Menopause

What is menopause

The menopause is:

• The definitive cessation of ovarian function, i.e. a sudden oestrogen deficiency.
• A life stage for each and every woman.
• The origin of certain changes and some disorders.
• Women who have the right information and healthy habits will enjoy better quality of life during this stage of their lives.
• The menopause is not:
• A disease.
• A sign of old age or loss of femininity.
• Not all women experience the same symptoms or experience symptoms with the same degree of intensity. 15% of women do not experience any discomfort at all.

How, when and why does the menopause happen?

The menopause marks the end of the fertile stage of a woman's life. It is a consequence of the natural ageing of the ovaries and the end of their reproductive and hormonal function. During this process of losing fertility, some hormonal disorders can arise that affect the way the body works.

As well as the natural menopause we have just described, there is also induced menopause, caused by removing the ovaries, chemotherapy treatment or radiotherapy treatment, autoimmune diseases or abnormal ovary function.

The menopause is considered to be early if it happens before the age of 40 years and late if it happens after the age of 57.

Short-term Symptoms 

The lack of oestrogen in the short term can cause:

1. Hot flushes and sweats: the lack of oestrogen causes the body's temperature to increase by almost 1 degree. Generally, hot flushes or a feeling of suffocation start at the thorax and rise up to the head and across the whole body. When a hot flush has happened, the body starts the process of going back to normal and in order to do so it produces sweat, which is the mechanism for reducing body temperature. Sweats may be as bothersome as or more so than hot flushes. 60%-80% of women experience them. 
2. The frequency of hot flushes may be once a day or every half an hour. Normally, episodes occur at night. They usually last between three and six minutes. This situation can go on for six months or two to three years on average. 15%-20% of women will, however, have them for the rest of their lives. 
3. Dizziness: a feeling of sickness and a sensation of not being stable.
4. Paraesthesia: a burning or pricking sensation or a feeling of extremities having fallen to sleep.  
5. Psychological symptoms: often associated with hot flushes or suffocation. The changes that take place for women during climacteric - which incorporates pre-menopause and menopause and lasts between 5 and 15 years - are the consequence, on the one hand, of endocrine and metabolic changes and, on the other hand, of an individual's psychological characteristics and social factors. The symptoms are:

• Nervousness
• Anxiety
• Tendency towards depression
• Decreased capacity to concentrate.

Medium-term Symptoms 

These come about 5-10 years after the beginning of menopause. 

1. Urinary alterations or genitourinary syndrome of menopause 

• Urogenital atrophy: the lack of oestrogen leads to decreased lubrication of the vagina and a decrease in the number of vaginal folds due to the loss of collagen.
• Urinary incontinence: a disorder that often affects post-menopausal women, but is not always linked to oestrogen deficiency. It can be a hygiene, social and psychological issue. 

The symptoms are: 

• Urinary incontinence
• Urinary urgency 
• Mixed incontinence (a combination of the two previous symptoms)
• Urinary infections

Current treatment is based on physiotherapy to improve pelvic floor muscle strength. Treatment with oestrogen improves mucosal trophism and can help to decrease symptoms and improve the symptomatology.

2. Skin alterations

The skin may also undergo changes caused by oestrogen deficiency, as well as by other age-related or external factors, such as exposure to sunlight.
The passage of time leads to decreased collagen and skin thickness, which causes the skin to become looser, more wrinkled and to lose its elasticity and sensitivity. 

3. Sexuality during menopause

The arrival of the menopause does not mean that a women's sex life has come to an end. The opposite perception is also mistaken. It depends more on social and cultural factors than on hormones. 

The menopause brings with it certain changes and may lead to some disorders, but this does not mean a loss of femininity:

• Decreased lubrication can sometimes cause discomfort during intercourse.
• Sexual arousal may be slower or less intense.
• Taking drugs and also suffering from some chronic illnesses may lead to decreased sexual desire.
• Certain types of surgical operations and treatments associated with such illness may cause women to feel less attractive.
• The psychological conditions associated with the menopause also affect sexual response.
• Today's beauty ideals can put pressure on menopausal women. Given the increased life expectancy in today's society, menopausal women still have a third of their lives ahead of them. This is a challenge that must be tackled and a myth that needs to be broken.

Long-term Symptoms  

These begin to appear 10 years or more after the beginning of menopause.

The lack of oestrogen in the long term can cause:

Osteoporosis

• Progressive loss of calcium in the bones. Oestrogen contributes to bone regeneration. The lack of oestrogen means that the bones no longer regenerate properly and the result is that in the first few years women may lose 2-3% of bone mass each year, which means that in 10 years they may lose 25% of their total bone mass.
• This affects more than 40% of menopausal women and leads to increased risk of fractures.

Cardiovascular Diseases

During the reproductive stage of their lives, women experience a greater degree of protection against cardiovascular diseases than men thanks to the action of oestrogen on the body.

• The lack of oestrogen may lead to increased risk of suffering cardiovascular diseases.
• Oestrogen deficiency increases the likelihood of coronary thrombosis due to the change in lipid metabolism, which affects clotting and fibrinolysis.
• It also has an impact on the weight changes that women experience during this hormonal phase, as more fat accumulates in the abdominal area.

With the lack of oestrogen during the menopause, women enter the risk group for cardiovascular diseases. The cardiovascular disease risk factors identified in women are:

• Age: over 55 years
• Family history
• Obesity
• Smoking
• Diabetes
• High blood pressure
• High cholesterol
• Stress
• Hypoestrogenism

Diagnosis 

The definition of the menopause is one year without having a period. Aside from that, the diagnosis will be clinical on account of all of the symptomatology explained above and also the findings of general tests, where there will be an increase in cholesterol, but the main signs relate to hormones, with a major increase in gonadotropins and particularly more than 40 IU/l FSH (follicle-stimulating hormone) and oestrogen deficiency, with values below 18 pg/ml.

Prevention rather than cure during the menopause

Healthy habits should be maintained during the menopause.

• Good diet: varied, rich in calcium and balance in proteins, sodium and phosphorous. Limited consumption of coffee, alcohol, fats and carbohydrates.
• Being in the sun for 15 minutes a day: ultraviolet rays turn dehydrocholesterol into vitamin D, which allows calcium taken in as part of a healthy diet to be absorbed into the intestine.
• Moderate physical exercise: physical inactivity reduces bone mass formation. If women do adequate exercise for their age and their general condition, they will achieve better equilibrium between bone formation and resorption.
• Stop smoking: tobacco contributes to reduced bone mass. 

Type of treatment

The menopause DOES NOT need to be treated but THERE ARE treatments to reduce some of the symptoms and improve the quality of life of affected women.

Phytoestrogens:

• What are they? They are biologically active plant derivatives found in many foods, such as legumes, green vegetables and cereals. They include various chemical derivatives (lignans, isoflavones and coumestan).
• What benefits do they bring? They help to alleviate the symptoms of menopause, including loss of bone mass. They have major antioxidant, antiviral and anti-inflammatory effects. A person's diet does not usually contain enough phytoestrogens, which means supplements are a good idea.

Hormonal treatment:

Oestrogen deficiency leads to the changes that some women experience. Hormone replacement therapy (HRT) involves supplementing these hormones. HRT allows minimum hormonal levels to be restored, allowing some women who have severe symptoms to retain a good quality of life. 

Medical consensus also warns of some risks:

• Not all women can receive HRT.
• The dosage prescription should be as low as possible.
• The treatment duration should be as short as possible and never longer than 5 years (aside from cases of early menopause), as it can increase the risk associated with breast cancer.

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