise and an unhealthy lifestyle can also trigger hormonal imbalance. The good news is the hormones can be controlled and imbalances can be set right with a few changes to your diet. Getting the right amount of food and nutrition in the body can reverse your hormonal problem, and help you optimize your health. So, start making the following changes now.Include calcium-rich, healthy foods like milk, cheese, leafy veggies, almonds, broccoli and kale to your diet.Hormonal imbalances can cause kidney stones, fractures, and weakened bones; by increasing the intake of calcium-rich foods, you can keep all these side effects away.Increased consumption of Omega 3 fatty acids like oily fish, flaxseeds, chia seeds, walnuts, soybeans, tofu, winter squash and olive oil will help in maintaining the balance of the hormones in the body.Vitamin D is an essential nutrient which can help maintain a healthy balance of hormones in the system. Milk, eggs, fish and cod liver oil are rich in vitamin D. You can also get Vitamin D by standing under direct sunlight for a few minutes every day.Increase intake of small, medium and long chain fatty acids. Avocados, coconut oil, salmon and some dairy products contain essential fatty acids in abundance, which are the building blocks for male hormone production in the body.These are some safe and natural ways to balance and restore hormones in the body. The right balance of micronutrients and macronutrients will help produce optimal hormone levels, so eat up and be healthy!

How Safe Is Testosterone Replacement ?

Dr. Anish Kumar Gupta, Andrologist
Testosterone Therapy – Know the Side Effects before the Benefits.It is important to first and foremost understand that Testosterone is not a recreational or a performance enhancement drug, and is strictly something to be prescribed by someone who knows why it is being done. Als,o supplementation is of no use, it is eventually replacement, which should be the key to understand its effects and some effects.Understand the potential risks and consider alternatives before boosting your hormones indefinitely.There is a notion that Testosterone is a performance enhancer, which promise that treating “low T” this way can make men feel more alert, energetic, mentally sharp, and sexually functional. But, beware, Men should be much more mindful of the possible long-term complications.The Low - T BoomJust being tired isn’t enough to get a testosterone prescription. If a man’s testosterone looks below the normal range, there is a good chance he could end up on hormone supplements—often indefinitely. On treatment, the body stops making testosterone. And it may or may not recover to a complete extent.This wouldn’t matter so much if we were sure that long-term hormone therapy is safe, but there are small risks that could add up to harm over time. That should be a bigger concern.What are the Risks?A relatively small number of men experience immediate side effects such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also like to watch out for high red blood cell counts, which could increase the risk of clotting.The evidence for long-term risks is mixed. Cancer prostate and cardiovascular risksneed to be assessed and monitored if symptoms complex deterioration occurs.Testosterone supplementation can affect your Fertility. While testosterone supplementation increases testosterone levels, and reduces some ofthe symptoms associated with hypogonadism, it decreases the body’s productionof LH and FSH. This is because when the brain detects that testosterone levels have increased, it will cut down the production of GnRH. The result is that the pituitary gland no longer produces FSH and LH at normal levels, so sperm production also declines. A lower sperm count means that a man’s chance of impregnating his partner will be lower.Before the Jump, Assess your health globally firstHave you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?If erectile dysfunction has caused you to suspect “low T” as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.Get an Accurate AssessmentInaccurate or misinterpreted test results can either falsely diagnose or miss a case oftestosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it’s at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone,or the amount of the hormone that is able to have effects on the body. After starting therapy, follow-up with your physician periodically to have testosterone checksand other lab tests to make sure the therapy is not causing any problems withyour prostate or blood chemistry.Be Mindful of Unknown RisksApproach testosterone therapy with caution if you areat high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, ormultiple risk factors for heart problems.Ask your doctor to explain the various side effects for the different 
formulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.Have Realistic ExpectationsTestosterone therapy is not an elixir of youth. There is no proof that it will restore youto the level of physical fitness or make you live longer, prevent heart diseaseor prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with theseexpectations in mind.If erectile function has been a problem, testosterone therapy might not fix it. Infact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections. Please Remember there are only two people who can prescribe Testosterone Replacement, a Urologist-Andrologist or an Endocrinologist. A general physician or gym instructor or a friend are not people who can prescribe Testosterone Replacement.

