Menopause is the end of a woman’s reproductive period, usually around the age of 50. It is marked by the end of menstruation as well as by the cessation of ovulation and the secretion by the ovaries of sex hormones (estrogen and progesterone).
Medically speaking, a woman is known to be menopausal when she has not had a period for 12 consecutive months. However, the onset of menopause, that is, the permanent cessation of periods, is at the start of these 12 months. It can therefore only be established retrospectively.
The 2 to 7 year period before menopause is called perimenopause. Ovulation becomes more irregular. Estrogen levels can vary dramatically. It is during these transitional years that menstrual irregularities and bothersome symptoms appear: hot flashes, sleep disturbances, mood swings, etc.
Premenopause: Period of fertility, from puberty
Perimenopause: Irregular periods: 2 to 7 years
Menopause: No menstruation for at least 1 year
Some people use the term postmenopause to describe the period of time after menopause, which is not entirely appropriate since menopause is a definitive state. A woman will be said to be “menopausal”.
Symptoms vary in intensity from woman to woman: some have no symptoms other than the cessation of menstruation, while others have moderate to severe symptoms (20-30% women).
After menopause, although the ovaries no longer secrete estrogen, the adrenal glands and adipose tissue (fat stores) continue to release small amounts of it.
Every woman begins her life with a set amount of oocytes, the female sex cells. However, menopause does not start when all the oocytes have been used. A woman has about 30,000 oocytes. Only 500 of them will go through the ovulation cycle. The age of menopause is mostly determined by genes. It can also be influenced by the state of health.
When menopause occurs before the age of 40, it is considered premature. Premature menopause can occur spontaneously or be caused by illness, medication, surgery, or radiation or chemotherapy treatment.
For example, the surgical removal of both ovaries causes menopause. On the other hand, removing the uterus (hysterectomy) alone is not enough to cause menopause (because the ovaries continue to produce estrogen). Cancer treatments, such as chemotherapy or radiotherapy, can lead to a more gradual cessation of periods. The effect of these treatments on the menstrual cycle depends on their potency. Periods can return when treatment is stopped.
Symptoms of Menopause
Symptoms are usually more pronounced during perimenopause. These symptoms are related to hormonal changes that occur during this transition period, but also to aging. They come on unpredictably and vary a lot from month to month.
- Irregular menstruation. They are a common manifestation of the hormonal instability that occurs during perimenopause.
- Hot flashes and night sweats. Hot flashes are usually felt first in the abdomen or chest. The heat rises in a few seconds to the neck and face. Their duration varies from a few seconds to a few minutes. Their frequency and intensity vary widely from woman to woman. They are sometimes accompanied by palpitations and sweating. 50 to 80% of women feel it. Hot flashes are the number one reason women seek medical attention during menopause.
- Night sweats: These are characterized by heavy sweating throughout the body. They occur at night and can interrupt sleep. The important question is whether hot flashes and night sweats affect quality of life enough to require treatment.
- Sleep disturbances. Sleep problems are a very common complaint during this time of transition. Generally, with age, the nights become shorter and the quality of sleep tends to be poorer. Hormonal changes can also interfere with sleep. For example, difficulty falling asleep and frequent waking up during the night are usually related to hot flashes and night sweats. These sleep disturbances can cause severe fatigue, irritability, mood swings, and difficulty concentrating.
- Mood disorders. While this remains controversial, the period surrounding menopause appears to be a time of greater emotional vulnerability. Irritability, tendency to cry more often, mood swings, anxiety, and lack of motivation or energy are the most common complaints reported during this time of life. Women who suffered from depression before menopause also sometimes see their symptoms worsen.
- Decreased libido. Sexual desire is a complex human phenomenon which, on the hormonal level, depends above all on sex hormones: estrogens and androgens (testosterone and dehydroepiandrosterone or DHEA). According to the results of a large study of women going through menopause, libido and sexual arousal tend to decline over time.
