Menopause: a brief yet complete journey from the beginning to the full handling

Background

Menopause is defined as the time when a woman has not had a period for 12 consecutive months and is not pregnant or ill. This marks the end of menstrual cycles and fertility. The average age of natural menopause is about 51 years, but it can vary between 45 and 55 years. Menopause is a natural stage in every woman’s life, characterized by the cessation of menstruation and the end of reproductive capacity. Although menopause is a physiological process, it can be accompanied by a number of symptoms that vary in intensity and duration from woman to woman. These symptoms can significantly affect the quality of life and may require therapeutic interventions. This article explores in detail the signs and symptoms of menopause, the underlying causes, and the treatment options available to manage the symptoms and improve the well-being of women at this stage of life.

Stages of menopause

Menopause is preceded and followed by two important stages:

• Perimenopause: It is the transition phase that precedes menopause. During this period, which can last from a few months to several years, the ovaries begin to produce less estrogen and progesterone. This causes irregular menstrual cycles and the onset of the first menopausal symptoms.
• Postmenopause: This is the period that begins after menopause. The symptoms of menopause may persist for a few years after the cessation of menstruation, but tend to decrease over time.

Signs and Symptoms of Menopause

Vasomotor Symptoms

Vasomotor symptoms, such as hot flashes and night sweats, are among the most common symptoms of menopause. These symptoms are caused by changes in the body’s temperature regulation system, probably related to the reduction in estrogen.

• Hot Flashes: hot flashes are characterized by a sudden sensation of heat that spreads mainly over the upper body, often accompanied by flushing of the skin and sweating. They can last from a few seconds to several minutes and vary in frequency from a few times a day to several times an hour.
• Night Sweats: similar to hot flashes, but they occur during sleep, disrupting sleep and contributing to insomnia.

Genitourinary Symptoms

The decrease in estrogen levels during menopause can cause a variety of genitourinary symptoms, which affect the reproductive and urinary systems.

• Vaginal Dryness: decreased estrogen leads to thinning and reduced elasticity of the vaginal tissues, causing dryness, itching, and pain during sexual intercourse.
• Vulvovaginal Atrophy: also known as genitourinary syndrome of menopause, this condition includes symptoms such as vaginal dryness, irritation, and decreased lubrication.
• Urinary Dysfunction: women may experience symptoms such as urinary urgency, incontinence, and increased frequency of urinary tract infections, due to the loss of elasticity and muscle tone in the pelvic floor.

Psychological and cognitive symptoms

Menopause can have a significant impact on mental and cognitive health.

• Depressed Mood: hormonal fluctuations can contribute to an increased risk of depression and anxiety during perimenopause and postmenopause.
• Irritability and Anxiety: many women report feelings of irritability, nervousness, and sudden mood changes.
• Brain Fog: some women report difficulty concentrating, memory problems, and a general feeling of mental confusion.

Physical symptoms

In addition to vasomotor and genitourinary symptoms, menopause can be associated with various physical symptoms.

• Weight Gain: many women experience weight gain, especially in the abdominal area, during and after menopause. This is related to metabolic changes and the reduction in estrogen.
• Joint and Muscle Pain: joint and muscle pain are common and may be related to aging and the decrease in estrogen, which has a protective role on bone and muscle mass.
• Bone Loss: menopause is associated with an increased risk of osteoporosis due to the reduction in estrogen, which is essential for maintaining bone density.

Diagnosis of menopause

Clinical Diagnosis

The diagnosis of menopause is primarily clinical and is based on the symptoms reported by the patient, such as hot flashes, vaginal dryness and menstrual irregularities. Menopause is definitively diagnosed when a woman has not had menstruation for 12 consecutive months.

Laboratory Tests

In some cases, doctors may order laboratory tests to confirm menopause, especially if the symptoms are atypical or if the patient is young. These tests include:

• Follicle Stimulating Hormone (FSH) Levels: Increased FSH levels are indicative of menopause, as the body tries to stimulate the ovaries to produce estrogen.
• Estradiol Levels: decreased levels of estradiol, a type of estrogen, are common during menopause.

Differential Diagnosis

It is important to rule out other conditions that can cause symptoms similar to menopause, such as thyroid disorders, depression, or other chronic diseases.

Treatments for menopause symptoms

Hormone Replacement Therapy (HRT)

Hormone replacement therapy is one of the most effective treatments for relieving the symptoms of menopause. HRT may include estrogen, with or without progestin, and can be given in different forms, such as tablets, patches, gels, or vaginal creams.

• Benefits: HRT is particularly effective at reducing vasomotor symptoms and improving quality of life. It may also prevent bone loss and reduce the risk of osteoporosis.
• Risks: HRT is associated with an increased risk of venous thromboembolism, stroke, and, in some cases, breast cancer. Therefore, it is important for women to discuss the benefits and risks with their doctor to determine if HRT is right for them.

Non-Hormonal Therapies

For women who cannot or do not want to take hormones, there are several non-hormonal treatment options to manage menopausal symptoms.

• Serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (SNRIs): these drugs, commonly used to treat depression, can be effective at reducing hot flashes and improving mood.
• Gabapentin: primarily used to treat epilepsy, gabapentin may reduce hot flashes in menopausal women.

• Herbal Medicine: Some herbal remedies, such as red clover, soy and black cohosh, have been used to relieve symptoms of menopause, although evidence of their effectiveness is limited.

Lifestyle and Behavioral Measures

Certain lifestyle changes can significantly help manage menopausal symptoms.

• Diet and Exercise: maintaining a balanced diet and regular exercise can help control weight, improve mood, and maintain bone health.
• Stress management: relaxation techniques, such as meditation, yoga, and deep breathing, can reduce symptoms of anxiety and improve sleep quality.
• Avoiding hot flash triggers: Identifying and avoiding hot flash triggers, such as hot drinks, spicy foods and stress, can help reduce the frequency and severity of hot flashes.

Osteoporosis treatments

Prevention and treatment of osteoporosis are especially important for postmenopausal women, who are at increased risk of bone fractures. Calcium and vitamin D supplementation can help prevent bone loss. Also foods rich in phosphorus (soy lecithin, eggs, nuts, ecc.) and other oligoelements (es. selenium, magnesiu, copper and the others) may help calcium to get best fixed in the bones.

• Bisphosphonates: drugs such as alendronate, zoledronate and risedronate can be used to prevent and treat osteoporosis.
• Denosumab therapy: A monoclonal antibody that reduces bone resorption and can be used in women with postmenopausal osteoporosis. A practioner or a specialist may hepl the patient to be selected for this therapy.

Psychological Implications and Support

Psychological Impact of Menopause

Menopause can have a significant impact on a woman’s mental health and self-esteem. Physical and hormonal changes can affect how a woman perceives herself, leading to feelings of loss or inadequacy. It is essential to recognize and treat the psychological symptoms of menopause with the same importance given to the physical symptoms. Finally, psychological counseling or cognitive behavioral therapy (CBT) may be helpful for women who experience significant psychological symptoms during menopause. Social support and participation in support groups can also provide a sense of community and help normalize the menopause experience.

• Edited by Dr. Gianfrancesco Cormaci, PhD, specialista in Clinical Biochemistry.

Scientific references

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