Menopause occurs when a woman has stopped menstruating for the last 12 consecutive months and is therefore unable to become pregnant naturally. It usually begins between the ages of 45 and 55, although it may appear before or after this age range. This disorder can cause uncomfortable discomfort such as hot flashes and weight gain. In most women it is not necessary to implement any type of treatment for this disorder.
Onset and duration of menopause
Many women begin to show symptoms of menopause four years before their last menstrual period. These symptoms often persist up to four years after the last menstrual cycle. On the other hand, a small percentage of women experience discomfort up to 10 years before menopause occurs, while one in 10 women experience discomfort up to 12 years after the last menstrual period.
The average age for the onset of menopause is considered to be 51 years old; however, it may occur earlier in Latina or African-American women. About 1% of women begin to have menopausal symptoms before the age of 40.
During the climacteric (a transitional period that begins years before menopause), menstrual cycles become irregular. The menstrual cycle may be delayed one or two periods or not occur at all. Menstrual flow may be heavy or completely absent.
Climacteric or perimenopause and menopause are caused by the physiological hypoestrogenism (low hormone level) of women due to the aging of their ovaries. From the anatomical point of view, there is a decrease of follicles in the ovaries. The decrease in the quality and quantity of follicles results in a gradual reduction of estradiol (estrogen) levels, which in turn causes climacteric symptoms. When menopause is definitively established, ovarian activity ceases completely and the woman has a deficiency of all sex hormones and an increase in FSH hormone.
On some occasions menopause can be induced and its most frequent causes are:
1. Surgical removal of the ovaries.
2. Ovarian ablation or stopping the function of the ovaries by hormone therapy, surgery or radiotherapy in women with estrogen receptor-positive tumors.
3. Pelvic injuries that severely damage the ovaries.
Symptoms of menopause may be unique to each woman. Discomfort is usually more severe when menopause occurs suddenly or over a shorter period of time. In addition to menstrual changes, which are characterized by less frequent menstrual cycles and variation in the amount of blood eliminated, there are also vasomotor symptoms including hot flashes and night sweats. Hot flashes may occur in up to 75% of women.
Other symptoms include
Insomnia, vaginal dryness, weight gain, depression, anxiety, difficulty concentrating, memory problems, decreased sexual desire, dry skin, eyes and mouth, sore and very sensitive breasts, urinary urgency, headache, increased heart rate, joint pain, decreased muscle and bone mass, thinning or loss of hair and increased hair in other areas of the body such as the face, neck, chest and upper back.
The diagnosis of this physiological condition is based on a thorough clinical history and an adequate physical examination by the physician. The woman must understand that menopause is the last menstruation she will have in her life, and it is diagnosed retrospectively once 12 consecutive months have passed since the cessation of menstrual bleeding, after having ruled out any other physiological or pathological cause.
After menopause, follicle stimulating hormone (FSH) levels remain high (≥ 40 mU/ml). Thus, FSH levels of 30 mU/ml or more, together with the absence of menses for one consecutive year, are usually confirmation of menopause.
Laboratory studies that are ordered to help confirm the diagnosis of menopause include:
1. Thyroid function tests.
2. Lipid profile (cholesterol, triglycerides, among others).
3. Liver function tests.
4. Renal function tests.
5. Hormone tests such as testosterone, progesterone, prolactin, estradiol and chorionic gonadotropin (hCG).
Complications of menopause
The most frequent complications of menopause may be:
1. Vulvovaginal atrophy.
2. Dyspareunia or painful intercourse.
3. Decreased metabolism.
5. Mood changes.
6. Periodontal disease.
7. Urinary incontinence.
8. Cardiovascular disease
A woman with severe menopausal symptoms that affect her quality of life is likely to require treatment. Hormone therapy can be an effective treatment in women under 60 years of age, or within 10 years of the onset of menopause, to decrease hot flashes, night sweats, flushing, vaginal atrophy and osteoporosis.
In general, treatments for climacteric and menopausal symptomatology may include: hormone replacement therapy, vaginal lubricants, antidepressant medications, or anxiolytic medications. Specific recommendations for hormone therapy are for those women who have recently entered menopause. If the patient has a uterus, estrogens and progesterone (progesterone prevents endometrial cancer) will be prescribed orally. If she does not have a uterus, she will only need estrogens.
Contraindications to hormone therapy
Contraindications to hormone replacement therapy include:
-Pregnancy or suspected pregnancy.
-Vaginal bleeding of unknown cause.
-Severe or chronic liver disease.
-Familial hypertriglyceridemia (increased levels of cholesterol, triglycerides, etc).
-Previous cardiovascular disease.
Duration of hormone treatment
The hormone treatment will be maintained for four years, after which it will be gradually discontinued. If the discomfort reappears, it can be used for another year. Vaginal creams are useful for women with vaginal dryness, itching and burning, as well as for pain and urinary urgency. Patients who cannot receive hormonal treatment may be prescribed an antidepressant or an anxiolytic to reduce the symptoms of the climacteric period. Among the most commonly used are diazepam, alprazolam, paroxetine and fluoxetine.
Pregnancy and climacteric
There is a possibility that a patient may become pregnant during the climacteric period, so it is advisable to use some form of contraception. If the woman is 50 years of age or older, she should use some method of contraception for one year after the last menstrual period. On the contrary, if she is younger than 50 years old, she will have to use a contraceptive method for two years after the last menstrual bleeding.