Hormones in Sex

Dr. Ramesh Maheshwari, Sexologist
In regard to sex and reproduction the most important endocrine glands are pituitary gland and the gonads or sex glands –Testes in male and ovaries in female. The anterior pituitary gland secretes two gonadotropic hormones:Follicle stimulating  Hormone (FSH) and Luteinizing hormone (LH).They play major roles in the function of male and female function. During pregnancy placenta secretes human chorionic gonadotropic hormone that has the same property as LH. This hormone stimulates the interstitial cells of fetal testis and  produces testosterone which promotes formation of male sexual organs. No testosterone is produced during childhood until the age of 10 to 13 years and lasts throughout life. On stimulation by LH from anterior pituitary, Testosterone is produced by the interstitial cells  of Leydig in the testes. FSH from anterior pituitary stimulates conversion of primary spermatocytes into secondary spermatocytes in the seminiferous tubules of testis. However, for complete formation of spermatozoa testosterone is needed. Thus FSH iniates proliferative process of spermatogenesis and testosterone does final maturation of spermatozoa. Testosterone secretion, after puberty, causes the penis, scrotum and testis to enlarge until the age of 20. Testosterone causes secondary sex characteristics of the male. In female, the anterior  pituitary produces gonadotropic hormones FSH and LH which act on ovaries and produce estrogen and progesterone. During the reproductive years there is monthly rhythmic changes in the rate of section of female hormones and as menstrual cycle, is of 28 days.Variation from   20 days to 36 days is taken as normal. At the age of about 8, the anterior pituitary begins secreting gonadotropic hormones, FSH & LH. These act on the ovaries. One of the follicles grows and ovulation takes place on the 14th day (counting from the first day of menstruation). During the growth of the follicle, estrogen is secreted. Following ovulation, the follicle develops into corpus luteum degenerates. The ovarian hormones, estrogen and progesterone decrease greatly and menstruation begins. Estrogen is responsible for secondary sex characters of the female. Progesterone is concerned with final preparation of uterus for pregnancy and the breasts for lactation. Male’s capacity to be stimulated sexually shows a marked increase  with the approach of adolescence. The frequencies of response to the point of orgasm reach the peak within three or four years after the onset of adolescence. Frequencies of sexual response in the male begin to decline after early thirties and drop steadily into old age. Among females, the median frequencies of sexual activities remain constant from late teens into the fifties and sixties. In maximum incidences of sexual response are not approached until some time late twenties and thirties. Individuals who are physically exhausted or in ill health are not easily aroused sexually if aroused they may not be capable of effective action and may fail reach orgasm. Estrogen occurs in equal amount in pre-adolescent female and male. But at the time of adolescence, estrogen increases abruptly in female. At the onset of adolescence there is no upsurge of sexual activities in the female. It is the male who suddenly becomes sexually active at adolescences. Androgen are found in both males and females. Adrenal glands also produce androgens. In preadolescence, the androgen levels begin to rise more markedly in the male. There is sudden upsurge of sexual  responsiveness and sexual activity are among males. In females, the levels of sexual  response and sexual activity are much lower than the levels in the males.When Testosterone is given to normal male, there is increase in frequency of morning erection, the frequency of erotic response to various stimuli and the frequency of masturbation. Testosterone is also used to increase the low rate of coitus which results in infertility. Sperm count also may increase by administration of Testosterone. However, indiscriminate use of testosterone may involve some danger like inhibited pituitary function and damage to the gonads. It may accelerate malignancy of prostate. Serum prostatic specific antigen estimation and  a digital examination of prostate are mandatory prior to administration of Testosterone. Both, androgen occur simultaneously in both the female and male bodies. There is a theory that estrogens counteract the effectiveness of androgens. Some clinicians use estrogen in effort to reduce the levels of responsiveness of males convicted as sex offenders. Though estrogens reduce the amount of androgens, the use of estrogens to lower sexual responses is debated. The adrenal cortex produces androgens and estrogens in both the males and females . In menopause when the estrogen level falls, the androgen produced by the adrenal glands is responsible for the growth of hair on the face females. Similarly, When the level of androgen falls in elderly males, the estrogen from the adrenal glands dominate and produce enlargement of breasts in the males. Hormonal levels may affect the intensity and frequency of response, the frequency of sexual activity , but there is no relationship between the hormone and individual response to particular sort of psychological stimuli. There is no evidence to prove that the patterns of sexual behavior can be modified by hormone therapy.

