43 year old post menopausal lady with a lump in the right breast since 2 months. Rapid increase in size, painless lump. O/e - 3*4 cm firm lump in the retroareolar region with no skin changes and no axillary lymphadenopathy. Comment on the mammograms - will share the USG tomorrow morning.

Friends today I am discussing about a very common problem faced by the females in there life at some stage of life. Menopause is the process through which a woman ceases to be fertile or menstruate. It is a normal part of life and is not considered a disease or a condition. Symptoms may occur years before a woman's final period. Some women may experience symptoms for months or years afterward. Despite being a natural process in the body of any woman, menopause can cause drastic changes that trigger severe symptoms. This article will explain the symptoms and causes of menopause, as well as how to diagnose and treat any symptoms that arise. Fast facts on menopause Menopause marks the end of a woman's fertility. Symptoms of menopause include night sweats, hot flashes, mood fluctuations, and cognitive changes. A reduction in estrogen levels can lead to the symptoms of menopause. There are a number of medical treatments and home remedies that can help with symptoms, including hormone replacement therapy (HRT) and self-management techniques. The average age of menopause in the United States (U.S.) is 51 years. Signs and symptoms Menopause hot flash woman fan Menopause is a natural change in the body. It causes symptoms such as hot flashes. While menopause is not a disease or disorder, it does trigger some profound changes in a woman's body. A diagnosis of menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms of menopause generally appear before the end of that one-year period. Irregular periods Changes to the menstrual pattern are the first noticeable symptoms of menopause. Some women may experience a period every 2 to 3 weeks. Others will not menstruate for months at a time. Lower fertility Perimenopause is the 3-to-5-year period before menopause. During the perimenopausal stage, a woman's estrogen levels will drop significantly. This reduces her chances of becoming pregnant. Vaginal dryness Dryness, itching, and discomfort of the vagina tend to occur during perimenopause. As a result, some women may experience dyspareunia, or pain during sex . Women experience this pain due to lowering estrogen levels. These lower levels cause vaginal atrophy. Vaginal atrophy is an inflammation of the vagina that happens as a result of the thinning and shrinking of the tissues, as well as decreased lubrication. A hot flash is a sudden sensation of heat in the upper body. It may start in the face, neck, or chest, and progress upward or downward. The skin may become red and patchy, and a woman will typically start to sweat. Her heart rate may suddenly increase, strengthen, or become irregular. Hot flashes generally occur during the first year after a woman's final period. Night sweats Hot flashes that occur during the sleep cycle are called night sweats. Most women say their hot flashes do not last more than a few minutes. However, studies have confirmed that moderate-to-severe night sweats and hot flashes may pose a problem for around 10.2 years. Disturbed sleep It can be difficult for women to fall asleep and stay asleep as they progress through menopause. In some cases, night sweats can lead to discomfort during the night and difficulty sleeping. Sleep disturbance may also be caused by insomnia or anxiety. Urinary problems Menopause can disrupt a woman's urinary cycle. Women tend to be more susceptible to urinary tract infections (UTIs) during menopause, such as cystitis. They may also find that they also need to visit the toilet more often. Emotional changes Women can experience depression and low mood during menopause. Hormonal changes can often trigger depressed feelings and mood swings. In many cases, these emotional symptoms also go hand-in-hand with sleep disturbance. Women may also experience low libido, or sex drive, as a result of these emotional changes. Problems focusing and learning Menopause can affect cognitive functions, such as concentration. Some women may also experience short-term memory problems and difficulty focusing for long periods. Other effects Other symptoms of menopause include: a buildup of fat in the abdomen, sometimes leading to overweight and obesity hair loss and thinning hair breast shrinkage Without treatment, symptoms usually taper off over a period of 2 to 5 years. However, symptoms can persist for longer. In some cases, vaginal dryness, itching, and discomfort can become chronic and eventually get worse without treatment. Complications Menopause can lead to the development of complications, including: Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease. Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing osteoporosis. Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause. Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk. Treatment HRT menopause pills Treatment for menopausal symptoms can range from hormone replacement therapy to self-management. During menopause, women can pursue a number of treatments to maintain comfort. Most women do not seek medical advice during this time, and many women require no treatment. However, a woman should visit a doctor if symptoms are affecting her quality of life. Women should choose the type of therapy dependent on their menopausal symptoms, medical history, and personal preferences. Hormone replacement therapy (HRT) Women can keep the symptoms of menopause at bay by supplementing their estrogen and progestin levels. Hormone replacement therapy can be received through a simple patch on the skin. This patch releases estrogen and progestin. HRT is highly effective for many of the symptoms that occur during menopause. There are benefits to HRT, but be conscious of the risks: Benefits of HRT HRT effectively treats many troublesome menopausal symptoms. It can help prevent osteoporosis. HRT can lower the risk of colorectal cancer. Risks of HRT HRT raises the risk of breast cancer, ovarian cancer, and uterine cancer. It increases the risk of coronary heart disease risk and stroke. Hormonal therapy slightly accelerates loss of tissue in the areas of the brain important for thinking and memory among women aged 65 years and over. Medicines There are other medicines available to help reduce the effects of menopause. Low-dose antidepressants Selective serotonin reuptake inhibitors (SSRIs) have been shown to decrease menopausal hot flashes. Drugs include: venlafaxine (Effexor) fluoxetine (Prozac, Sarafem) paroxetine (Paxil, others) citalopram (Celexa) Drug treatment for hot flashes Hot flashes can be treated using gabapentin, available under the brand name Neurontin, and clonidine, which is often sold as Catapres. Clonidine can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes, but unpleasant side effects are common, including constipation, dry eyes, and nightmares. Vaginal estrogen may be applied to the area as a tablet, ring, or cream. This medication effectively treats vaginal dryness, dyspareunia, and some urinary problems. Moisturisers are available over-the-counter. Causes Aging woman A woman's estrogen levels drop during the aging process. A reduction in levels of the hormones estrogen and progesterone triggers the effects of menopause. Estrogen regulates menstruation, and progesterone is involved with preparing the body for pregnancy. Perimenopause begins when the ovaries start producing less of these two hormones. By the time a woman reaches her late thirties, the ovaries start producing less progesterone and estrogen. Fertility starts to decline long before the onset of any menopausal or perimenopausal symptoms. The ovaries produce less estrogen and progesterone over time until they shut down completely. Menstruation will then stop completely. This change is gradual in most women, but some find that their menstrual cycle continues as normal and then suddenly stops. Ovaries tend to stop producing eggs after the age of 45 years, but they may cease production before then. This is known as premature menopause. Although rare, this can occur at any age. A number of underlying conditions can cause premature menopause, including: enzyme deficiencies Down's syndrome Turner's syndrome Addison's disease hypothyroidism Certain surgeries and procedures may also lead to premature ovarian failure, such as: surgery to remove the ovaries surgery to remove the womb radiotherapy to the pelvic area chemotherapy to the pelvic area There is no way to prevent menopause, but its symptoms and effects can be managed. Diagnosis A doctor should be able to diagnose menopause or perimenopause in a woman using her age, questions about her menstrual patterns, and feedback about any physical signs. The test works by measuring anti-Müllerian hormone (AMH) in the blood, according to the U.S. Food and Drug Administration. This hormone is a marker of ovarian function. Used with other clinical evaluations and laboratory findings, it can give a better idea of a woman's menopausal status than was previously possible. The test may also help those who have symptoms of perimenopause, which is the stage before menopause. At this stage, too there may also be adverse health impacts. Early menopause is associated with a higher risk of: osteoporosis and fracture heart disease cognitive changes vaginal changes loss of libido mood changes Another types of test is for follicle-stimulating hormone (FSH). During menopause FSH levels rise. However, FSH is also not always a reliable indicator of menopause, as levels tend to fluctuate during menopause and perimenopause. Under certain circumstances, a doctor may order a blood test to determine the estrogen level. Low thyroid activity can cause similar symptoms to those seen in menopause, so a doctor may recommend a blood test to determine the level of thyroid-stimulating hormone. Self-management It is often possible to manage the symptoms of menopause without medical intervention. Exercise Exercise during menopause can have a range of benefits, including preventing weight gain, reducing cancer risk, protecting the bones, and boosting general mood. Pilates, for example, has shown great benefit in reducing all menopausal symptoms not related to the urinary system and genitals, including sleep problems and hot flashes. Women should exercise earlier in the day during menopause to avoid causing any interruptions to their sleep cycle. Kegel exercises can be useful for preventing urinary incontinence. These are exercises to strengthen the pelvic floor. Practicing 3 or 4 times a day can lead to a noticeable improvement in symptoms within months. Nutrition It is important to maintain a healthful and varied diet when managing the bodily effects of menopause. Researchers found that omega-3 may ease psychological distress and depressive symptoms. Omega-3 is available in foods such as oily fish. Supplements are also available. Women experiencing menopause should eat a well-balanced diet that includes: vegetables fruits whole grains unsaturated fats fiber unrefined carbohydrates Try to consume between 1,200 and 1,500 milligrams (mg) of calcium and plenty of vitamin D each day. Deep breathing techniques, guided meditation, and progressive relaxation can also help limit sleep disturbance. Stress can aggravate hot flashes and night sweats, so avoiding known stressors and practicing relaxation techniques can help these symptoms. Other steps to self-manage menopause