Menopause: the basics
Menopause marks the end of a woman’s menstrual cycles, and commonly occurs between the ages of 45 and 55, but there are factors that can speed up the process such as smoking, living at high altitudes, and malnutrition.
Contrary to popular belief, menopause does not occur over night. Perimenopause is the transition period in which women experience a gradual loss of ovarian function, resulting in a decreased production of estrogens and progesterone, along with a series of body changes. The official diagnosis of menopause only comes after a woman has spent a year without menstruating and does not usually require additional medical tests for confirmation.
During the years before reaching menopause, the female reproductive system has already started the aging process, and the changes that occur before and after menopause are described in different stages:
- Reproductive stage: from the time of a woman’s first menstrual period to the early menopausal transition.
- Early menopausal transition: The duration of this phase is variable, lasting 3- 5 years. During this period, menstruation takes place, but the length of cycles is irregular, with at least 7 days difference from one cycle to the next.
- Late menopausal transition: The duration of this phase is 1-3 years, during which women have intervals of no menstruation (amenorrhea) that last 60 days or more. During this stage, the classic vasomotor symptoms of menopause begin to appear, hot flashes and/or night sweats.
- Early post-menopausal: It usually lasts around 2 years, starting after the last menstrual cycle. This is the stage at which a woman is most likely to have vasomotor symptoms.
- Late post-menopausal: Finally, this stage lasts the rest of the woman´s life. Over time, the symptoms of genitourinary syndrome of menopause tend to increase. These symptoms will be explained in detail later on.
Menopause is not classified as a disease, as it is a physiological process that occurs in women. However, because it can produce symptoms that can affect a woman’s quality of life, it is sometimes considered a medical condition that may benefit from medical treatment.
Hormone levels during menopause
As the ovaries age, the response to hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) decreases. The function of these two hormones is to promote ovulation and to stimulate production of estrogen. Because of this altered response, the levels of progesterone and estrogen fluctuate before dropping and stabilizing, resulting in shorter and less regular menstrual cycles, and fewer ovulations.
The main hormonal changes that are seen during menopause are:
- Decrease in the progesterone levels during menopause.
- The ovaries produce less estrogen, levels fluctuate until it finally decreases and becomes stable.
- Low levels of estrogen result in the increase of LH and FSH levels.
- Androgens also decrease.
Body changes before and after menopause
Is accompanied by various symptoms, which are more likely to occur as perimenopausal symptoms, or after menopause.
Perimenopause is part of the menopausal transition and includes several years before the last menstrual period up to the last menstruation itself. During this phase, women may experience mild to severe symptoms that include:
- Irregular menstrual periods: This is usually the first symptom of perimenopause. Menstrual periods usually increase in frequency at first, but eventually become more spaced out over time, and may even disappear for a few months at a time. These changes are very common but not the norm, some women experience regular menstrual periods until menopause.
- Hot flashes/night sweats: It is one of the most common symptoms and affects about 80% of women. These usually begin before the last menstrual period and can occur for 7 years, although some women experience them for more than 10 years. In most cases, they tend to soften and become milder over time. It is described as a feeling of sudden warmth or heat, which can be accompanied by sweating (sometimes profuse sweating), where the face, head and neck may become red and warm. These episodes usually last between 30 seconds and five minutes each. When these occur during your sleep, they may manifest as night sweats. The cause is not known, although it is suspected that it may be due to an imbalance in the hypothalamus, which regulates body temperature.
- Breast tenderness
- Mood swings
- Severe migraine headaches.
- Other symptoms can include depression, irritability, anxiety, sleep disorders, fatigue, etc.
Symptoms after menopause
Symptoms described above usually tend to become milder after menopause, nevertheless, the drop in estrogen levels may continue to have other effects on a woman’s health and quality of life:
- Reproductive system: Vaginal atrophy occurs, where the skin lining of the vagina becomes thinner, drier, and less elastic, which may result in painful sexual intercourse. Also, the libido, sexual desire, can decrease with age.
- Urinary system: The lining of the urethra thins, and the urethra shortens, which is why urinary tract infections are more frequent in older women. Some experience urinary urgency, which is the sudden need to urinate, which may also be accompanied by urinary incontinence.
- Skin: Both aging and decreased estrogen levels contribute to the decline in collagen and elastin formation in the skin, these proteins give the skin strength and elasticity, respectively. This is why it is common to feel thinner and drier skin as one ages.
- Bone: Bone density is also affected by the drop in estrogen levels, causing it to decrease. Because of this, women after menopause are more likely to suffer from osteoporosis, and, as bones become less dense and weaker, the probability of fractures are higher.
- Cholesterol: After menopause, “bad cholesterol” (LDL) concentration increases, and “good cholesterol” (HDL) remains the same as before menopause. This condition may explain why women at this age are more likely to suffer from cardiovascular problems, such as atherosclerosis, the build-up of fat in the arteries.
Menopause research and common treatments
While menopause is not a disease, understanding how it occurs and affects women’s bodies is key to coping with the symptoms. Research on menopause and hormonal changes has paved the way for different treatments that aim to alleviate symptoms and make the process more manageable to improve a woman’s quality of life. Some of the most common therapies are:
- Cognitive-behavioral therapy: It is generally used in the transition to menopause and post-menopause to help control hot flashes and night sweats.
- Hormone Replacement Therapy (HTR): Estrogens and/or progesterone are used to alleviate symptoms such as, hot flashes, night sweats, vaginal dryness, and prevent bone loss, improving life quality but can cause side effects like mood changes or fluid retention.
- Non-Hormonal medications: Some drugs, like antidepressants may help reduce hot flashes, anxiety, and irritability. Also, antiepileptics can contribute to improving symptoms and sometimes, sleeping pills are recommended to treat insomnia.
- Vaginal therapy: Creams, rings, or vaginal tablets with estrogen to address vaginal dryness and discomfort during intercourse.
- Osteoporosis therapy: To prevent bone loss associated with menopause.
- Lifestyle changes: A healthy diet, regular exercise, and stress management techniques can help reduce the symptoms of menopause.
Clinical studies and continued research in menopause are essential to improve treatment options and safety, especially concerning hormone replacement therapy (to further understand how it affects women’s overall health, the risks and how to minimize them). Additionally, research can also offer effective and safe alternatives for the many women who seek non-hormonal options.
Another key research topic is the relationship between menopause and bone health, as it is important for developing effective strategies to prevent and treat osteoporosis and bone loss. Gradually, more personalized approaches are being studied which help to address individual needs, considering lifestyle and overall health factors.
While there are still unanswered questions, menopause research continues to advance our knowledge and understanding of the physiological processes involved in women’s life cycles and improve treatment options to promote health and well-being.