Women's Health

Females have been bestowed by the nature with important role of procreation and mammals have evolved vivi-parity as nature's best experimental modal for better survival of their limited number of off springs as compared to other phyla. Menstruation an inherent physiological Function generally starts some time after girl's tenth birthday during the phase of development known as puberty. The years follow before it without ova being produced.

Puberty in female child is a period of intense hormonal activity during which certain subtle changes take place in her body, as an adaptation to perform an essential biological function of child bearing. The female hormones viz. estrogen and progesterone in harmony with other factors. Perform functions to maintain homeostasis for better health. However, in the aging certain changes occur which trigger many functional changes which affect woman’s health, such that the quality of life is affected. As a girl becomes a women, a women also has to pass through a phase of menopause.

The terms menarche menstruation and menopause, are derived from the root men (-sem), related to an event taking place every four weeks and menopause is defined as permanent cessation of menstruation

Resulting from the loss of ovarian follicular activity. It is generally recognized as having occurred after twelve consecutive months of amenorrhea (absence of menstruation) for which there are no other obvious pathological factors. As a matter of fact primates including human females have to undergo this phase in their lives and as the ovaries cease cease to function many symptoms manifest which change the life cycle and adjust accordingly is what Ayurved has emphasized. However, with change in life patterns and awareness towards certain undesirable/unpleasant effects viz Alzheimers, cardiovascular effects and osteoporotic changes could appear and incidence of life threatening breast carcinoma is increased, which hitherto have either remained unnoticed, or went untreated or used to be treated by self medication.

In contrast to age at menarche the age at menopause appears to be independent of environmental factors, educational background, or physical state. Although age menarche varied from 11-17 years in various geographical areas and 14.3 years being the average age, the age of menopause was less variable. The number of pregnancies also had no influence on the menopausal symptoms to set in. However, married women were found to have higher age at menopause that spinsters (49.8 versus 47.8) years and stimulation of female sexual organs through regular sexual contact was considered to be the causative factor for higher age at menopause. Physical build-up also seems to have no effect on age at menopause. These are all expected since menopause is dependent on the ovarian follicular activity which although had millions of primitive eggs at birth which get exhausted through follicular atresia during each month, an activity even continuing during prolonged comatose state.

Since the pattern of setting of menopause is practically identical, it seems likely that no major ethnic differences exist so for as the age at menopause is concerned. With increased longevity during the past century the expected life-span of women has increased dramatically form 50 years to over 80 years hence on an average women would spend as many years under menopause as under menopause as under fertile reproductive phase and effective therapeutic management of menopausal phase would be a cornerstone in strategies for preserving or improving women health. From the standpoint of pharmaceutical industry, it is an opportunity to be exploited for development of such products which may alleviate the unpleasant symptoms of menopause besides evolving therapeutic strategies for life threatening increases in incidence of breast and endometrial carcinoma.

The main organ functions that get affected during menopause are nervous system, cardiovascular system and bone architecture. The main hormonal element which is implicated in menopause is estrogen and it is long been appreciated that estradiol is a potent neurotrophic and neuroprotective factor during embryonic and development. Its role in sexual differentiation during embryogenesis was studied in early twentieth century. However, soon it was realized that estrogen exert profound protective action on adult brain in both human and animal models. Studies provided physiological and molecular basis for the myths that estrogen influence the aspects of memory, cognition and mood in healthy young and menopausal women. There are also indications that estrogen appear to delay the onset of and slow the decline in cognitive functions associated with neurogenerative diseases such as Alzheimer’s or Parkinson’s disease.

It is well established that estrogen plays a pivotal role in female development, growth and reproduction. During sex differentiation in females the wolffian duct the progenitor of male reproductive duct system degenerates thus allowing the mullerian duct system to differentiate into female genital tract.