Achieve an Elegant Menopause- Ayurveda Way

Mr. Rajiv Vasudevan
Menopause is not a disease. It is a normal pause to the rhythm of a body function. Hence, the effects of this pause are to be managed naturally.Well, Ayurveda has acknowledged menopause as a natural transition. And it says that each woman has unique symptoms during this phase owing to the uniqueness in one's body and mental constitution. Hence a personalized unique approach is a must to ease the signs and symptoms of Menopause. With this precise understanding, Ayurveda ensures that menopause can be health promoting, spiritually-transforming and free of signs and symptoms at all the body- mind and spirit level.As related to the concerns of Brain Fog/ Natural Decline in the Menopause, Ayurveda Attributes this to the physiological stage of Parihaani (Degeneration) to VATA. Beyond 50 Vata is naturally at its peak, leading to various Vata signs in the body like - anxiety, insomnia(lack of sleep), Diminishing memory, forgetfulness etc.Ayurveda gives significance to Kala - time in its chikitsa approach in all the diseases. There is always a right time to address the disease. The imbalance of menopause sets in much early in a woman's life - that is in her mid 30s and 40s. Health problems at menopause represent imbalances in the body that were already growing in the body and are unmasked by the stress of shifting hormones. So to minimize the symptoms at Menopause and for an easy transition get in charge of your health much early in life.The natural aggravation of Vata in the upcoming stage of Parihaani (Degeneration) should be addressed right on time. An extended approach of Diet, Lifestyle, Medicine and Panchakarma effectively balances Vata.Ayurveda System of Medicine advocates the following CHECKLIST for all the WOMEN for a GRACEFUL MENOPAUSE1. Am I eating the right food that suits my body constitution?2. Is it the right lifestyle that I am following?3. Is my mind and body in harmony, or is there a disconnect which needs to be addressed?4. Am I able to balance my work and life well?5. Is my reproductive health up to the optimum? Menarche at Right Age, Regular Periods, Uneventful Pregnancies, Uneventful Post Pregnancy Period, Genital Hygiene6. What are the Methods of Contraception adopted during the Sexually Active Period- Oral Contraceptives, Intra Uterine Device?7. Am I just beyond disease or am I actually possessing the good health with all my vital parameters- Weight, Sleep, Appetite, Motion etc. intact?If any of the above list poses a risk for you, address them right on time and get in charge of your health for a beautiful transition to menopause. Hormone therapy is a tangled mess of risks, benefits, and side effects. Studies have been published about hormone therapies raising risk of aggressive Breast Cancers.Do not subject yourselves to Hormone Replacement therapies immediately.THINK TWICE BEFORE YOU POP A HORMONE PILL. HORMONE REPLACEMENT THERAPY IS NOT VERY SAFE.

Ayurveda for Menopause

Dr. Vishal Bhuva, Ayurveda
Menopause is a “pause” period of the menstrual cycle. It is called “Raja Nivrutti” in Ayurveda, which literally means retirement of menses.According to Ayurveda, menopause is linked with aging. Menopausal phase is an important benchmark for a woman. It brings upon a lot of changes in a female’s life. All these changes and their effects are commonly known as “Menopausal Syndrome”.Menopausal Syndrome is not a disease. However, when all these changes are aggressive, it brings a lot of dis-ease in the life and can make this syndrome a disease.Menopausal symptoms are experienced by 75-85% of woman. A diet containing hot spicy food, alcohol, caffeine and a stressful lifestyle will often exacerbate the symptoms of menopause.Herbs can help soothe the symptoms of menopause. Ayurvedic herbs possess certain phytoestrogens that connect with the body’s estrogen receptors. These estrogen receptors enable the hormones to function properly, thereby help smooth the transition through menopause.These herbs address almost all the changes of the menopause, without any side effects. In fact, they have an effect almost parallel to hormone replacement therapy and synthetic hormones medication.Common Herbs Used for Menopause:1. Anethum sova (Mishreya)2. Saraca indica (Ashoka)3. Trigonella foenum graecum (Methika)4. Asparagus racemosus (Shatavari) 5. Hemidesmus indicus (Sariva) 6. Emblica officianalis (Amalaki)Treatment of Menopausal Symptoms:• Dryness of vagina• Irritation and mood fluctuations • Hot flashes and night sweats• Bone health• Loss of libidoAyurveda can give relief from above symptoms & can give healthy life.Ayurveda is the perfect solution for a healthy aging and can create wonders. Ayurvedic healthcare can help one go through the menopausal phase with greater comfort and ease, without many problems.

