What is menopause?
Menopause is a natural state in the life of a woman, in which the hormonal function of the ovaries ceases and, therefore, is expressed with the definitive absence of menstruation. Generally, this happens between the ages of 45-55 years, with the usual average being 50 years.
The diagnosis of menopause is made when the woman spends at least 1 year without menstruation. Any alteration that is expressed around that period is called perimenopause or climacteric. During this period the transition between the reproductive and non-reproductive stage of the woman takes place. This is due to the gradual decrease in the production of estrogen and progesterone that generates, among other symptoms, the cessation of menstruation. Surgical menopause is artificially produced by the surgical removal of the ovaries. The hysterectomy (or removal of the uterus) also generates an absence of menstruation, but this does not represent a menopause since the ovaries will continue with their function until it ceases. A hysterectomy does not condition an early menopause.
What symptoms does it generate?
Women who are in peri-menopause express very different symptoms. The perception of them is variable according to each patient:
- Menstrual disorders: it is the most frequent symptom and it appears early. The cycles can be shortened or lengthened, with more or less menstrual flow. This is due to an absence of ovulation. Generally, the cycles are spaced more and more with the consequent disappearance of menstruation.
- Vaginal dryness: the mucous membranes suffer a progressive thinning, with the alteration of the lubrication that causes dryness. Therefore, it is common for women to complain of vulvo-vaginal itching or pain with sexual intercourse.
- Hot flashes: are alterations in the vasomotor system. They consist of a sensation of heat that they describe as ascending from the neck to the face and that generates palpitations and sweating. They can happen at any time of the day and, in general, are accentuated during the hottest months of the year.
- Sleep disturbance: the vast majority of women experience insomnia during this period.
- Mood alterations: emotional alterations make up one of the most difficult symptoms to treat. It can manifest with emotional ups and downs. Irritation and sadness are the most common, which can be encompassed in a more important depression.
- Decrease in libido: sexual desire usually decreases. It is accompanied in turn by an alteration in the perception of one’s own body.
- Changes in the body and weight gain: menopause is usually accompanied by some metabolic changes, such as the onset of diabetes, hypertension, overweight and obesity. This is due to an increase in body fat. The sedentary lifestyle accelerates this process. Women after menopause have increased risk of heart attacks.
- Osteopenia and osteoporosis: this is the progressive demineralization that is generated by the decrease in the levels of estrogen in the blood. All women will suffer some degree of demineralization. The excessive loss of calcium can lead to osteoporosis, which represents a significant fragility of bones with an increased risk of fractures. There are other factors that can contribute to the acceleration of this process, such as immobilization, the use of corticosteroids, anorexia nervosa, smoking, and early menopause, among others.
What is the treatment of menopause?
The treatment during the climacteric has the purpose of giving a better quality of life to those women who suffer any of the aforementioned symptoms. Generally, it is preferred to treat each symptom individually, although in patients with very florid symptoms and poor quality of life, a hormone substitution is chosen for short periods. To all this we must add lifestyle changes to reduce the incidence of symptoms.
North American Menopause Society