| Ovaries are the organs of female reproductive system, which secrete female hormones estrogen
and progesterone. Estrogen and progesterone are responsible for menstruation (monthly periods). When the secretions of these hormones are gradually reduced by ovaries, the process of termination of menstrual cycles stats. However, menstrual cycles seldom cease abruptly; there is an interval termed the "perimenopause" or "menopausal transition", during which there are considerable hormonal fluctuations. The perimenopause usually begins a few years before the last menstrual cycle;the cycles become irregular, and there are often symptoms suggesting a decline in estrogen concentration. |
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Finally it leads to complete cessation of menstruation. Menopause is the permanent end of menstruation (monthly periods) and fertility. It is a natural process and not a disease. One can not predict which period will be the last.
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Post menopause: Once 12 months have passed since the last period, one reaches menopause. The remaining life is a postmenopausal period. Post menopause is a time when most of the distress of the menopausal changes has faded.
The age of menopause ranges from 40-58 years. The age of menopause has not changed over the past few centuries, but there has been a gradual increase in life expectancy. Whereas in previous centuries women were not expected to live beyond menopause, women now spend one third to one half of their life after menopause.
Menopause is not disease but it can lead to some symptoms or can predispose a female to some medical disorders in postmenopausal period.
HOt flushes, (sudden warmth and then sweating), mood changes, migraine, vision changes, dryness of vagina, weight gain, urinary incontinence are some of the problems in the postmenopausal period.
But most alarming and medically significant problems of menopause are heart diseases and osteoporosis.
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| Menopause and Heart diseases |
| Estrogen has a protective role in cardiovascular system (heart and blood vessels). To understand role of estrogen in cardiovascular system it is essential to know a few facts about the relation of heart diseases and cholesterol. |
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Cholesterol travels in blood around the body in tiny clumps of fat and protein called lipoproteins. Low-density lipoprotein cholesterol (LDL-C) is termed as bad cholesterol and high-density lipoprotein cholesterol (HDL-C) is good cholesterol. Increase in LDL-C and/or reduction in HDL-C is responsible for heart diseases.
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| High LDL-C levels in blood lead to deposition of LDL-C on blood vessels. This results in formation of plaque and loss of elasticity of blood vessels i.e.; arteriosclerosis, which can lead to coronary artery disease of heart attack. HDL-C offers protection to blood vessels and reduction in HDL-C also leads to increased chances of heart diseases. |
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| Estrogen decreases LDL-C levels and increases HDL-C levels in the blood. The raised HDL-C / LDL-C ratio is probably responsible for rarity of heart diseases in premonopausal women. Lack of estrogen secretion in postmenopausal period takes away this protection and predisposes women for heart diseases. |
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A study found that 10-year incidence of cardiovascular disorders in postmenopausal women aged 50-59 was 4-fold higher than in premenopausal women of the same age range.
Osteoporosis is decreased density of bones. In other words it is thinning and weakening of bones. To understand the relation of menopause and osteoporosi it is essential to know a few things about bones.
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Bones provide the framework around which the body is constructed and protect and support internal organs. The strength offered by the bones is primarily due to calcium in the bone. Osteoblasts are the cells that are responsible for deposition of calcium from blood on the bones and osteoclasts are the cells, which take away calcium from the bone into blood. In brief, osteoblasts increase bone density and steoclasts reduce bone density. The effect of steoblasts is called as osteoblastic activity and effect of osteoclasts is called as oseteoclastic activity. Osteoporosis encompasses a wide spectrum of conditions associated with imbalance of osteoclastic and osteoblastic activities.
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| Estrogen has a significant positive effect on this calcium balance. Estogen deficiency increases osteoclastic activity and reduces bone density. Estrogen deficiency, after menopasuse causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist and spine. |
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In brief postmenopausal women are, by nature, at more risk for heart diseases and osteoporosis compared to premenopausal women. The supposedly modern lifestyle has an additional adverse impact on the health status of postmenopausal women. To understand the negative contribution of lifestyle in postmenopausal disorders it is essential to understand the concept of oxidative stress. |
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| To understand the role of oxidative stress one must know about certain elements called as the free radicals. An atom has protons and neutrons at its center and electron revolving around the center in orbits. In normal conditions, these electrons are found in pairs. If an electron revolving around the center is nor paired, the spices is called as a free radical. Free radicals are unstable and highly reactive. To achieve stability they 'rob' electrons from the surrounding molecules to produce an electron pair. Due to this, the molecule from which the electron is removed becomes unstable and turns into a free radical. This process of 'robbing' repeats with the new free radical and the chain progresses. In this way, a single radical is capable of producing a sequence of electron transfer reactions. The process of the removal of electron is called as oxidation. And the stress thus generated by the free radicals is called oxidative stress. These free radicals attack fatty acids and proteins in cell membranes and cause damage to it. Free radicals also damage the DNA. |
| Oxidative Stress and Heart Diseases |
It is estimated that by 20-40, women in the India, will represent a higher proportion of cardiovascular deaths than men. One can not deny the role of oxidative stress in this estimation.
