Index
Togglesummary of menopause
Menopause is not a disease, but a period of a woman’s life that appears on average at 51 years of age (with very large differences between women in different countries). At the physiological level, there is cessation of secretion of ovarian hormones, including estrogens and progesterone. We speak of menopause, when the woman has not had any menstrual period for 12 consecutive months.
In some women, symptoms may occur due to these hormonal changes.
The main symptoms of menopause are the famous hot flashes, but also weight gain (often in the abdominal area), dry skin and vagina, osteoporosis or psychological problems.
Menopause treatment depends on the symptoms and is based on various therapies. On one side are conventional or chemical therapies and on the other more alternative treatments, including herbal medicines.
Conventional treatments include hormone replacement (however, for women at risk, read our contraindications article), as well as antidepressants, gabapentin, treatments against osteoporosis or local therapies such as vaginal estrogen.
On the side of natural treatments, there are medicinal plants that can have a beneficial effect especially on hot flashes, such as cimicifuga or sage. Soy is always less recommended in menopause due to the lack of proof of effectiveness and even indications of ineffectiveness.
In addition to hot flashes, a major problem with menopause is weight gain. Menopause requires weight control or even weight loss, either alone or with the help of a doctor or nutritionist, preferably. An interesting recommendation is to avoid sugar intake at night, opt for fruits, vegetables and proteins.
Participation in sports or physical exercise is highly recommended for postmenopausal women to lose weight and have better cardiovascular health (the abdominal fat seen in many postmenopausal women can pose an important cardiovascular risk). To lose or maintain weight, doctors recommend doing at least 30 minutes of exercise each day, for example, brisk walking or dancing.
Interesting study carried out on 6,000 Brazilian women in menopause
Study carried out by Hospital das Clínicas de São Paulo, in women over 40 years old, for 10 years.
Here are the interesting data and results obtained through that study:
– more than half of women were overweight or obese by menopausal age.
– two thirds of women had vasomotor symptoms with the famous hot flashes
– on average, Brazilian women (according to the study) have menopause at 48 years old
– 81.5% of menopausal women suffer from other chronic diseases such as hypertension, diabetes, tumors (cancer) or even thyroid problems.
– hot flashes, palpitations and sadness (depression), are symptoms that appear more in younger women who end up having menopause. But after several years of menopause (post-menopause, in the terminology), these symptoms naturally tend to diminish.
– weight gain during menopause increases symptoms such as hot flashes and depression, as well as joint and/or muscle pain.
Definition
Menopause is characterized by a physiological interruption of menstrual cycles, due to the interruption of hormonal secretion from the ovaries (estrogens and progesterone) and the closure of ovulation. We speak of menopause when a woman no longer menstruates for 12 consecutive months.
menopause age
Some American books (from the Mayo Clinic) report that menopausal symptoms can appear in women younger than 40 and older than 55. It is important to distinguish between menopause and symptoms (see Diagnosis for more information), as menopausal or pre-menopausal symptoms may manifest earlier (eg 12 consecutive months without menstruation).
Summarizing, we can say that menopause develops in two stages (set called perimenopause), namely:
– pre-menopause (which can last for several months or years), with possible menopausal symptoms.
– menopause (which lasts between 6 months and 1 year). The period that follows is post-menopause (with possible menopausal symptoms).
In the past, few women lived past menopause.
Epidemiology
The University of Pittsburgh, which conducted a hot flash survey in 2016 (read more in Symptoms, below), estimates that nearly 80% of women may experience hot flashes, night sweats, or both during menopause.
Causes
Menopause affects all women and is a natural hormonal process. It is a physiological interruption of menstrual cycles and is caused by the cessation of secretion of progesterone and estrogen by the ovaries. Menopause marks the end of menstruation and fertility.
The weight gain often observed at menopause, due to the drop in estrogen concentration, causes a decrease in muscle mass. We know that muscle burns calories before fat, therefore there is a decrease in muscle mass, this requires a reduction in daily caloric intake.
