Everything you need to know about menopause

What is it

Menopause is the term commonly used to refer to the climacteric, that is, the period of the woman’s life in which menstruation ceases.

However, a more correct definition makes menopause coincide with the last menstruation.

It is preceded by a period, premenopause, which can last several years during which the menstrual cycle is irregular and can be accompanied by hot flashes and night sweats.

The next period is postmenopause, in which menstruation has disappeared altogether; Conventionally it begins after 6-12 consecutive months of total absence of menstruation.

Menopause generally takes place between the ages of 45 and 53, and is statistically more frequent around the age of 50. Here’s when it comes to early, premature or late menopause:

Causes

Menopause occurs with the exhaustion of the ovarian reserve: every woman is born with a well-defined number of oocytes, which are exhausted during life. When the ovaries, under the action of the pituitary, cease to produce ovarian follicles, consequently the production of estrogen also ends, an event that corresponds to the end of the fertile age. And the symptoms of menopause arise.

It is a genetically determined moment and, therefore, predictable to a large extent on the basis of the age at which it occurred in one’s mother.

Typically a woman is declared in menopause when the menstrual cycle is absent for at least 12 consecutive months. To monitor this transition phase, the gynecologist prescribes blood tests to assess the level of hormones involved: the definitive diagnosis is made with the dosage of estrogen, which decreases, and follicle-stimulating hormone (FSH), which increases.

Although usually a natural occurrence, menopause can also be due to surgical removal of the ovaries or uterus, radiation therapies or the use of drugs, such as chemotherapy. Smoking can also anticipate this moment.

The sharp drop in estrogen levels is associated with various manifestations affecting the heart and brain. Over time, hypertension and atherosclerosis, difficulties in attention, concentration and memory, hot flashes, insomnia, anxious manifestations may appear.

As for the musculoskeletal system, loss of bone density occurs with osteopenia and osteoporosis, joint pain, loss of muscle mass. Hormonal deficiency also involves the regulation of fat and sugar metabolism, which causes weight gain over time and a different distribution of fat, concentrated at the abdominal circumference, where the formation of the characteristic pads is more frequent, mostly seen as unsightly.

A less known consequence concerns the change in the intestinal ecosystem: estrogens play a role in determining the quantity and quality of digestive secretions. The salivary glands are less efficient and changes in the intestine cause constipation, bloating and digestive difficulties.

Common symptoms

The climacteric can present with more or less severe symptoms. In some cases menstruation disappears suddenly, while in others menstrual flow decreases during premenopause and appear:

– hot flashes

– excessive sweating

-Palpitations

– redness in the face

– fatigue and muscle pain

– mood swings and depression

-insomnia

– disorders of the urinary tract and dryness of the vaginal mucosa.

Alongside the physical symptoms, menopause has effects on sexuality, which is why this phase of life is often experienced as a moment of deprivation and considered, especially in modern Western society, synonymous with aging.

The drop in estrogen and progesterone, in fact, is also accompanied by a decrease in sexual desire. At the same time, the disappearance of estrogen induces vaginal atrophy, which manifests itself with a progressive modification of the walls of the vagina that become narrower, with a decrease in the elasticity of the tissues and with the reduction of lubrication. As a result of these phenomena, many menopausal women experience pain during sexual intercourse.

The decline in libido begins even before menopause, and is due to the progressive decrease in the production of male hormones, such as testosterone and, consequently, also dopamine, an important neurotransmitter for sexual activity.

In the same way, the drop in estrogen determines the reduction of serotonin levels, linked not only to the sexual sphere, but also to the mechanisms that regulate sleep and mood.

Finally, from an aesthetic point of view, it is possible to observe an impact of the new hormonal profile also on skin and hair: the decrease in estrogen causes a decrease in collagen production, the skin becomes thinner and less elastic and tends to dryness. These are gradual changes that become more evident five years after the beginning of the menopausal period, and start mostly from vaginal dryness, and then progressively worsen.

Menopause, however, does not necessarily involve hair loss, but these can become thinner and less voluminous, also due to the stress that often accompanies this period.

The disruption of hormonal fluctuations, however, has not only negative effects; In some women, in fact, the moment of menopause leads to an improvement in migraine, with less frequent and less intense attacks.

Finally, it should be remembered that there are also less common menopause disorders but all in all not so uncommon: these are both physical problems, such as urinary incontinence, and psychological and psychophysical, such as anxiety, irritability, fatigue, mood changes (related to the drop in libido) and so on. All these symptoms, if contained or not prolonged in time beyond a few days or weeks, should not worry excessively.

