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A stage defined by the permanent cessation of ovarian function and a decrease in oestrogen levels, leading to a range of clinical changes whose presentation and progression vary from one woman to another.
Menopause is a natural stage in a woman’s life that marks the end of reproductive life. It is confirmed after twelve consecutive months without menstruation and occurs because the ovaries gradually stop functioning and hormone production decreases, particularly oestrogens.
This hormonal change can cause physical and emotional changes, with an intensity that varies widely between women.
Menopause is:
With good information, healthy lifestyle habits and, when necessary, medical follow-up, most women can maintain a good quality of life during this stage.
Menopause is not:
Some women hardly notice any changes, while others experience more intense symptoms. Approximately 15% of women do not have significant discomfort.
Menopause occurs when the ovaries progressively stop producing hormones, especially oestrogens, leading to the permanent cessation of menstruation.
It usually appears between the ages of 45 and 55, although the age may vary from one woman to another. This variability is related to the fact that women are born with a finite number of eggs, which gradually decreases throughout life. Genetic and environmental factors, as well as certain medical conditions or treatments, influence this process and determine when menopause is reached.
The way menopause begins also varies. In many women, changes occur gradually, while in others symptoms may appear more intensely from the outset, or may be mild or absent.
In some cases, menopause does not occur naturally but is induced, when certain medical treatments or procedures cause the ovaries to stop functioning abruptly, as can happen after some gynaecological surgeries or treatments such as chemotherapy or radiotherapy.
The decrease and fluctuation in oestrogen levels during perimenopause and the first years after menopause can cause a range of short-term symptoms. These hormonal changes may affect different organs and systems in the body, as oestrogen receptors are distributed throughout the organism.
Hot flushes are sudden episodes of intense heat caused by changes in the system that regulates body temperature. They are often accompanied by skin flushing and, in some cases, palpitations. When a hot flush ends, the body attempts to restore normal temperature by producing sweat, which is the natural cooling mechanism. Sweating can be as bothersome as, or even more bothersome than, the hot flush itself.
When these episodes occur at night, they can disrupt sleep and make rest more difficult. Hot flushes and night sweats are the most common symptoms of menopause and affect approximately three out of four women at some point.
Their frequency varies widely: some women experience them occasionally, while others may have several episodes during the day or night. Each episode usually lasts a few minutes. In most women, these symptoms tend to improve over time, although their course may differ from one woman to another.
Difficulty falling asleep, nighttime awakenings or non-restorative sleep are common. These disturbances may be related to night sweats, but also to the hormonal changes typical of this stage. Lack of rest can lead to daytime fatigue and a sense of reduced physical and mental performance.
During this stage, mood changes such as nervousness, irritability, anxiety or low mood may occur. Difficulties with concentration, a sensation of “brain fog” or mild memory problems are also common. These changes are mainly related to hormonal fluctuations, although they may also be influenced by personal, family, work and social factors that often coincide with this period of life.
These symptoms may appear gradually, fluctuate over time or change in intensity. Not all women experience them, nor with the same severity. When they interfere with quality of life, it is advisable to seek advice to receive information and consider appropriate support and treatment options.
Years after menopause, reduced oestrogen levels may lead to gradual changes in different parts of the body.
Changes in the genital and urinary area
Oestrogens play an important role in maintaining the health of the vagina, vulva and urinary tract. When oestrogen levels fall, these tissues may become drier, more delicate and more sensitive.
This may cause:
Unlike other menopausal symptoms, these changes do not usually resolve on their own over time, but they can be treated. Pelvic floor physiotherapy helps improve urinary control, and the use of vaginal moisturisers and lubricants, as well as local oestrogen treatments, can relieve dryness and discomfort.
Skin changes
With decreasing oestrogen levels, the skin may lose some of its hydration, elasticity and firmness, becoming drier, thinner or more sensitive. In addition to hormonal changes, other factors such as ageing, sun exposure and lifestyle habits also play a role.
Sexuality during menopause
Menopause does not mean the end of sexuality. However, some women may notice changes. Reduced vaginal lubrication may make intercourse less comfortable, and arousal may take longer. Changes in sexual desire may also occur.
Sexual experience during this stage does not depend solely on hormones, but also on overall health, self-image, previous experiences and life circumstances. With appropriate information and treatment when needed, many women maintain a satisfying sex life.
In the long term, reduced oestrogen levels may affect bone and cardiovascular health. These changes are not immediately noticeable but are important for future health.
Bone health
Oestrogens help keep bones strong. After menopause, reduced oestrogen levels may promote a progressive loss of bone mass, increasing the risk of osteoporosis and fractures. Osteoporosis often causes no symptoms until a fracture occurs, which is why prevention and medical follow-up are essential.To protect bone health, regular physical activity is particularly important, especially strength and weight-bearing exercises, which help maintain bone density and muscle strength. Ensuring adequate calcium and vitamin D intake, through diet or supplements when necessary, is also key, as these nutrients are essential for bone health.
The combination of healthy lifestyle habits, physical activity and appropriate medical follow-up helps reduce fracture risk and preserve long-term bone health.
Cardiovascular health
Before menopause, women have a certain degree of protection against cardiovascular disease. As oestrogen levels decline, this protection decreases and cardiovascular risk increases with age.
Hormonal changes may contribute to increased cholesterol levels, abdominal fat and other risk factors. Maintaining healthy habits, such as a balanced diet, regular physical activity and avoiding tobacco, is particularly important at this stage.
Menopause is considered confirmed after twelve consecutive months without menstruation, provided there is no other explanation. This is the criterion generally used.
In most women, diagnosis is based on clinical history and symptoms. Age, changes in the menstrual cycle and the presence of symptoms such as hot flushes, sleep disturbances or mood changes are usually sufficient to identify this stage. In these cases, routine hormonal blood tests are not required. Hormonal testing is only necessary in specific situations.
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