Let's talk about Menopause
Menopause is a normal natural biological process in all women, and it is the end of their reproductive phase, recognized through the natural interruption of menstruation. After 12 consecutive months without any menstruation, menopause can be confirmed.
The human body goes through different phases throughout its life. In the case of women, when puberty is reached, between the ages of 8 and 13, the ovaries begin a regular monthly process of releasing eggs, menstruation. It turns out that the number of eggs that the woman has to release is limited, and this release generally lasts for 30 to 35 years. Thus, it is normally between the ages of 40 and 58 that spontaneous menopause occurs, although there may be cases in which this occurs earlier or later.
The reduction in activity of the ovaries is not, as a rule, abrupt. It is a gradual process, more or less accelerated, which is usually only recognized by the irregularity of menstruation. Accompanying the reduction in the frequency of menstruation, the woman also begins to produce less estrogen and progesterone, altering her hormonal balance.
Ideally this will be a gradual process, thus limiting the impact and intensity of symptoms associated with menopause. The process can even extend over several years, with irregularities in menstrual cycles and a drop in the production of female hormones.
Currently, all over the world, we are witnessing an increase in average life expectancy and it would be expected that, for this reason, menopause could be gradually delaying its appearance, but this is not the case. The age at menopause has remained constant.
Menopause is a universal, inevitable and irreversible biological process for all women. However, this does not mean that it is free of dangers. It can even be a very troubled period for women due to all the changes in their bodies and minds, as this marks the beginning of their physiological aging.
Main Symptoms
Regarding the symptoms of menopause, it should be noted that this can be quite different from woman to woman, and there are even women who have few or no symptoms until the complete cessation of menstruation. Even so, we can recognize a series of common symptoms associated with the progressive reduction in the production of female hormones, with a special focus on estrogens.
Symptoms tend not to appear all at once. In fact, we can even divide the symptomatology into short, medium and long term.
Early Symptoms
- Vasomotor disturbances – popularly called “hot flushes” and are characterized by the uncontrollable appearance of sudden and strong hot flashes, accompanied by an excessive increase in sweat production and the 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 after menopause;
- Psychological disorders – these are characterized by difficulty falling asleep and the possibility of insomnia, but also by greater irritability and difficulty in emotional control. Depressive episodes, anxiety and memory loss may even arise;
- Irregularities in the length of menstrual cycles and the amount of blood flow;
Intermediate Symptoms
- Urogenital atrophy – also known as vaginal atrophy, is characterized by the reduction of the vaginal mucosa which ends up drying out the vaginal walls, removing their elasticity. This dryness is usually accompanied by itching and irritation, and sexual intercourse can be quite uncomfortable, or even painful, which can reduce the woman’s libido and self-esteem;
- urinary complications – it is common at this stage to have a greater tendency for the appearance of urinary infections, and may even become recurrent. Episodes of incontinence may appear.
Late Symptoms
- Osteoporosis – characterized by loss of bone density, as estrogens promote the fixation of calcium in the bones. This reduction in bone density can result in a greater potential for fractures to occur;
- Changes in the skin, hair and nails – the skin begins to lose its elasticity and a greater number of more intense wrinkles appear. Nails start to get thinner and more brittle, as well as hair strands;
changes in the distribution of fat in the body – it starts to concentrate more in the abdominal region, instead of the hips and buttocks. This symptom may be associated with a greater risk of related diseases, such as diabetes mellitus and hypertension; - Increased risk of cardiovascular diseases – due to the importance of estrogens in the balance of blood fats, which increases the risk of heart attacks and strokes, among other cardiovascular problems;
Main Causes
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 she was born with. It is in these follicles that the eggs originate and are released regularly and monthly from the first menstruation to the last. When the last follicles die, there are no more eggs to release and the ovaries fail, drastically reducing the concentrations of female hormones.
There are, however, other less common possible causes for menopause. For example, if a woman needs to have a hysterectomy (surgery to remove the uterus) it may also be necessary to have the ovaries removed. In this case, without ovaries, there is no menstruation. Also, if a woman needs to undergo intensive chemotherapy or radiotherapy treatments, menopause can be induced.
In these cases, where the cause of menopause is not natural and since the interruption of female hormone production is abrupt, menopause symptoms can appear immediately after the procedures, in an aggressive way.
There are still quite rare cases, in about 1% of women, in which there may be an early menopause. That is, this appears before the age of 40. Such cases are usually associated with premature ovarian failure, in which the woman stops producing hormones ahead of time, and may be associated with smoking, hypothyroidism, autoimmune diseases, epilepsy, consumption of antidepressants and absence of pregnancies.
Diagnosis
The diagnosis for menopause goes through a clinical evaluation, in which the doctor assesses the woman’s age and if there are no identifiable causes for the absence of menstruation for a period of at least 12 months, with menstrual irregularities or with the symptoms of vasomotor disorders . If the patient is within the normal age, between 45 and 52 years old, and has no identifiable causes for the absence of menstruation, she is in the menopausal phase.
Treatment
Menopause itself has no treatment, it is an irreversible biological process, when it occurs naturally. The treatment, or treatments available, aim to respond to the discomfort caused by the symptoms, or directly to the cause of unnatural menopause.
For a large number of women, going through the menopausal process does not represent any need for treatment to alleviate the symptoms, as these tend to disappear over time and are tolerable.
For women who really need help, treatment varies depending on the symptom that most bothers them:
- vasomotor disturbances and psychological disturbances – the treatment involves hormone replacement therapy, that is, the patient takes drugs composed of synthetic hormones that allow to reduce hormonal dysregulation. This therapy should be carefully considered between the patient and her doctor, as it has several contraindications.
- Urogenital atrophy and urinary infections – treatment involves topical therapy based on estrogens, through the application of creams, lotions or vaginal pills, which intend to act locally.
By adopting a healthy lifestyle combined with a balanced diet, it is possible to reduce the symptoms associated with menopause.
Prevention
Being a natural and universal process, we can only try not to provoke the onset of an early menopause by reducing risky behaviors such as smoking. We already know that, on average, women who smoke start menopause between 1 and 2 years earlier than a non-smoking woman.