In menopause it is essential to eat foods with lower calorie content, changing some eating habits. It is particularly advisable to consume foods with a low glycemic index.
Causes of hot flashes
– In October 2016, a study carried out by researchers from the University of California at Los Angeles (UCLA) and published in the specialized journal Menopause, showed that hot flashes and also episodes of night sweating can come from genetic variants, 14 variations to be precise and all located on chromosome number 4. These variants affect a receptor in the brain that regulates the release of estrogen, which would cause the vasomotor symptoms of menopause (hot flashes and night sweats).
– A study published in May 2017 showed that women suffering from obesity (BMI greater than 30) suffered more from menopausal hot flashes than leaner women. A possible explanation for these more pronounced symptoms in obese women is that adipose tissue acts as a strong thermal insulator. This insulation makes heat distribution more difficult, which causes obese women to experience more hot flashes. This study was published on May 29, 2017 in the American scientific journal Menopause .
Read: 8 factors that favor hot flashes
Symptoms
Firstly, menopausal symptoms vary from one woman to another, which means that some will have marked and severe symptoms, while others will only have mild symptoms, if any.
It should also be known that surgery that removes the uterus and ovaries causes menopause with no transition phase (no pre-menopause). In this case, the symptoms are usually marked with, in particular, significant hot flashes.
We also distinguish between premenopausal (1) and menopausal (2) symptoms.
1. Possible premenopausal symptoms (before and/or after menopause)
– menstrual periods in general irregular (very heavy or on the contrary, not very heavy), very short periods with possible bleeding between them;
– psychic disorders: irritability, anxiety , sadness;
– physical disorders: sore breasts, headaches , migraines , weight gain, irregular hot flashes or more frequent cystitis ;
– possible menopausal-like disorders (see below);
2. Possible menopausal symptoms
– amenorrhea (absence of menstruation or cessation of menstruation).
– heat waves (in English, hot flashes) and nocturnal episodes of perspiration.
Hot flashes occur in particular after a disturbance in the secretion of catecholamine hormones. More information on the causes in our complete menopause file
Main symptoms of hot flashes
Hot flashes are intense, especially in the face, neck and chest. The skin may turn red. Like fever, hot flashes can also lead to chills with a feeling of cold sweats. Perspiration caused by hot flashes is sometimes so intense that the bed is slightly wet.
- An American study carried out by the Wake Forest Baptist Medical Center in North Carolina (USA) in February 2015 showed that more than half of women with menopause suffer for more than 7 years with the vasomotor symptoms of menopause, such as hot flashes and episodes of night sweats. This is an interesting study because it shows the long duration of these typical menopausal symptoms. The study published in JAMA Internal Medicine (online version) also showed that women who entered early menopause tend to suffer from these symptoms for longer periods, about 12 years;
- A study carried out by the University of Pittsburgh showed that hot flashes and also night sweats do not manifest themselves in the same way in all women. The researchers confirmed the results mentioned above; hot flashes tend to last an average of between 7 and 10 years after the last menstruation. This study included about 1,500 women who were on average (median to be precise) between 15 years before and during menopause. They found that there were significant differences between ethnic groups, weights and other lifestyle habits. For example, obese women were more likely than average to experience menopausal symptoms early (eg, before entering actual menopause). Women who drank alcohol moderately or frequently were more likely to experience menopausal symptoms for a longer period, including hot flashes. This study was published in the July 2016 issue of the specialized journal Menopause: The Journal of the North American Menopause Society;
– cutaneous-mucosal signs (allergies).
– atrophy of Organs genital organs.
– Vaginal dryness , pain and difficulties during sex may occur.
– urinary problems: cystitis , urinary tract infections or more frequent urinary incontinence. Urinary incontinence during menopause is mainly due to loss of elasticity in the tissues of the vagina and urethra. Sometimes a simple cough or laugh promotes urinary incontinence.
– psychic disorders: irritability, anxiety , sadness and depression .
– physical disorders: sore breasts, headaches , migraines .
– increased cardiovascular risk ( infarction ).
