Menopause: Current Concepts Chittaranjan N Purandare, Suvarna S Khadilkar
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1 Menopause: Current Concepts
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The statements and opinions contained in the chapters of the book on “Menopause: Current Concepts” are solely those of the individual authors and contributors, and not necessarily reflect the opinions or recommendation of the FOGSI.
Because of the rapid advances in the medical science, the editors recommended that independent verification of diagnosis or drug doses should be undertaken and references should always be made to the approved prescribing information for any product or procedure prior to its use.
Articles which have been published, become the property of FOGSI and should not be published or reproduced in full or in part without the permission of the editors. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic mechanical, photographing, recording, or otherwise without the prior written permission of the editors of the book.
3 Menopause: Current Concepts
Editor Chittaranjan N Purandare MD (Bom) MA Obst (Ireland) DGO DFP D Obst RCPI (Dublin) FICOG FICMCH FRSH (Lon) FICA (USA) Hon. Obstetrician and Gynaecologist Sir JJ Group of Hospital, Mumbai Hon Prof, Obst and Gyn Grant Medical College, Mumbai Consultant, Obst Gyn Bombay Hospital, Mumbai Secretary General, FOGSI President Mumbai OBGYN Society 2003–2004 Joint Associate Editor Journal FOGSI Associate Editor Suvarna S Khadilkar MD DGO FICOG Associate Professor, Department of Obstetrics and Gynaecology Grant Medical College Mumbai Chairperson “Menopause Committee” MOGS 2002-2004 Joint Assistant Secretary Journal FOGSI
____________ A FOGSI Publication ____________
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Menopause: Current Concepts
© 2004 Federation of Obstetric and Gynaecological Societies of India (FOGSI)
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition: 2004
9788180613012
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Dedicated to my father
Mr Narahari N Purandare
whose ideals and example of honesty,
integrity, dedication and hardwork have
encouraged me to strive on ceaselessly 6
FOREWORD
With increasing longevity the postmenopausal lifespan of a woman is now remarkably extended and has more than doubled. Perimenopausal complaints needing short-term treatment are easy to deal with. But longer periods of estrogen deprivation lead to serious problems, the chief ones being osteoporosis and affections of the heart and blood vessels. The conventional and logical estrogen therapy administered for long periods carries unacceptable risk of malignancy, mainly in the uterus and the breast. This has necessitated newer modalities of management like drugs specifically benefiting bone metabolism and hormones modified to selectively target end organs. All of these come at a price with their own problems. There is no universally applicable ideal management yet in sight. It is, hence, not surprising that alternative medicines are enthusiastically promoted to replace allopathic drugs. But they have yet to prove themselves. In the maze of these issues healthy lifestyle stands out as one with undisputable benefits devoid of any side-effects. Proper counselling is of almost importance and becomes mandatory.
This excellent book thoroughly discusses all the issues concerning menopause and critically evaluates the current concepts. The contributors are authorities on the subject and very efficiently deal their respective topic covering all its aspects. The editors, Prof CN Purandare and Prof Suvarna Khadilkar, are excellent clinicians and very popular teachers of long-standing. I congratulate them for bringing out this excellent book which fulfils a long-standing demand. I am sure the book will be of great help not only to practicing gynaecologists but also students— undergraduate and postgraduate and teachers. I appreciate the hardwork put in by the editors and compliment them.
Dr Mahendra Parikh
Emeritus Professor
Ob/Gyn Nowrosjee Wadia Maternity Hospital
and Seth GS Medical College, Mumbai
Past President MOGS
Past President FOGSI
Editor Indian Journal FOGSI 7
FOREWORD
I am happy to know that a book on “ Menopause— Current Concepts” is being published under the ages of the Federation of Obstetrics and Gynaecological Societies of India.
With increasing life expectancy in the modern times. A significant number of women pass through menopause and pass one-third of their lives span in menopausal state. The symptoms as a result of estrogen deprivation are not reflected only in the genital tract of women but also in her cardiovascular, skeletal and psychological health aspects.
In developing countries, the only physician women may see in the lifetime is one who takes care during her childbirth. He often continues to be a health care provider for an extended period. The gynecologist is thus has a privilege position but also has a great responsibility to know all about menopause and care for their patients with latest development in scientific understanding of the subject.
I congratulate Dr CN Purandare, President of Mumbai Obstetrics and Gynecological Society and his colleagues who have discussed all aspects of menopause in this book. The contents of the book are complete and stimulating.
Every physician may understand that women when seeking advice for menopause related symptoms approaches them, it is the best time to guide them on the benefits of changed lifestyle emphasizing on the issues of diets and exercises.
DK Tank
Past President MOGS
Past President FOGSI
President-SAFOG
[South Asian Federation of Obstetrics and Gynaecology]
President Elect AOFOG
[Asia and Oceania Federation of Obstetrics and Gynaecology] 8
BRIEF BIODATA
Editor
CHITTARANJAN N PURANDARE MD (Bom) MAO (IRL) DGO DFP DO RCPI (Dublin), FICOG FICMCH MD
Chittaranjan N Purandare MD (Bom), MAO (IRL), DGO, DFP, DO RCPI (Dublin), FICOG, FICMCH, MD, in Obstetrics and Gynaecology from Bombay University with merit in 1978. Subsequently went to Republic of Ireland considered to be one of the main center for Obstetrics and Gynaecology in Europe in 1979. Trained at the prestigious hospital of University College Galway and National University of Ireland. Awarded the degree MAO (Masters in the Art of Obstetrics) by research. He was the first Indian to do so. He trained in the field of Fetal Medicine and Ultrasonography in obstetrics.