- Dryness of the mucous membranes. Stopping the secretion of estrogen by the ovaries decreases the production of mucus in the vagina and bladder. This drop in production causes the mucous membranes to dry and thin out. In addition, vaginal secretions change: they become more watery and more alkaline (less acidic). More than half of menopausal women experience discomfort related to vaginal dryness. These discomforts are manifested by itching, a burning sensation in the vagina and on the vulva and pain during intercourse. This dryness of the mucous membranes does not present a health risk. There are solutions to relieve the discomfort it causes.
- Aging skin, drier hair. The skin tends to become drier, and the wrinkles, more pronounced. The hair becomes drier and more fragile. In fact, the drop in estrogen leads to a reduction in the production of collagen and elastin, 2 substances that play an important role in the elasticity of the skin as well as in its tone. However, the main causes of the appearance of wrinkles remain time (aging) and cumulative exposure to the sun. In addition, other factors can change the appearance of the skin and hair, such as a slowing of the activity of the thyroid gland (hypothyroidism). We must therefore assess the overall situation.
The intensity of symptoms depends a lot on the conditions under which menopause occurs. In North America, for example, nearly 80% of women experience symptoms upon entering menopause, mostly hot flashes. In Asia, it’s barely 20%. These differences are explained by the following 2 factors, characteristic of Asia:
- an abundant consumption of soy products (soy), a food that has a high content of phytoestrogens;
- a change of status leading to an enhancement of the role of the elder woman for her experience and her wisdom.
Genetic factors do not seem to be involved, as studies on immigrant populations have pointed out.
Menopause also occurs at a time in life that often brings other changes: the departure of children, early retirement, etc. In addition, the end of the possibility of giving birth (even if most women have given it up at this age) constitutes a psychological factor which confronts women with aging, and therefore with death. The state of mind in front of these changes influences the intensity of the symptoms.
Other factors for a severe menopause include lack of exercise, sedentary lifestyle and poor diet.
How to prevent strong effects of menopause
Menopause is the result of a natural evolution. However, studies from around the world show that differences in lifestyle, diet and physical activities can influence the intensity and type of symptoms that women experience during menopause.
In general, a woman will put all the chances on her side by adopting the following preventive measures before age 50.
- Favor foods that promote good bone and heart health: rich in calcium, vitamin D, magnesium, phosphorus, boron, silica, vitamin K and essential fatty acids (omega-3 in particular), but low in saturated fat, and providing vegetable protein instead of animal protein;
- Eat foods rich in phytoestrogens (soy, flax seeds, chickpeas, onions, etc.);
- If needed, take calcium and vitamin D supplements;
- Regularly engage in physical activity that works the heart and joints, as well as flexibility and balance exercises;
- Cultivate a positive attitude towards life;
- Remain sexually active;
- Practice Kegel exercises, both to combat stress urinary incontinence and to improve sex life by increasing the tone of the vaginal muscles;
- No smoking. In addition to harming bones and the heart, tobacco destroys estrogen.
- In addition, as explained above, women, because they are menopausal, but especially because they are advancing in age, are at greater risk of osteoporosis, cardiovascular disease, cancer of the endometrium and breast cancer. Care will therefore be taken to apply the preventive measures associated with these diseases.
How to treat the effects of menopause
A healthy lifestyle helps reduce the intensity of menopause symptoms, improves heart and bone health, and provides some protection against many health problems.
To reduce hot flashes
- Instead of having 3 main meals, reduce portions and plan healthy snacks between meals;
- Drink a lot of water ;
- Avoid or considerably reduce your consumption of stimulants: hot drinks, coffee, alcohol, spicy foods;
- Reduce your consumption of concentrated sugars;
- Consume foods rich in phytoestrogens regularly.
Any form of physical activity is better than no physical activity. For all women, and especially those entering this transition period, daily exercise provides several important benefits:
- maintain or achieve a healthy weight;
- keep the cardiovascular system in good shape;
- reduce the loss of bone density and the risk of falls;
- reduce the risk of breast cancer;
- stimulate sexual desire.
In addition, studies indicate that sedentary women are more likely to have moderate or severe hot flashes compared to women who exercise regularly.
It is recommended to be moderately active for at least 30 minutes a day and to incorporate flexibility exercises into your routine: stretching, tai chi or yoga, for example. For appropriate advice, consult a kinesiologist (the specialist in physical activity).
