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How to treat, without hormones, the symptoms of climacteric
The terms climacteric and menopause often cause a lot of confusion because they are used as if they had the same meaning, when in reality they are distinct events.
Climacteric is a naturally occurring endocrine phenomenon in all women. Women have a limited number of ovarian follicles, which produce the major female hormones: estrogen and progesterone. The number of follicles gradually decreases, since, with each menstrual cycle, a group of them is recruited to promote ovulation. In the end, when there are few viable follicles, the ovaries gradually lose the ability to produce their hormones, which usually occurs around 41 years of age. At this stage, menses continue normally, although they may assume irregular rhythm. Thus, the climacteric marks the end of a woman's reproductive life.
The search for medications that do not contain hormones to mitigate climacteric symptoms is a very important strategy to improve the quality of life of women who are in this phase of life and can not undergo HRT.
Menopause is nothing more than the last menstruation, at which time the woman enters the postmenopausal period. It can be said that the woman presented her last menstruation when she has been without menstruar for more than a year. In Brazilian women, this phenomenon occurs around the age of 51.
Several symptoms may be present during the climacteric period. They are mainly caused by reduced production of the major female hormones. These include vasomotor symptoms, which include hot flashes (hot flashes) and night sweats, which cause major discomfort. These symptoms affect about 80% of women, disappearing spontaneously in about 50% of them within four years, but remain in 30% of those over 60 years, extremely uncomfortable situation. They may appear spontaneously, throughout the day, or be associated with triggering factors such as emotions, sudden changes in temperature, stress, alcohol consumption, coffee, or hot beverages. Other common clinical manifestations in the climacteric are insomnia, tingling, mood changes, tiredness, muscle aches, joint pains, headache, palpitation, tinnitus, reduced libido, decreased vaginal lubrication, fat deposition in the abdomen and flanks. > It is important to note that women spend approximately one third of their lives after menopause. It is obvious that such symptoms significantly reduce the quality of life and need to be treated. The reference treatment is hormone replacement therapy (HRT), currently available in several presentations. Although HRT is effective in reducing symptoms, some recent studies have tested the relationship between the risk and benefit of HRT, in particular the potential for increased risk of breast cancer. This has caused many women to discontinue HRT. There are also women who do not adapt with HRT and those for whom there are contraindications because of an increased risk of breast cancer, for example.
For this reason, there is a new interest in vasomotor therapy with non-hormonal medicines that can improve the quality of life of women, without, however, increasing the risk of serious diseases.
Treatment can be performed without the aid of medication (non-pharmacological treatment), using, for example, acupuncture or by making lifestyle modifications. In this case, wearing light clothing, lowering room temperature, drinking cold drinks, avoiding hot and spicy foods, practicing physical activity, reducing weight, and quitting smoking are measures that can help improve symptoms.Drugs are another strategy often used alone or in association with non-pharmacological therapies. Drug treatment includes HRT (estrogen, progesterone, tibolone, and selective modulators of estrogenic hormones) and non-hormonal therapy. The best studied non-hormonal substances are antidepressants acting via serotonin via serotonin / noradrenaline and gabapentin. Non-hormonal medications used to treat clinical manifestations of climacteric can be divided into five major groups:
Serotonin-active drugs: examples are paroxetine, citalopram, escitalopran, sertraline, and fluoxetine. Paroxetine has recently been approved by the FDA for the treatment of climacteric vasomotor symptoms. It is the first non-hormonal drug approved for this purpose in the United States. The new drug, Brisdelle®, contains a lower dose of paroxetine (7.5mg) compared to a 20mg dose of the tablets usually available on the market
Drugs acting via serotonin + noradrenaline (examples: venlafaxine, devalafaxin and duloxetine)
- Antiepileptics (example: gabapentin). Pregabalin, a substance used to treat fibromyalgia, also seems to be effective
- Herbal medicines (examples: Cemicifuga racemosa, Glycine max, Valerian, isoflavones, etc.)
- Homeopathy has also been used, especially for the relief of vasomotor symptoms. Some substances used in homeopathy are
- A. racemosa, A. montana, Glonoinum, L. mutus and S. canadensis
- . The search for medications that do not contain hormones to mitigate climacteric symptoms is a very important strategy to improve the quality of life of women who are at this stage of life and can not undergo HRT. It should be emphasized, however, that non-hormonal medicines, even herbal medicines, can have severe side effects at high doses. In addition, they can interact with other medications that the woman is already using, causing several complications. Thus, although important advances are occurring, therapy should always be individual, performed under medical supervision, with careful evaluation between risks and benefits.
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