The incidence of cardiovascular disease differs significantly between the two sexes. The incidence of atherosclerotic diseases is low in pre-menopausal women and rises in menopausal women. Important role that estrogen play in development of atherosclerosis was established in mid fifties of the last century when administration of estrogen in animals tends to inhibit the development of atherosclerosis other wise produced by high cholesterol diet. Recent data suggest that direct actions of estrogen on blood vessels, besides it's effect on circulating lipid levels, contribute significantly to cardiovascular protective effects of estrogen.

One of the most distinctive effects of estrogen on the skeleton is inhibition of longitudinal and radial bone growth. It is a common observation that the growth in height is halted as a child attains menarche (similarly when a boy attains puberty). Due to malformed ovaries eunuchs are generally taller than their normal siblings. This inhibition of bone elongation is because of direct effect sex hormones on the chondrogenesis in the growth plate.

Bone density is measured by either single photon absorptiometry (SPA) or quantitative tomography (QCT). Due to technicality of the instruments involved SPA measures cortical bone density in the appendages i.e. hand and foot (fore and hind limbs) and QCT measures bone density in spine. Besides many other biochemical markers of bone’s physiological functioning and bone formation increase in incidence of fracture is an alarming attribute of osteoporosis. A high incidence of radiolucency if found in routine X’ray films of the spine in menopausal women.

Bone consists of cells and an inter cellular matrix of organic and inorganic substances. The organic matter is made up of collagen, orosomucoid and resistant proteins. The collagen is similar to that found in many other connective tissues. The mucoid is a protein mucopolysachharide complex containing chondroitin sulfate and is less soluble in hot water.

The inorganic matter is responsible for the rigidity of bone and constitutes about two thirds of the bone weight. It is mainly composed of calcium as phosphate (about 85%); and carbonate (10%) and small amounts of calcium fluoride and magnesium fluoride. The radiolucency is a function of amount of these minerals in bones. During adult hood, there is an intricate balance between bone forming cells (osteoblasts) and bone resorbing cells (osteoclasts) which gets altered during advancingage, thus resulting in loss of fragility in bones. The decreased in protein matrix permits demineralization vis-à-vis decalcification, chemical moieties of these degradation products have been utilized as biochemical diagnostic markers of the degree of osteoporotic progress. This resulting softening of bone, now can not sustain the weight sheer associated with body movements and thus making an individual more susceptible to fracture. While fractures other than spine or hip can be managed with ambulatory and/or surgical manipulations, the one in spine often results in compression of softened vertebral body and intervertebral disc. A principal symptom is mainly persistent pain which may be crippling. Such fractures may produce pressure on spinal root and sciatica.

Bone mineral density (BMD) or index (BMI) are now days most talked about terms which have made general public more-aware of osteoporosis. Otherwise osteoporosis is a normal aging phenomenon both in females and males. Since androgenic hormone i.e. testosterone in males and female hormones i.e estrogen and

Progesterone both decline with advancing age,the resultant development of bone fragility

Or osteoporosis is so amalgamated that hormones deficiency is implicitly correlated with development of osteoporosis. in contrast to men there is a large amount of data relating

To bone mass in females. Alternatively muscle weakness is an important clinical problem in old age, thus contributing functional limitation for daily activities and related problems such as an increased risk for falls.

Ordinary radiological investigations at time fail to detect such fractures and effected

Persons tend to adopt bending posture and need a stick support for normal movement,

Vertebral fractures are well recognized consequence of menopausal bone loss and are most common osteoporotic fractures. All vertebral fractures whether symptomatic or radiographically identified are associated with increased mortality and morbidity including back pain and decreased activity with consequent increased days of best rest.

Vertebral fractures are serious and irreversible outcome of osteoporosis and are predicative indicator of future susceptibility to fractures unless otherwise treated because

Osteoporosis is actually a quickly progressing disease.

Quality of life issues are particularly important when considering management of menopause .Promotion of healthy lifestyle including dietary advice, encouragement and

Counseling regarding physical activity are the palliative measures which should be considered.

By Brajesh Malaviya

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