Deep breathing, massage, yoga, visualization, meditation, etc. can also help with sleep problems, if they occur. Relaxation may help relieve other symptoms of menopause.
To combat the various problems associated with menopause, doctors use 3 types of pharmacological approaches:
- general hormonal treatment;
- local hormonal treatment;
- non-hormonal treatments.
General hormonal therapy
Hormone therapy replaces hormones that the ovaries has stopped making. It allows the majority of women to see their symptoms (hot flashes, sleep disturbances, mood swings) decrease or even disappear for the entire duration of hormone therapy.
It is important to know that most women who start general hormone therapy will regain their symptoms when they stop treatment because the body will go through a hormonal transition again. Some women, for example, might decide to take hormone therapy for a few years and then decide to stop taking it when they retire, knowing that their symptoms will be easier to manage at this time in life.
Systemic hormone therapy usually uses a combination of estrogen and progestins. Estrogens alone are reserved for women who have had the uterus removed (hysterectomy) since, taken over a prolonged period, they increase the risk of uterine cancer. Adding a progestin reduces this risk.
These days, hormone therapy is reserved for women with severe menopausal symptoms and whose quality of life is sufficiently compromised to warrant it. The Society of Obstetricians and Gynecologists of Canada recommends that physicians prescribe the lowest effective dose for the shortest possible time. The maximum recommended duration is 5 years.
Hormonal therapy can help slow the loss of bone mass and thus reduce the risk of fractures. However, it should not be prescribed for this sole purpose.
Sometimes hormone replacement therapy has side effects that are harmless, but unpleasant. Check with your doctor.
Some women take the hormones continuously, that is, they take estrogen and progestins every day. Your period will stop. Usually, they do not resume when hormone therapy stops, if it has lasted long enough. Other women are on cyclical therapy, taking progestins only 14 days a month and estrogen daily. Cyclical hormone therapy causes “false periods” or withdrawal bleeding (unrelated to ovulation, as with the birth control pill).
Local hormonal treatment
Small doses of estrogen administered vaginally are intended to relieve symptoms associated with vaginal dryness and thinning of the mucous membranes. However, it has no therapeutic effect on hot flashes, sleep disturbances and mood disorders. Local hormone therapy does not have the side effects and risks associated with systemic hormone therapy.
Estrogens can be given into the vagina using a cream, ring, or tablets. Their effectiveness is the same. The vaginal cream and the tablets are inserted into the vagina using an applicator. The estrogen-infused vaginal ring is made of flexible plastic. It fits deep into the vagina and should be changed every 3 months. Most women tolerate it well, but some find it uncomfortable or sometimes has a tendency to move and come out of the vagina.
At the start of treatment, when the vaginal mucosa is very thin, estrogen locally applied in the vagina may diffuse into the body. However, no adverse long-term health consequences have been reported at the recommended doses.
Non-hormonal drugs can help reduce some symptoms of menopause.
Against hot flashes
- Antidepressants. Studies suggest that some antidepressants may decrease hot flashes (but the effect is less than that of hormone therapy) whether or not there is underlying depression. This option may be an attractive choice for a woman who has depressive symptoms and hot flashes, but who does not wish to take hormones.
- Antihypertensive drugs. Clonidine, a medicine used to lower blood pressure, has been shown to be slightly more effective than placebo in relieving hot flashes. This medicine is not widely used, however, as it causes several side effects, such as dry mouth, drowsiness and constipation.
Against vaginal dryness
Replens Moisturizing Gel has been shown to be an effective vaginal moisturizer in relieving itching and irritation as well as pain during sex. It is applied every 2 to 3 days.
Against mood swings
The use of antidepressants, anxiolytics and sleeping pills should not be part of the arsenal of basic menopausal care. Their prescription must meet the same criteria and the same rigor as for any other period of life.
Several non-hormonal drugs are used to increase bone density and decrease the risk of fractures.
Against sleep problems
Exercise regularly, use various means to relax (deep breathing, massage, etc.), avoid caffeine and alcohol and drink German chamomile or valerian herbal tea before bed.