All women who reach middle age eventually go through the hormonal transition of menopause. However, this important biological phenomenon has long been relegated to the background, talked about quietly or referred to with euphemisms such as “transformation”. Menopause has been discussed more openly among women and in the media in recent years, says Nanette Santoro, MD, professor of obstetrics and gynecology at the University of Colorado School of Medicine and a longtime menopause researcher.
Much of what is known about menopause comes from the Study of Women’s Health Across the Nation (SWAN), an epidemiological investigation that has followed nearly 3,000 women in the United States since 1994. This is a good start, but more research is needed. Too big to cohabitate, says Santoro, with many questions left to answer. Other areas have shown more extensive follow-up, such as the famous Framingham Heart Study, which followed more than 14,000 people. It was Swan, for example, who found that women with frequent and persistent hot flashes had an increased risk of heart disease. And it was Swan who confirmed long-standing observations by women that lean body mass decreases and fat increases during transition, even though total weight does not change.
Other research has led to a better understanding of the biology behind the main symptom of menopause: hot flashes. Researchers at the University of Arizona, the University of North Carolina, and other centers have found that a decrease in estrogen in the brain’s hypothalamus causes some neurons to grow in excitable sections of this brain region involved in temperature regulation. This important discovery is expected to lead to new targeted non-hormonal therapies.
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What Really Triggers Menopause?
it all starts with perimenopause,
A girl is born with all the eggs inside her ovaries that she will need in her lifetime. Surrounding these eggs are granulosa cells that produce hormones, especially estrogen. In middle age, as eggs become less and less viable, estrogen production declines.
This, combined with a consistently low release of eggs, results in irregular menstrual cycles. When there is a delay of one week or more in several cycles to several months, the woman is said to have entered perimenopause.
This phase typically begins in the mid-forties, although it can begin a decade earlier or even later, and can last anywhere from two to eight years. Late perimenopause occurs when some cycles are at least 60 days late. Santoro says it’s the change in hormone levels, not the decline outright, that causes the symptoms associated with menopause.
Fertility declines during this time, although ovulation (and pregnancy) is still possible, according to the North American Menopause Society, which is why the group recommends continued use of birth control.
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What is menopause?
Although many women label the entire process as menopause, the term technically refers to the time when estrogen levels drop so low that ovulation and menstruation cease permanently.
Some doctors measure the level of a hormone, follicle-stimulating hormone (FSH), which determines whether a woman is in menopause, to determine when ovulation decreases. But because levels fluctuate, it’s not an accurate marker, says Jackie Thielen, MD, director of the Mayo Clinic Women’s Health Specialty Clinic.
In the US, the average age at which women reach menopause is 52, although between 40 and 60 is considered normal. From then on, and for the rest of her life, women you are in the postmenopausal phase.
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Can menopause be brought forward?
Some women go through menopause naturally before the age of 40, which is considered “premature”.
Others who undergo medical treatments that remove or severely damage both ovaries, such as cancer surgery, chemotherapy, and radiation therapy, go into menopause right away. Because of the sudden hormonal changes, symptoms of induced menopause are often more severe, according to NAMS.
What are the common symptoms of menopause?
get hot: Up to 80 percent of women experience these vasomotor symptoms (VMS), characterized by a sudden, intense sensation of warmth in the upper body, while the skin flushes from the dilation of blood vessels.
Hot flashes typically last one to five minutes and can occur several times a day, according to NAMS. Those that occur at night and are accompanied by excessive sweating are called night sweats. Hot flashes may end when a woman reaches menopause, but they may also persist for a decade or more.
Some women hardly have any trouble with hot flashes, while others find them debilitating. “These symptoms are not trivial. They affect many women’s lives, their relationships, and their ability to function at work,” says Stephanie Faubion, MD, director of the Mayo Clinic Center for Women’s Health and medical director of NAMS.
trouble sleepingAccording to the U.S. Department of Health and Human Services’ Office on Women’s Health, changes in levels of the reproductive hormone progesterone can disrupt the ability to fall asleep and stay asleep. Night sweats also make it difficult to sleep.