In various studies the oxidative stress in the body was found to be raised in heart diseases . Not only the heart diseases but also the individual risk factors of heart disease are also associated with increased burden of oxidative stress. Increased number of free radicals is found in obesity, diabetes and high blood pressure. Smoking also generates free radicals and produce oxidative stress. |
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| Oxidative Stress and Osteoporosis |
One of the factors significantly influencing bone mass is oxidative stress. A study has established a biochemical link between increased oxidative stress and reduced bone density. The increased activity of osteoclasts leads to increased called cytokines are involved in the development of osteoporosis caused by oxidative stress.
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Modern Life Style is associated with higher oxidative stress.
Cigarette smoke contains numerous free radicals. Exposure to these free radicals is what causes oxidative damage. Oxidative stress due to smoking is also found in passive smokers ( simply put, people who are around those who smoke). |
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Increasing concern exists over the adverse effects of air pollution on our health. Epidemiological studies have shown a clear association between various disorders and air pollutants. The culprit here is, again, the oxidative stress caused bye these pollutants through the generation of free radicals. And again, there's nothing or very little we can do to alleviate this stress in a short term.
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| A foreign organism, after its entry into the human body, finds a specific place and gets lodged there. After it gets comfortable in its chosen environment, it multiplies and increases drastically in number. These large numbers of the organisms form a colony at that particular site and are responsible for damage to the site, in some cases throughout the body. This is an infection. And in any infection the body is exposed to danger through the generation of oxidative stress by the free radicals. |
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Alcoholism is the physical and emotional dependency on the use of alcohol.
An alcoholic is so enslaved to this addiction that quitting drinking or, in some cases, even a reduction in the consumption causes serious physical and emotional withdrawal symptoms. Chronic alcohol consumption is associated with increased oxidative stress due to the formation of free radicals.
In brief the life style factors like smoking, pollution, infections, alcohol consumption, et. are associated with additional burden of oxidative stress. |
| Oxidative Stress and Estrogen |
| Evidence suggests that estrogens can have effect against free radical. In other words estrogen can couneract the oxidative stress generated in the body. As women undergo menopause, circulating concentrations of estrogen decrease. That is the reason why women in postmenopausal age group are more prone for the disorders those are associated with higher oxidative stress. |
| Oxidative Stress and Postmenopausal Age |
| In summary, the following issues should be considered carefully while dealing with the menopause |
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Estrogen protects human body from oxidative stress. |
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There is a significant reduction in estrogen secretion in postmenopausal women. |
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Current lifestyle is associated with additional burden of oxidative stress. |
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Therefore modern women in postmenopausal age group are at more risk for the disorders that are associated with lack of estrogen and higher oxidative stress (heart diseases and osteoporosis. |
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After menopause, women need some additional support to counterattack the free radicals and oxidative stress generated by free radicals |
| Anti Oxidants |
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| Antioxidants are substances whose presence, in relatively low concentrations, significantly inhibits the rate of oxidation. It is the counter to the process of oxidation. Antioxidants deal with these free radicals and control oxidative stress. Every woman, after menopause, is exposed to additional oxidative stress due to an excessive burden of free radicals. To neutralize this oxidative stress human body has a store of natural antioxidants present in the form of various secretions such as albumin, bilirubin, estrogen, etc. These are the Natural (physiolgical) antioxidants that human body uses to fight off the potential (damage) threat posed by oxidative stress. These natural antioxidants, which are synthesized in human bodies, may not be always sufficient to take care of the additional burden of free radicals generated after menopause. So, one needs to extract antioxidants from the diet. But supposedly "modern", and deviously unhealthy, food habits prevent the sufficient intake of the much needed dietary antioxidants. This is the reason why postmenopausal women need additional supply of antioxidants. Various herbal antioxidants present in nature have the potential to offer an range of advantages after menopause. Any nutritional supplement, which offers ingredients having significant antioxidant activity, can have positive impact on the health status of women in postmenopausal age group. |
| References |
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Am Heart J. 1986; 111:383-390. |
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Circulation 2001; 104:2746-2753. |
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Biochemical and Biophysical Research Communications 2001; 288:275-279. |
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Biochemistry, 2007 / 22(2) 101-105. |
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Therapy 2005; 2(5):787-796. |
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Semin Reprod Endocrinol.1998; 16(4) : 281-308. |
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