Manage Menopause Weight Gain

Ms. Swati Kapoor, Dietitian/Nutritionist
Weight gain during menopause is a big concern for women. The menopausal phase triggers changes in body shape resulting on an average weight gain of about  5-10 kg. This weight is primarily  hormone related and has a direct impact on appetite, metabolism, and fat storage.  Therefore controlling weight during this time becomes extremely difficult due to fluctuating estrogen, testosterone, and androgen levels. These added kilos further aggravate depression and anxiety which in turns can bring on the hot flashes and disturbed sleep.Estrogen plays a big role in menopausal weight gain especially as the estrogen levels decline with age as the body stops ovulating. Due to the decrease in estrogen levels produced by the ovaries, body searches for other sources to substitute the shortage of estrogen in the body. Meanwhile fat cells in our body have the natural capability to produce estrogen, hence the body starts restoring to these cells  to convert calories into fat to increase estrogen levels. Unfortunately fat cells don't burn calories the way muscle cells do, which causes this unwanted weight gain.Insulin resistance caused by reduced tendency of naturally processing simple carbohydrates in the body is another cause of weight gain during menopause. Simple carbohydrates like those found in white bread, pasta, processed snack foods, beer and wine, which raise blood-sugar levels. Over time, eating a high-carb diet can lead a person into becoming insulin resistant. When a person is insulin resistant, a much higher proportion of consumed calories are turned into fat.Stress causes the body to release the hormone cortisol which in turn blocks weight loss. When stressed, the body goes into survival mode and holds onto fat. It is also due to high sugar levels and the presence of toxins in the body which gets accumulated in the body overtime.Losing weight during menopause isn’t impossible and understanding why weight gain occurs during menopause is the first step in starting a weight loss program. Eating healthy and eliminating certain foods is the key to maintaining a healthy weight during, and after, menopause.Adding foods to your diet that contain plant-based estrogen can help to balance the hormones. Eating soy, as well as fruits and vegetables that contain phyto-estrogens, can help the body function normally so fat is not as difficult to lose. Plums, grapes, strawberries, apples, beets, carrots, cucumbers and lettuce are just some of the foods that can help balance estrogen during menopause. Eating a diet rich in fiber, antioxidants and nutrients is the best way to slowly lose weight during menopause in order to reduce the risk of toxins, and inflammation, being released into the body.