symptoms There are a few ways for a woman to comfortably accommodate the effects of menopause: Avoid tight clothing. Limit the consumption of spicy food, caffeine, and alcohol. Stay sexually active to reduce vaginal dryness. Keep stress levels to a minimum, and get plenty of rest. Maintain a cool and comfortable temperature in the bedroom at night to minimize night sweats. Wake up and go to sleep at the same times every day to regulate the sleep cycle. Smoking can exacerbate symptoms, so avoiding it is important. Staying active and healthy and responding to symptoms rapidly can help a woman maintain a good quality of life during menopause. Primary Homoeopathic Remedies Graphites A woman who is chilly, pale, and sluggish—with trouble concentrating, and a tendency toward weight gain during or after menopause—is likely to respond to this remedy. Hot flushing and sweats at night are often seen. A person who needs this remedy may also have a tendency toward skin problems with oozing cracked eruptions, and be very slow to become alert when waking in the morning. Lachesis mutus This remedy relieves hot flashes from menopause, especially when hot flashes are relieved by sweating or the occurrence of periods. Sepia This remedy can be helpful if a woman's periods are sometimes late and scanty, but heavy and flooding at other times. Her pelvic organs can feel weak and sagging, and she may have a craving for vinegar or sour foods. Women who need this remedy usually feel dragged-out and weary, with an irritable detachment regarding family members, and a loss of interest in daily tasks. Exercise, especially dancing, may brighten up the woman's mood and improve her energy. Sulphur This remedy is often helpful for hot flashes and flushing during menopause, when the woman wakes in the early morning hours and throws the covers off. She may be very anxious, weep a lot, and worry excessively about her health. A person needing Sulphur often is mentally active (or even eccentric), inclined toward messy habits, and usually feels worse from warmth. Other Remedies Belladonna This remedy relieves hot flashes with profuse sweating and head congestion. Calcarea carbonica This remedy may be helpful to a woman with heavy flooding, night sweats and flushing (despite a general chilliness), as well as weight gain during menopause. People who need this remedy are usually responsible and hard-working, yet somewhat slow or plodding and can be easily fatigued. Anxiety may be strong, and overwork or stress may lead to temporary breakdown. Stiff joints or cramps in the legs and feet, and cravings for eggs and sweets are other indications for Calcarea. Glonoinum This relieves sudden hot flashes with throbbing headaches or congestion, aggravated by heat. Ignatia Ignatia is often helpful for emotional ups and downs occurring during menopause. The woman will be very sensitive, but may try to hide her feelings—seeming guarded and defensive, moody, or hysterical. Headaches, muscle spasms, and menstrual cramps can occur, along with irregular periods. A heavy feeling in the chest, a tendency to sigh and yawn, and sudden outbursts of tears or laughter are strong indications for Ignatia. Lilium tigrinum A woman likely to respond to this remedy feels hurried, anxious, and very emotional — with a tendency to fly into rages and make other people "walk on eggs." She often has a sensation of tightness in her chest, and a feeling as if her pelvic organs are pressing out, which can make her feel a need to sit a lot or cross her legs. Natrum muriaticum A woman who needs this remedy may seem reserved, but has strong emotions that she keeps inside. She often feels deep grief and may dwell on the loss of happy times from the past or brood about hurts and disappointments. During menopause, she can have irregular periods accompanied by backaches or migraines. A person who needs this remedy usually craves salt, and feels worse from being in the sun. Pulsatilla A person who needs this remedy is usually soft and emotional, with changeable moods and a tendency toward tears. Women are very attached to their families and find it hard to bear the thought of the children growing up and leaving home. They usually feel deeply insecure about getting older. A fondness for desserts and butter can often lead to weight problems. Changeable moods, irregular periods, queasy feelings, alternating heat and chills, and lack of thirst are common. Aggravation from stuffy rooms and improvement in open air may confirm the choice of Pulsatilla. Staphysagria A person who needs this remedy usually seems mild-mannered, shy, and accommodating, but has many suppressed emotions. Women around the time of menopause may become depressed, or have outbursts of unaccustomed rage (even throwing or breaking things). Many people needing Staphysagria have deferred to a spouse for many years, or have experienced abuse in childhood.

42 year old lady with a fungating breast lesion X 5 months duration. Extensive matted LN in right Axillary and Lymphedema in the right UL. Supraclav LN present as well. IDC - grade 3. TNBC. Metastasis to lungs, liver. Let's discuss the management. It is sad to see such advanced cases.

59 year old male came with a lesion over the tongue for the last 3 days. It was associated with pain and fever. This occurred following the first dose of chemotherapy for male breast cancer. What are your thoughts about the lesion?

36 year old lady came to me after a screening mammogram which she got done herself because her sister (39 years) was recently diagnosed with breast cancer. O/e - 1*1 cm lump was palpable in the right breast at 11 o clock. No other lump or enlarged LN. No nipple discharge. Points for discussion: 1. Discuss mammogram findings 2. Would you order a MRI for this patient