Challenges when measuring person-centred dementia care in nursing homes: a discussion paper.

Menopause leads to permanent inhibition of menstrual cycle and is responsible for a holistic decline in mental and physical health of women. In this study, we demonstrate the ameliorating effect of SheVari4, a standardized root extract of Shatavari or on perimenopausal and menopausal women. Daily consumption of 100 mg of the extract for 8 weeks led to significant improvement in menopausal health as assessed by MENQOL score and endocrine restoration. The formulation was safe to use and led to overall rejuvenation of health and metabolism. Menopause represents the natural physiological confirmation of the end of reproductive phase in a woman’s life marked by the absence of periods for 12 consecutive months. The primary reason accounting for the onset of menopause is the significant decline in production of reproductive hormones estrogen and progesterone by ageing ovarian follicles. The anterior pituitary tries to compensate for this loss by producing more Follicle Stimulating Hormone (FSH) () and Luteinizing Hormone (LH) () leading to a perturbed feedback loop, endocrine imbalance and disruption of Hypothalamic-Pituitary-Ovarian (HPO) axis (). Symptoms of menopause typically start appearing around 45 years, a condition referred to as perimenopause where menstrual cycles become irregular with frequent skipping of periods and continues within 1 year of menopause () with vasomotor symptoms including hot flashes, night sweats () and other Genitourinary syndromes (GSM) (). Although classified as a natural physiological response of the body, menopause is often associated with a lot of health issues and ailments including cardiovascular diseases (), sarcopenia (), osteoporosis () as well as occasional cognitive dysfunctions leading to a gross decline in the body’s homeostasis. Menopause associated psychophysiological discomfort and decline in mental health has been the biggest challenge toward the well-being of women past their reproductive age (). The psychological changes imparted by fall in estrogen levels severely jeopardize the daily chores in a woman’s life affecting sleep cycle, metabolic activity, concentration and work efficiency. This eventually leads to anxiety and a permanent state of depression () induced by fluctuations in the levels of serotonin and GABA (). Besides the natural course of aging, menopause such as conditions can often be caused by specific medical interventions such as oophorectomy or surgical removal of ovaries (), chemotherapy () and endometriosis (). Till date, the most popular curative strategy to treat menopausal distress has been hormone replacement therapy (HRT), or the collective set of procedures, which involve external administration of estrogen (along with progesterone if the patient has intact uterus) mostly in the form of oral, mucosal or epidermal absorption to make up for the deficit of production of these hormones in the body (). HRT mimics the ovary in terms of production of estrogen and progesterone and works best for persons who are below 60 years of age or within 10 years of menopause. Beyond the age of 60, finite risk factors of venous thrombosis increase significantly (). Possibilities of venous thrombosis also shoot up with individuals with greater body mass index (BMI) () as well as in persons with factor V Leiden inherited blood clotting disorder (both homozygous and heterozygous alleles) (). Apart from this critical issue, HRT is also associated with a finite risk of cardiovascular ailments (), dementia and breast cancer (). Other minor but discomforting side effects of HRT include swelling with associated pain in breasts, sporadic vaginal bleeding, digestive problems with frequent bloating, headaches, mood swings, hair loss and occasional skin rashes.