Let's talk about Menopause
Menopause is a natural biological process normal in all women, marking the end of their reproductive phase, and is recognized through the natural interruption of menstruation. After 12 consecutive months without any menstruation, the diagnosis for menopause can be confirmed.
The human body goes over the course of its life through several phases. In women, when puberty is reached, between 8 and 13 years, the ovaries begin a regular monthly egg release process, called menstruation. Women only have a limited number of eggs to release during their life span, usually occurring during 30 to 35 years. Thus, it is usually when women reach around 40 and 58 years that spontaneous menopause occurs, even if there may be cases where it occurs early or later.
The reduction of ovarian activity is not, as a rule, abrupt. It is a gradual process, more or less accelerated, which is usually only recognized for the irregularity of menstruations. Following the reduction of menstruation frequency, women also begin to produce fewer estrogens and progesterone, altering their hormonal balance.
Ideally it will be a gradual process, thus limiting the impact and intensity of symptoms associated with menopause. The process may even extend over several years, with irregularities in menstrual cycles and the drop in production of female hormones.
Today, a bit all over the world, we witness an increase in average life expectancy and would be expected that menopause would gradually be delayed, however, this is not the case. The age of menopause has kept constant over time.
Menopause is a universal biological process, inevitable and irreversible for all women. However, this does not mean that it is exempt from dangers. It can even be a very troubled period for women due to all changes in their bodies and minds, as it marks the beginning of their physiological aging.
Regarding menopause symptomatology, it should be noted that it may differ greatly from woman to woman, existing even women who have few or none of the symptoms until the total interruption of menstruation. Still, we can recognize a series of common symptoms associated with the progressive reduction of female hormones, with a special focus on estrogens.
The symptoms do not tend to appear all at once. In fact, we can even divide the short, medium and long-term symptomatology.
• Vasomotor disturbances – popularly referred to as “hot flashes”, are characterized by the uncontrollable emergence of sudden and strong heat waves, accompanied by excessive increase in sweat production and possibility of palpitations. This is the most common symptom for most women (between 60% and 80%), being usually more intense in the first two years and ending around five years of menopause;
• Psychological disturbances – these are characterized by the difficulty in falling asleep and the possibility of insomnia, but also by greater irritability and difficulty in emotional control. Even depressive episodes, anxiety and memory loss may come up;
• Irregularities in the duration of menstrual cycles and the amount of blood flow;
• Urogenital atrophy – also referred to as vaginal atrophy, it is characterized by the decrease in the vaginal mucosa which ends up drying the vaginal walls, reducing their elasticity. This dryness is often accompanied by itching and irritation, and may still be quite uncomfortable, or even painful to maintain sexual relations, which may reduce women’s libido and self-esteem;
• Urinary complications – it is common at this stage to have a greater tendency towards the emergence of urinary infections and they may even become recurring. Episodes of incontinence may arise.
• Osteoporosis – characterized by loss of bone density, since estrogens promote calcium fixation in bones. This reduction of bone density may result in greater potential for fractures;
• Changes in skin, hair and nails – the skin begins to lose its elasticity and thus increasing the number and intensity of wrinkles. The nails start to get thinner and brighter, as well as the hair;
• Changes in fat distribution in the body – fat begins to focus more on the abdominal region, rather than hips and buttocks. This symptom may be associated with a higher risk of related diseases such as diabetes mellitus and hypertension;
• Increased risk of cardiovascular disease – resulting from the importance of estrogens in the balance of blood fats, this increases the risk of heart attacks and strokes, among other cardiovascular problems;
All women, from the moment they are born, have a finite reserve of germ cells, the so-called follicles, in the ovaries. No woman has the ability to form more follicles than those with which she was born. It is in these follicles that eggs originate and are regularly released every month from the first menstruation to the last. When the last follicles die there will be no more eggs to release and the ovaries begin to decline, dramatically reducing the concentrations of female hormones.
There are, however, other possible but less common causes for menopause. For example, if a woman requires a hysterectomy (surgery to remove the uterus) it may also be necessary to remove the ovaries. In this case, without ovaries there is no menstruation. Also, if a woman needs intensive chemotherapy or radiotherapy treatments, it may induce menopause.
In these cases, where the cause of menopause is not natural and since the interruption of production of female hormones is abrupt, menopause symptoms may arise immediately after procedures, sometimes aggressively.
There are still very rare cases, in about 1% of women, where there may be developed an early menopause. That is, when it arises before the age of 40. Usually, such cases are associated with premature ovarian decline, in which women stop producing hormones ahead of time, and may be associated with smoking, hypothyroidism, autoimmune diseases, epilepsy, antidepressants and the absence of pregnancies.
The diagnosis for menopause undergoes a clinical assessment, in which the doctor evaluates the woman’s age and if there are no identifiable causes for the absence of menstruation for at least 12 months with menstrual irregularities or the symptoms of vasomotor disturbances. If the patient is within the normal age, between 45 and 52 years old, and does not have identifiable causes for the absence of menstruation, it is in the menopause phase.
Menopause itself has no treatment. It is an irreversible biological process when it occurs naturally. Treatments, or available treatments, aim to respond to the discomfort caused by symptoms, or directly to the cause of a non-natural menopause.
For a large number of women, to pass through the process of menopause does not necessarily means that any drugs or treatments are required to attenuate symptoms, as they tend to disappear over time and may be tolerable.
For women who really need help, the treatment varies depending on the symptom that represents the most discomfort:
Vasomotor disorders and psychological disturbances – Treatment is characterized by hormone replacement therapy, i.e., the patient takes medications composed of synthetic hormones that allow the reduction of hormonal deregulation. This therapy should be very well thought out between the patient and his doctor, as it has several contraindications.
Urogenital atrophy and urinary tract infections – Treatment involves a topical estrogen -based therapy through the application of vaginal creams, lotions or pills that are meant to act locally.
By adopting a healthy lifestyle coupled with a balanced diet, it is possible to reduce the symptoms associated with menopause naturally.
Being a natural and universal process, we can only seek not to provoke early menopause by reducing risk behaviors such as smoking. We already know that on average smoking women start menopause 1-2 years before a non-smoking woman.