What is Menopause?

A natural process

Menopause in women is a natural process that is defined as the absence of menstrual bleeding for 12 months1. Perimenopause (the period before menopause) and post-menopause (the period after menopause) are characterized by significant changes in the hormonal balance in women’s bodies, particularly by the decrease in estrogen and progesterone levels2. Estrogen helps regulate the functioning of many organs and systems, including the brain, sexual organs, bones, muscles, blood vessels, and skin3. The declining estrogen levels in women have a profound impact on their bodies and often comes with significant symptoms, such as hot flushes or joint pain, which may last for up to 12 years.2 (Menopausal symptoms: individual women, individual experiences, but you are not alone).

Progesterone is a hormone that is responsible for preparing the uterus for pregnancy, and it is produced in the second half of the menstrual cycle after ovulation4. Menopause is also marked by the end of the fertility age, which may cause psychological impact for women and their families.

While menopause is both natural and inevitable, it is important to learn its mechanisms and potential consequences, as well as how to deal with this special moment in women’s life to maintain a good quality of life. Speaking with doctors, family members, is an important step in managing menopause.


Consequences of menopause on the health of women

Beyond its actual symptoms (Menopausal symptoms: individual women, individual experiences, but you are not alone), menopause can lead to dangerous health outcomes for women. The resulting imbalance in the body’s sex hormones prevents the ovaries from generating estrogen and releasing an egg each month.

Unaddressed menopause can lead to numerous consequences. Here are just a few of them:

  • Osteoporosis: Postmenopausal women are susceptible to primary osteoporosis since osteoporosis is closely related to estrogen deficiency. During the menopausal transition period, the drop in estrogen leads to more bone resorption than formation, which might result in osteoporosis5. The prevalence of osteoporosis in postmenopausal women may reach 10%, in other words up to 1 postmenopausal woman in 10 may suffer from this disease 14. Osteoporosis leads to higher fragility in bones, hence to higher risk of fracture. It affects mostly wrist, hip and spine15.
  • Cardiovascular disease: In postmenopausal women, blood pressure starts to increase. LDL cholesterol, or “bad” cholesterol, tends to increase, while HDL, or “good” cholesterol, declines or remains the same. Triglycerides, certain types of fats in the blood, also increase. All these factors can lead to heart events6.
  • Alzheimer’s disease: Estrogen is responsible for brain functioning in women; thus, decreased estrogen might alter brain functioning. Women suffer more often from Alzheimer’s disease (about 2/3 of Alzheimer patients are women7), and some researchers link the increased risk to unaddressed menopause8.
  • Cognitive and psychological problems, such as depression or anxiety (Psychological consequences of menopause).
  • Skin changes: Estrogen is important for keeping the skin healthy. As estrogen levels decrease with menopause, many skin changes occur, including dryness, atrophy, fine wrinkling, and poor wound healing9. Low estrogen is synonymous with skin aging.
  • Sexual health: Although vagina dryness and pain during the intercourse may arise at all ages, it is by far more frequent in women undergoing menopause13. As the estrogen levels decline in the women body, the tissues at the level of vagina become drier, leading to dryness and painful intercourse13.


Given all its potential consequences, it is important to discuss menopause and establish a care plan with a doctor. Solutions that will help you go through this period exist and may improve your quality of life.


Early menopause

Menopause typically occurs around 50 years old, with the usual age range being 45–5510 years old. In about 1% of cases, menopause can occur before 40 years old, which is called early menopause11. Early menopause women may suffer from neurological diseases, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease, and infertility11. The reasons for early menopause are not always clear, but autoimmune diseases, mumps infection, smoking, radiation and chemotherapy, surgery on ovaries, or prolonged Gonadotropin Releasing Hormone GnRH therapy are sometimes considered potential causes11.

 

In the case of early menopause, a doctor should be urgently consulted to establish the cause and devise a care plan to treat it. Women undergoing early menopause are at greater risk for cardiovascular diseases and bone fragility11.
If experiencing regular menopause symptoms (Menopausal symptoms: individual women, individual experiences, but you are not alone), please contact a healthcare professional and ask for help. 


References
1. Harlow SD, Paramsothy P. Menstruation and the menopausal transition. Obstet Gynecol Clin North Am. 2011;38(3):595-607
2. U.S. Department of Health & Human Services, Menopause, https://www.womenshealth.gov/menopause/menopause-basics#1. Published 2019. Accessed 18 October 2020
3. Sacks D., Freeborn D., Cunningham L., Low Estrogen Levels in Menopause, University of Rochester Medical School, https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00559. Accessed 18 October 2020
4. Haldeman-Englert C., Foley M., Turley R., Progesterone, University of Rochester Medical School, https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=progesterone. Accessed 18 October 2020
5. Ji MX, Yu Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015;1(1):9-13.
6. American Heart Association, Menopause and Heart Disease,  https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/menopause-and-heart-disease. Accessed 18 October 2020
7. Carrillo M., Alzheimer’s Association, Why Does Alzheimer’s Disease Affect More Women Than Men? New Alzheimer’s Association Grant Will Help Researchers Explore That Question, https://www.alz.org/blog/alz/february_2016/why_does_alzheimer_s_disease_affect_more_women_tha, Published 2016. Accessed 18 October 2020
8. Ratnakumar A, Zimmerman S, Jordan B, Mar J. Estrogen activates Alzheimer’s disease genes. Alzheimers Dement (N Y). 2019;5:906-917.
9. Rzepecki AK, Murase JE, Juran R, Fabi SG, McLellan BN. Estrogen-deficient skin: The role of topical therapy. Int J Womens Dermatol. 2019;5(2):85-90.
10. Johnson A, Roberts L, Elkins G. Complementary and alternative medicine for menopause. J Evid Based Integr Med. 2019;24.
11. Okeke T, Anyaehie U, Ezenyeaku C. Premature menopause. Ann Med Health Sci Res. 2013;3(1):90-95.
12. NHS. Menopause – Symptoms. https://www.nhs.uk/conditions/menopause/symptoms/#:~:text=Symptoms%20usually%20start%20a%20few,for%20up%20to%2012%20years. Accessed 18 October 2020
13. Harvard Health Publishing, Don’t ignore vaginal dryness and pain, https://www.health.harvard.edu/womens-health/dont-ignore-vaginal-dryness-and-pain, Published 2019. Accessed 18 October 2020
14. Tian L, Yang R, Wei L, et al. Prevalence of osteoporosis and related lifestyle and metabolic factors of postmenopausal women and elderly men: A cross-sectional study in Gansu province, Northwestern of China. Medicine (Baltimore). 2017;96(43):e8294.
15. NHS, Overview-Osteoporosis, https://www.nhs.uk/conditions/osteoporosis/, Published 2019. Accessed 18 October 2020

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