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humor turns: Research has shown that the rate of depression in women during perimenopause or menopause is almost double that of women who have not yet gone through it.
It is not clear whether this is due directly to hormones or sadness over the loss of fertility or to other problems. According to researchers, women who can’t sleep because of hot flashes and sweats are also more likely to be depressed.
Others who are not depressed may feel irritable or have unexplained crying spells. People who have experienced similar mood swings before their menstrual cycle, or after giving birth, are particularly prone.
vaginal changesPain and discomfort during intercourse is due to thinning of the tissue as estrogen decreases. With corresponding dryness in the bladder and urethra, this is known as the genitourinary syndrome of menopause (GSM). Most menopause symptoms resolve with time, but GSM brings about permanent physical changes, notes Santoro.
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When do symptoms appear?
According to the SWAN study, most symptoms appear or intensify in the late stages of perimenopause. But according to the results of an online survey published in 2021, they may appear soon, even before the change in the same period. Faubion, who was not involved in the research.
What are effective treatments for the effects of menopause?
Basic lifestyle changes help many women cope. Hot flashes are best tolerated by dressing in layers and taking deep, slow breaths and drinking cool water as soon as they begin. Since increased body fat is associated with worsening hot flashes, people who are overweight or obese may benefit from losing weight. Smoking is also related to the intensity of hot flashes.
Improving sleep requires following a regular schedule, avoiding late afternoon naps, and avoiding caffeine and alcohol late in the day.
Several mind-body methods have been shown to be effective, including hypnotherapy, which reduces severe hot flashes, and cognitive-behavioral therapy (CBT), which reduces their frequency.
According to NAMS, several studies have shown that herbs and other remedies promoted to relieve menopause “are not likely to provide relief from hot flashes”.
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Symptoms that seriously affect a woman’s life require medical treatment, especially the hormones estrogen and progesterone. Women who are still perimenopausal are prescribed birth control, because they need higher levels of these hormones to prevent pregnancy. Women who are past menopause are prescribed menopausal hormone therapy (MHT), usually in the form of patches or pills, says NAMS’s Faubion.
Risks of Treatment for the Effects of Menopause
Faubion says many doctors are afraid to prescribe menopausal hormone therapy because of the widely reported 2002 results of the Women’s Health Initiative, which found an increased risk of heart disease, breast cancer and stroke in women taking estrogen and progesterone. has increased. But that study wasn’t designed to determine whether young women in the midst of symptoms benefited from treatment, and included only a small percentage of them, he says. They say that a subsequent re-evaluation of the WHI results has disproved their conclusion that MHT is unsafe for this group.
“If a woman is younger than 60 and less than 10 years past menopause, the benefits of hormone therapy outweigh the risks,” says Faubion. This may not be the case for women with a history of breast cancer, uterine cancer, liver disease, heart disease, stroke, blood clots, or smoking, who should discuss this directly with their doctor.
Other drugs prescribed for menopause are clonidine (a drug used to treat high blood pressure) and gabapentin. With the discovery of brain neurons as a cause of hot flashes, the US Food and Drug Administration (FDA) is currently reviewing a specific non-hormonal treatment, phaseolingent. In early research, the drug reduced weekly hot flashes by 45%.
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Mayo’s Thielen says GSM symptoms can be treated with a vaginal moisturizer or vaginally administered estrogen, which appears to be safer than systemic hormones. Pelvic floor physical therapy and vaginal laser treatment are also worthwhile, according to MyMenoPlan, a website aimed at personalizing treatment advice that was developed by a network of menopause researchers and funded by the National Institutes of Health.
In Spain, the Ministry of Health has a guide to solve all kinds of doubts related to menopause and the approach to vasomotor and vaginal symptoms.
Since menopause symptoms can last for years, effective coping also involves accepting a new normal, Thielen says. “The process of losing estrogen and learning to live with erratic and then low levels is what the experience of menopause is all about.”