Menopause: A Transition, Not the End of Life

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
Aging is an inevitable phenomenon in our lives. Often our parents or grand-parents say “we are aged now, so it’s just a matter of few years”. But is it really so? French author Jules Renard said “It`s not how old you are, it`s how you are old”. Scientific studies has shown that “we can expect to become old”. There are mainly two reasons for it. One is our life style changes, leading to faster aging of the general population. The second thing is profound improvement in medical care that made it possible to conquer death even at the age of 80 years.In 1000 BC, the life expectancy was only 18 years. By 100 BC, the time of Julius Caesar, it had reached 25 years. In 2005, it was 80 years for women and 75 years for men. And today, you can expect to reach 82 years if you are a male and 85 years if you are a female. Men and women population need to be addressed differently from social, economic and biological points of view. Half of men at 85 and above live with their wives, but only 10% of elderly women live with their husbands. Aging is nothing but a sign of maturity. There are three signs of maturity in each sex. Two of them are common in both men and women; graying of hair and cataract in eye. The third one is unique to each sex. In men, it’s increased size of prostate gland (prostatism) and in female, it’s menopause. Menopause is unavoidable in a woman’s life. In simplest term, it is the cessation of menstruation permanently at the end of reproductive life. The ovaries stop secreting female sex hormones- mainly estrogen and progesterone. In medical terminology, menstruation should be absent for 12 consecutive cycles to define it as menopause. Though menopause is the stoppage of reproductive function, it has profound effect in almost every organ of the body. Despite our socio-economic improvement, the age of menopause remains relatively the same; average 51 years with range of 45 to 55 years. However, there are some causes that may cause early menopause. If it occurs before 40 years, it’s called premature menopause. This needs medical consultation because it is caused by some serious diseases like genetic causes (may have family history of premature menopause- in elder sisters and mother), smoking, autoimmune disorders (body makes destructive substances against itself) etc. Sometimes premature menopause is the side-effect of some treatments like drugs (especially anti-cancer drugs), radiation and removal of ovaries by surgery. On the other hand, if menstruation continues to occur after 55 years, it’s called delayed menopause. It also deserves consultation with gynaecologists, as it is often caused by diabetes, some tumours and even some cancers. So, if menopause occurs too early or too late, it should never be ignored. But if menopause occurs in time, do the women should consult gynaecologists? Well. You can find the answers from this article. Most of the women have some common problems after menopause; they become irritable or depressed and sometimes very much emotional and moody. Even suicidal tendency is not uncommon. Often they complain of sudden sensation of excessive warmth, the hot sensation, as if there is something burning on the head, the ears or other parts of the body. This is called “hot flush”, which is often associated with excessive sweating at night, palpitation and anxiety. This happens due to absence of estrogen hormone. These problems can be solved by hormonal drugs. Even non-hormonal drugs also work well. So, timely treatment can give them good quality of life and you don’t have to say “my mother has become intolerable these days”.Frequently our mothers and grand-mothers complain of having back-pain or pain in the bones. This is due to osteoporosis; the destruction of components of bones and joints. They often get fracture with minor trauma. Again, this is due to deficiency of estrogen and also inadequate calcium intake. So, the treatment of this problem is exercise (at least 30 minutes per day), avoidance of smoking and the drugs that inhibits bone formation and adequate calcium and vitamin D intake. Hormone therapy is also effective and there are many non-hormonal drugs that can prevent destruction of bone. Thus timely medical consultation may stop our mothers saying “I cannot go outside for pain in my knees”.Cardiovascular disease is the leading cause of death in elderly. Before the age of 40 years, males are more likely to die, than females, due to heart attacks. After 40, the sex difference is lost. This is because of absence of estrogen in women after menopause that alters the composition of fat (especially cholesterol) in blood. Cholesterol get deposited in the wall of blood vessels. Such problems can be avoided by dietary control, control of high blood pressure and diabetes and regular medical checkup. The worst problem of the menopause is faced by the urinary and reproductive systems, i.e., the private parts of the body. In medical terminology, this is called “pelvic atrophy”. Our women remain very silent of it; most of them do not consult doctors for such problems. There is feeling of increased frequency of urination (women has go to the toilets frequently), burning sensation during urination and sometimes inability to hold the urine until they can reach the toilet or leakage of urine during coughing and sneezing (medically called “urinary incontinence”). The incontinence is not only a medical problem but also a social and hygienic embarrassment, for which many women avoid participation in social activities and even do not want to go outside. Sexuality is a thing that is often ignored both by the elderly people as well as the doctors. Menopause does not mean end of the conjugal life. Often the women may feel decreased libido (the desire) because of low hormone levels. And again there is difficulty in keeping intimacy for problems in the concerned area (due to decreased blood supply), again due to deficiency of estrogens. This may even lead to damage to the private parts and bleeding, while leading the conjugal life. For this, the couples should not suffer silently. There are many treatments that can avoid such urinary and sexual problems. Sometimes, simple counselling and some special exercises may prove to be adequate. Otherwise hormonal drugs (estrogens) can be used. And for this purpose, even we don’t need to take the hormones orally or by injection; simple local use of some creams or jellies help a lot. You will be surprised to know that testosterone may also help some women, because testosterone is not only found in male but is also an important female hormone. Those who want to avoid hormones, can try other non-hormonal agents. Even pregnancy is possible after menopause. There have been many examples of conception, either naturally or by test-tube baby (in vitro fertilization), after menopause. The recent