Perimenopausal Women Essay

majority of perimenopausal women will experience bothersome symptoms due to declining or fluctuating estrogens level in their menopausal transition [1]. Because of a development of medical science, women now live more than one-third of their lifetimes beyond menopausal transition [2]. There are several symptoms associated with menopausal transition but the VMS almost affect 75% of women [3-5]. However, the presentation and severity of VMS varies between each women as in some women with significant physical distress and functional impairment thus requiring medical intervention [2]. Hot flashes present as episodic sensation of heat, intense sweating flushing over face, neck and upper chest followed by palpitation and anxiety [4]. Each episodes of VMS lasted for 3-10 minutes and reoccurred with varying frequency per day [6]. The pathophysiology of VMS still unknown but it was thought that the withdrawal of estrogen rather than the lower level of estrogen is responsible for central thermoregulatory dysfunction and VMS to occur [7]. This mechanism is regulated by many neurotransmitters but norepinephrine is the primary neurotransmitter that lower the thermoregulatory set point and trigger the heat loss mechanism [3].
Hormone
replacement therapy is the most effective treatment for menopausal VMS but due to its adverse effect, now many women are reluctant to use HRT [8]. Data from the meta-analysis of 16 studies demonstrate that prolonged used of estrogen has 30% higher relative risk for breast cancer [9, 10]. So, the search for the alternative to HRT were initiated such as SSRIs, SNRIs, clonidine, acupuncture, soy supplements etc. but the result are inconsistent. Among them SSRIs and SNRIs, seem to be more effective and having favorable adverse effects. However, studies of SSRIs and SNRIs showed mixed results; some studies reduced VMS by 50-60% and no effect in other study [11].
Therefore, I am doing this review to find the effectiveness and adverse effect to reach on the conclusion for the prescription of SSRIs and SNRIs for the menopausal vasomotor syndrome.

1.2 Physiological changes during menopausal transition
Menopause is an expected transitional life occurrence in women, generally occurs 12 months after the final menstrual period [12].
Although a great increase in the life expectancy of women, the age at menopause remains constant. The age at menopause is genetically determined and not affected by race, socioeconomic status and age at menarche, or a number of previous ovulation [13]. The average age for the final menstrual period is 51.5 years [14]. The menopausal transition is changes in menstrual cycle and endocrine, beginning with irregular menstrual cycle and increase follicle stimulating hormone (FSH) and ends with the Final Menstrual Period. Menopausal transition starts with the loss of follicular activity in wide range of age (42-58 years)
[15].
During reproductive life of women, gonadotrophic releasing hormone (GnRH) is release from arcuate nucleus of the medial basal hypothalamus in a pulsatile fashion. It binds to GnRH receptors on pituitary gonadotropes to stimulate cyclic release of the gonadotropins i.e. luteinizing hormone (LH) and follicular stimulating hormone (FSH). These gonadotropins, in turn, stimulate to produce ovarian sex steroids estrogen, progesterone, and the peptide hormone inhibin. During the reproductive years, estrogen and progesterone exert both positive and negative feedback on pituitary gonadotropins secretion and on the amplitude and frequency of GnRH release. Inhibin produced in granulosa cells exerts important negative feedback response for FHS secretion from pituitary. These tightly regulated endocrine hormones maintain menstrual cycle regular and predictable.