Management of Menopause Maninder Ahuja
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History and Evolution of MenopauseCHAPTER ONE

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Before mid sixties of nineteen century not much was known about menopause and so menopause was perceived as something very negative by those women who had to suffer menopausal symptoms and it was perceived as a period of loss of fertility to loss of perhaps feminism with symptoms of itching in vagina, dry vagina, irritability and feeling of being bloated.
But after sixties it was discovered that loss of ovarian function and depletion of ovarian hormones, was responsible for symptoms of menopause. In 1978 first International Menopause Society was formed. Indian menopause society was formed in 1995 and in 2007 Indian Menopause Society became member of International Menopause Society and a member of CAMS. When these international societies came into existence, work on menopause started at a faster pace and now we know there are many more symptoms of menopause, and so far about 35 symptoms have been associated with menopause.
Not all the women have to suffer from menopause and some just “Breeze Through” it. But as the Baby Bloomers are entering into menopause and life expectancy is increasing so not only for that the number of menopausal women is increasing but also because of the fact that life expectancy is increasing.
So now we find that women have to spend almost one of their lives in this period and with the women entering late into matrimony and being successful entrepreneurs quality of life has become an important issue. Therefore, it has become important issue to create 3awareness in the media and in the clinician about the problems and interventions available about menopause.
In the later part of nineteenth century hormone replacement therapy was being utilized as “elixir of life” and it was used for prevention of heart disease, prevention of osteoporosis and over all well being of women and perhaps in dosage and formulation which were perhaps beyond what was required. In 2002 came the results of various studies like WHI, HERS, Million Women Studies, which again started “New Wheel Of Thinking” about role of hormones, dosage, routes of administration, new formulations and new indication. But the fact remains that hormones have a role to play and menopausal women do need care. It was Dr Wolf H Utian who first presented his paper on menopause.
Woman is the axle around whom not only whole family but whole society revolves. No society can survive without a strong family structure. Societies fall apart where there is a weak family tree and who is the anchorperson of the family? None other than a woman who is the main guiding factor behind all the successful men and responsible for the main health of the society and nation and world at large so her role becomes more important in the twilight years of her life i.e. menopausal and perimenopausal years when she should be most healthy and active physically as well as mentally and psychologically and that is the time when because of the pressure of changing physical and social scenario sometimes she completely becomes a mess physically as well as mentally. As average life expectancy is increasing so is the period a woman has to spend in 4menopause period. With average life expectancy of 68 years for Indians and 80 years for Americans and average age of menopause being 46 to 51 years almost all women spend 1/3rd of their whole life in menopause.
In USA by age 51 years 89% of women are in menopause and by 40 years only 0.5% of women are in menopause. Between 40 to 50 years about 7% of women are in menopause.
So we have to care for health of menopausal women whose number is increasing.
The total group of postmenopausal women in the United States is increasing. In the year 2000, there were an estimated 31.2 million women older than 55 years, compared with 28.7 in 1990. By the year 2020, the size of this group is estimated to be 45.9 million.
India becomes the second country in the world after China to cross the one billion mark and is home to 16.7% of the world population. The population of India is expected to increase to 1400 million in 2026.
 
POPULATION DISTRIBUTION PYRAMID
From 2001 to 2026 the proportion of population aged less than 15 years is projected to decline from 35.4 to 23.4%. Because of declining fertility and increase in life expectancy, the population of the middle aged (15 to 59 years) and the older ages (60 years and above) are set to increase considerably. The number of older persons in the population is expected to increase by more than double from 71 million in 2001 to 173 million in 2026.5
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Figure 1: Percentage of population by broad age groups in India 2001–2026
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Figure 2: Projected population pyramid: India-2001
So in the population pyramid the base of the pyramid is becoming narrower while the middle would be broadened (Figs 1 to 3).
Data on the number of menopausal population is lacking in India. The number of women in the postmenopausal ages 50 to 59 years is projected to increase from 36 million in 2000 to 63 million in 2020.6
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Figure 3: Projected population pyramid: India-2006
So with this increasing number of women in menopause and because women have to spend one third part of her life in menopause it is very important that we take preventive and curative measures to give her quality of life and a very productive menopause life.