Performed the First Intrauterine Surgery in India for Posterior Urethral valve obstruction.
Devised an Operation for Cancer Cervix known as Purandare's Modification of Radical Hysterectomy resulting in increased survival rate following Cancer Cervix Surgery.
Presently Honorary Professor and Unit Head, Grant Medical College and JJ Group of Hospitals, Mumbai. Involved actively in teaching undergraduate and postgraduate students in obstetrics and gynaecology. Examiner for MBBS and MD obstetrics and gynecology Mumbai, Pune, Gwalior and Ajmer University.
Examiner for DGO College of Physicians and Surgeons, Mumbai.
Presented over 100 papers at National and International Conferences and published over 50 papers in National and International Journals. Invited Guest speaker at many conferences in India and abroad, Invited to give the prestigious Dr Menon Oration at Obstetrics and Gynecology Society Vishakhapatnam. Editor of Three Postgraduate Obstetrics and Gynaecology Books. Written Chapters in Special subjects in Five Obstetrics and Gynaecology Postgraduate Books. President of Mumbai Obstetrics and Gynaecology Society for Year 2003-04.
Secretary General FOGSI Joint Associate Editor of Indian Obstetrics and Gynaecology Journal of FOGSI. Consultant Obstetrician and Gynaecologist at Bombay Hospital and Medical Research Centre, Mumbai and Honorary Consultant Obstetrics and Gynecology to Mumbai Police. Currently on Governing Council of Yuvak Prathisthan a mother NGO working in the field of HIV/AIDS. Awarded Rashtriya Gaurav Award for Contribution and Excellence in the field of Obstetrics and Gynaecology Year 2002.9
BRIEF BIODATA
Associate Editor
SUVARNA S KHADILKAR MD DGO FICOG
Dr. Suvarna S Khadilkar is currently working as an associate professor of Obstetrics and Gynecology, Grant medical college and Sir JJ hospital , Mumbai.
After completing her graduation and postgraduation from Grant Medical College, Mumbai, She received training in ART in Australia. She joined the Grant Medical College as a lecturer and thereafter as an associate professor in the department of obstetrics and gynaecology. She has a total of 18 years of undergraduate and postgraduate teaching experience. She is an undergraduate and postgraduate examiner at Bombay University and Maharashtra Health University.
She has been deeply interested in academics and excelled in the field of research. Her special interests are, Infertility and Reproductive Endocrinology. She is the co- editor of the book “ Progress in Reproductive Endocrinology”, a FOGSI publication. She has contributed several book chapters for FOGSI publications.
She has been appointed as Joint assistant secretary , Editorial board of Journal of obstetrics and gynecology of India. She is editor of the news letter of AMWI [Association of Medical Women of India]., Mumbai 2002. She is also a member of the editorial board of scientific journal of AMWI. She is actively involved with all the activities of the FOGSI, MOGS and AMWI.
After having elected on the managing council of MOGS, She has been the Chairperson of the MOGS committee on “ Menopause” and has won the “ Duru Shah Best committee award”2003. She is the active member of FOGSI committees like Reproductive Endocrinology and Safe Motherhood committee.
She has done original research in the field of Infertility, Semenology, Tuberculosis, Amniotic fluid index, and family planning.
She has several national and international presentations and publications to her credit. She has delivered over 50 invited lectures.
She has won several awards for her excellent scientific research, to mention a few: Kumud Tamaskar Prize,1999, MOGS Young Scientist Award 2000, C. S. Dawn FOGSI award, Johnson and Johnson MOGS Trophy-2001, Best Paper Prize at international level.
Her original work in infertility was given the best scientific paper prize at World congress on Infertility—Sept 1999. She has been the first to start an IUI lab at government medical college in Mumbai. Her work on Amniotic fluid index gave first reference range of AFI in the Indian population, accepted and published on International Forum.
She has also contributed several articles to lay press for public education. She continues to strive for creating health awareness and spreading knowledge in medical and social spheres.10
CONTRIBUTORS PREFACE
As longevity increases more and more patients in the menopausal group have to be treated for a variety of conditions associated with menopause.
The early vasomotor changes have always been accepted by the Indian woman as a way of life and has never opted for any treatment. With the advent of knowledge of the effects of menopause, various methods of treatment have come into existence albeit with their advantages and disadvantages.
There is still no medicine which benefits an aging woman in toto and hence, the understanding of problems associated with aging and their treatment are of primary importance for the patient and the treating clinician.
An early diagnosis of cancer and its treatment has also been extensively reviewed in this book along with the physiological, pathological and pharmacological aspects of menopause.
I am confident that the “ Current Concepts of Menopause” will give an overview of this gigantic problem.
Chittaranjan N Purandare