Complications

Menopause is associated with changes in health in general and the increased risk of certain diseases. Often, in fact, due to hormonal changes during the climacteric, hypertension, hypercholesterolemia, hyperglycemia and osteoporosis are accentuated.

It is therefore necessary, on the part of the woman, greater attention with respect to nutrition, the practice of physical exercise and the execution of periodic clinical checks, in order to operate an effective prevention of the most common complications.

In fact, childbearing age guarantees natural protection from cardiovascular diseases: for example, before menopause, the risk of heart attack is significantly lower for women than for men.

With the arrival of menopause, the lipid picture changes. Estrogen helps keep “good” HDL and “bad” LDL cholesterol levels in balance; their progressive disappearance causes instead the increase of LDL cholesterol and the decrease of the good one. This phenomenon, together with the increase in weight and pressure and a higher risk of diabetes, means that over time the probability of incurring stroke or heart attack increases to reach the levels found in the male population.

In addition, the risk of cardiovascular consequences, in the long term, is greater for women who have had more intense neurovegetative symptoms (such as flushing, sleep disturbances, night sweats, etc.).

In 60% of cases, the tendency to overweight also increases, because fat allows the body to retain estrogen for longer. Bones, heart and blood vessels are the structures that are most affected by these conditions, also leading, in chain, to an increase in the aforementioned cardiovascular risk.

During menopause, blood loss may occur, even when the cycle has disappeared. Generally it is a transient disorder, but it is always good to bring it to the attention of the gynecologist for a diagnostic deepening by means of a hysteroscopy and a possible histological examination. They could in fact be the indicator of the presence of a polyp, a fibroid or thickening of the endometrial wall.

Treatment

If the symptoms of menopause interfere with work, relationships and life as a couple, it is possible to undergo estrogen-based treatment, sometimes associated with progestogens.

This is hormone replacement therapy, consisting of pills, patches, gels or sprays that, by correcting hormonal imbalances, counteract the disorders associated with climacteric. These treatments should be prescribed by your doctor.

Hormone replacement therapy must in fact be personalized, identifying the most suitable formulation, route and duration of administration on a case-by-case basis and is all the more effective the sooner it is started. It is generally recommended only for women who have relevant and disabling vasomotor symptoms, such as hot flashes, which often interfere with the quality and duration of sleep.

The duration of hormone replacement therapy is about 5 years, if prolonged longer it can cause a slight increase in the risk of breast cancer. For this same reason it is always not recommended for women who have had a diagnosis of cancer or those with important familiarity for this disease.

For some years in gynecology new molecules have been available to counteract the consequences of menopause at the genital level, improving tissue lubrication and elasticity.

Calcium, activated vitamin D and bisphosphonates can help counteract osteoporosis, while transdermic clonidine, progestogens and phytoestrogens derived from soy and red clover are complementary drugs to hormone replacement therapy. In general, vitamins and minerals are essential to better experience menopause, and sometimes your doctor may recommend the use of some specific supplements.

Finally, some antidepressants can keep hot flashes in check, and testosterone can be used to increase libido and improve mood. For example, to counteract the symptoms related to the genital sphere, local therapies with creams based on this hormone can be prescribed.

It is essential, however, that all the therapies mentioned are always prescribed by medical specialists, following a visit and the correct evaluation of the specific problems of their patients. Diagnosis and prescription must take into account the peculiar alterations of this stage of life, habits, needs and condition of patients, and ensure that the health and well-being of body and mind is always preserved.

Remember, moreover, that menopause is not in itself a disease or a specific syndrome, but only a completely physiological transition period which, it is true, brings indisputable changes in one’s standard quality of life, but which should not be lived in a traumatic way: net of some complex changes in habits, the process should be faced, where possible, in a natural way, with the support of one’s family and carrying out one’s everyday life in the most continuous way.

To pharmacological therapies, if they are really essential, it is still advisable to support an adequate lifestyle, which includes a healthy and balanced diet and regular physical activity, avoiding cigarette smoking or the consumption of excessive amounts of alcohol, the main risk factors at this stage. Women who have an unregulated lifestyle could experience certain benefits and could better face menopause, if they embarked on a progressive path of improvement of their daily lives.

In particular, the practice of a sport can promote both mood, thanks to the increase in the production of endorphins, and the sexual sphere, as it contributes to the production of testosterone.