socio-economic trend of delaying the age of marriage and child-birth is making this issue of pregnancy after menopause very much relevant.Cancer is the second leading cause of death in elderly, after heart attack. Lung cancer is increasing day by day in women and even non-smokers can also have lung cancers. Discharge of blood with cough or vomiting, long-standing cough, chest pain and weight loss needs consultation with chest physician. Breast cancer is a major cause of death in women. This can be avoided by monthly self-breast examination and consultation; if any abnormal swelling or discharge is found. Colo-rectal cancer (cancer of lower part of our digestive tract), recently showed increased incidence in all the age groups. So, if there is any bleeding with stool or passage of black coloured stool, it should never be ignored. Ovarian cancer is showing increased incidences all over the world. Despite significant improvement in cancer management, ovarian cancer is a nightmare of the gynaecologists. Often, even after best possible treatment, patients of ovarian cancer don’t survive beyond one year of diagnosis. So, if you have any problems in digestion, abdominal discomfort, pain and swelling, please don’t just go to medicine shop to take antacids; instead go to your doctor. Post-menopausal bleeding is a medical term, used to describe the condition where there is bleeding through vagina, after menopause. Even if the bleeding is only one drop, it should never be ignored. Though, most causes of such bleeding are not worrisome (due to drugs and ‘’pelvic atrophy”- as mentioned earlier), some cancers may present in this way. Cancer of endometrium (the inner lining of uterus) almost always present with post-menopausal bleeding. Cancer of cervix (the mouth of uterus) is the commonest cancer of reproductive system in our country, which is totally preventable by timely diagnosis by screening (even before actual cancer occurs) and timely HPV vaccination. “What cannot be cured, must be endured”. We cannot cure the menopause, nor can we avoid it. But definitely we can give our older generation a better quality of life. The first step is obviously making them aware of the menopause and its aftermaths. Second issue is regular health checkup by physicians and gynaecologists, even if they feel no problems as such. But the most important issue is managing their problems. As mentioned above, life-style modifications (like diet, exercise) and non-hormonal drugs play important role. But if we consider the basic problem is menopause, it’s simply deficiency of secretion of female sex hormones from the ovaries. So, if we can artificially introduce those hormones in women, menopausal symptoms can be reduced. This led to emergence of a treatment modality, called HRT (Hormone Replacement Therapy). Clearly, as discussed earlier, HRT is required in women complaining of menopausal symptoms like “hot flush”, urinary and sexual problems, osteoporosis, and mood depression and also for young women having premature menopause. HRT does not only help to improve these problems, but also has some added advantage like preventing excessive weight gain, problems in oral cavity, eyes and ears and even colorectal cancer. Majority of the women report feeling better and having improved quality of life (social, personal, biological and conjugal) after start of HRT. There are multiple ways to give HRT to a woman. Those include injections (one in 1-3 month), oral tablets, local creams or jellies, skin patches etc. And the drugs include estrogen only, estrogen plus progesterone, tibolone etc. Now the million-dollar question is, “is HRT absolutely safe?” The answer is difficult to give in one word. After the publication of the reports of the WHI (Women’s Health Initiative) and the MWS (Million Women Study), there have been a great hue and cry regarding safety of HRT. Those study found out many serious side effects of HRT and concluded that HRT should not be used in all the menopausal women. However, subsequently, many flaws of those studies were found out and subsequent review of the WHI study proved that HRT has few side effects. Thrombosis (increased tendency of blood to form clots) is a known side effect of hormonal drugs, but the problem occurs only to those who are at risk of thrombosis due to other causes (like obesity). Breast cancer is definitely a risk factor but the risk is small. So, the women need to continue self-breast examination and yearly checkup by their consultants. Blood fat concentration (cholesterol) may be altered, which needs regular lipid profile checkup. And finally there is increased risk of heart attacks and stroke. But possibility of heart attack is there only if HRT is started in very elderly women (after 60 years) and those who are already have some risks (obesity, smokers, and hypertensive). Even, timely initiation of HRT (before 60 years) can protect the heart and brain against stroke. Thus HRT is found to have very minimum side-effects and that too at the expense of so many benefits. There are very few women who should not use HRT; those having thrombosis, heart disease or liver disease at present and very high blood fat level (high triglyceride). If the woman has any mass in the breast or post-menopausal bleeding, then HRT should be used only when the diagnosis of the mass or the bleeding is certain. To be on the safe side, before start of HRT, details examination by the consultant doctor is required. This includes checkup of blood pressure, heart, breast, liver and the pelvic organs. The best time to start HRT is as early as after menopause. For premature menopause, the women are relatively younger (before 40, even before 30). So, they should start HRT soon after consultation with doctors, if HRT is suitable for them. For women with natural menopause, HRT should be started before 60 years. Annual visit to the doctor is necessary to detect any side effects and to find whether HRT is needed further or not. HRT need not be continued lifelong. Most of the women can stop it after 5 years. Very few women have to continue it beyond 10 years. Actually, after 2-3 years of HRT, most of the menopausal problems subside and women do not require to continue HRT. However, before stoppage, doctor consultation is required. In a nutshell, elderly people deserve special care. But that does not mean they should always be in the bed. They should continue their day to day activities. They have the full right to enjoy their life by themselves. What we can do is be supportive to boost up their confidence and self-esteem. That needs social as well as medical attention. Regular touch with physician and gynaecologist cannot be over emphasized. Most of the symptoms can be taken care by life style modifications and drugs. HRT should be used as necessary. HRT is very safe and cost-effective modality. “Not everyone grows to be old, but everyone has been younger than he is now”.