Menopause, what it means, when it starts and what it entails
The average age of the population has increased considerably in recent decades: about 30% of women are over 50 years old and many efforts must be made to ensure good health conditions in peri- and post-menopause.
Two hundred years ago only 30% of women lived to menopause. Today, however, more than 90% of women reach this important stage in their lives.
Indeed, given that the average life expectancy for a woman is approximately 82 years, this means that she lives more than a third of her life in menopause .
What is menopause
The term menopause derives from the Greek menos (month) and pausis (cessation) and is literally defined as the last menstrual flow.
In reality, the question is broader and more complex and a woman can be defined as menopausal only after an amenorrhea (absence of menstrual cycle) of at least one year.
The series of changes that leads to the last menstrual flow is referred to as perimenopause , which includes the phase that begins with the first hormonal changes and menstrual cycles and ends 12 months after the last menstrual period.
Symptoms of perimenopause
The perimenppause for years has been referred to as climacteric, from the Greek klimax (scale).
Perimenopus is linked to short, medium and long-term discomfort.
Short-term symptoms:
- reduced fertility
- menstrual irregularity
- vasomotor symptoms
Medium-term symptoms:
- manifestations affecting the skin and the urogenital system
Long term names:
- skeletal pathologies
- diseases of the cardiovascular system
Fertility in perimenopause and postmenopause
A woman is born with a defined number of oocytes which gradually decreases throughout her life. By her 40s she has only a few thousand left and few, if any, post-menopausal. Postmenopause is the phase that includes early postmenopause (the first 5 years after menopause) and late postmenopause (the years after the first 5).
The cessation of menstruation is determined precisely by the depletion of the oocytes. This process consists of two main moments:
- an initial decline in fertility without menstrual cycle abnormalities
- a subsequent period in which the follicular phase shortens and alterations also appear in the luteal phase
The main hormonal markers that indicate the approach of menopause are the values of the hormone FSH and del’Inhibin B.
FSH levels >= 30 MIU/ml are considered a diagnosis of menopause but may not be correct as these values may vary if ovarian activity resumes as occurs in perimenopause.
Three hormones are currently being evaluated at the same time: FSH, inhibin B and the anti-Müllerian hormone (AMH) . Further information can also be obtained from the ovarian volume.
Menstrual cycles in perimenopause
As menopause approaches, menstrual cycles become increasingly irregular. If 3 or more periods are missed in a 12-month period, it is probable that the transition to menopause will be completed in 4 years.
Hormonal imbalances associated with perimenopause (absence of progesterone production associated with continued estrogen production) can cause endometrial hyperplasia. Menstruation becomes abundant, prolonged, unpredictable.
Consequences of menopause
They are divided into immediate, intermediate and long-term.
The immediate consequences:
- hot flashes and sweats: 70% of women suffer from it (but only 10-20% of Chinese and Japanese women, perhaps due to different eating habits: greater consumption of soy isoflavones?)
- insomnia
- anxiety
- irritability
- memory loss
- tiredness
- poor ability to concentrate
Women who have experienced postpartum depression or premenstrual syndrome appear to be more prone to depression during perimenopause.
The reduction in sexual desire is quite frequent and is linked not only to hormonal changes but also to the decrease in vaginal lubrication.
The intermediate consequences:
The low value of estrogen in menopause leads to a loss of collagen with all the consequences related to it.
The long-term consequences
They are dependent on the skeletal, cardiovascular and central nervous systems.
One of the main problems is represented by osteoporosis : a disorder of bone composition that leads to a reduction in bone strength and an increased risk of fracture.
After menopause, the risk of developing diseases of the cardiovascular system also increases. 50% of women will develop heart problems and only 4% will develop breast cancer (although the opposite is often perceived by public opinion).
Estrogens also affect the vasculature of the central nervous system.
How to cope with menopause?
To date, the most effective treatment for treating symptoms related to menopause is hormone replacement therapy.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.