– weight gain; and particularly the increase in abdominal fat.
Weight gain during menopause
In the United States, it is estimated that at the age of 50, women gain an average of 0.5 kg per year from the third year after the onset of menopause, generally characterized by increased abdominal fat (often there is an increase of fat in the thighs). The decrease in the concentration of estrogen in this period of the woman’s life explains these alterations. In 2008, in the United States, 73.8% of women over 60 years old suffered from abdominal obesity (excess abdominal fat). This represents an increased risk of developing diabetes and cardiovascular diseases (such as myocardial infarction, stroke, etc.). Also read in menopause good advice about the risk of consuming too much sugar at night.
– dry skin (decreased sebaceous glands); dry eyes ;
– osteoporosis (in the long term). For your information, this disease cannot be treated (see under treatment ) with hormone replacement therapy (HRT), however, taking bisphosphotes can have a positive effect (70% improvement in calcification and bone density).
– thinner hair.
– sleep disorders.
– type 2 diabetes . According to a study published in July 2016 in the specialized journal Menopause , women who enter menopause before age 46 (remember that in the United States the average age of menopause is 51 years) were 25% more likely to suffer from type 2 diabetes. 2 compared to those who enter menopause between the ages of 46 and 55. Women who enter menopause after age 55 were 12% more likely to suffer from this form of diabetes. The study was led by Dr. Erin LeBlanc of Kaiser Permanente in the United States and focused on the analysis of more than 124,000 women (from the US Women’s Health Initiative database ).
Note on psychological symptoms of menopause
– A Swiss study published in 2016, which analyzed 168 women, showed that postmenopausal women no longer suffer from depression and other mental illnesses such as anxiety before this period in a woman’s life. In other words, menopause would have no impact on a woman’s psychological health. Two Swiss institutions, the University Psychiatric Clinic (PUK) and the ZHAW Zurich, carried out the study published in the journal World Psychiatry in June 2016.
It should be noted that prior to this 2016 Swiss study, other American studies had suggested a link between menopause and increased risk of depression and other mental illnesses such as anxiety.
Diagnosis
Although it is not a disease, menopause can be “diagnosed” by a doctor.
We speak of menopause when a woman does not menstruate for 12 consecutive months. Attention, it is possible to have menopausal symptoms much earlier than age (menopause and symptoms are different things). Some women experience symptoms from their 30s or 40s (eg irregular menstruation).
In June 2010, Iranian researchers released a simple blood test that accurately indicates when a woman will reach menopause. This test is based on the levels of anti-Müllerian hormone (AMH), secreted by the ovaries and can be useful for many women, who will be able to better plan their lives (when they intend to have children…). So far, we do not know if and when this test will be commercialized.
In order to identify premenopausal women, one must first eliminate the existence of any precancerous lesion or the presence of endometrial cancer, which can manifest in the same way.
Therefore additional tests are needed to be sure that it is a pre-menopausal state with its characteristic symptoms (and not a disease like cancer).
Treatments
The main aim of treatments is to alleviate and reduce menopausal symptoms.
Hormone therapy:
The doctor may prescribe hormone replacement therapy (HRT). However, some women at risk (for example, with a family history of breast cancer) should avoid taking HRT.
2017 HRT Study
HRT does not increase the risk of premature death in women, either from general causes or specifically from cancer or heart disease, according to a study published in September 2017. These long-term results came from the largest clinical trial on HRT already performed. Women who took estrogen for an average of 7 years or a combination of estrogen and progesterone for an average of 5 years showed no increased risk of mortality during follow-up ( see follow-up) that lasted 18 years, when compared to women who received a placebo (inactive drug). More than 27,000 women participated in this study. The researchers only looked at women who were taking HRT containing estrogen or progesterone in pill form and not in other dosage forms such as gels, patches or sprays. This study was conducted by Brigham and Women’s Hospital in Boston, USA, and published on September 12, 2017 in the scientific journal Journal of the American Medical Association (DOI: 10.1001 / jama.2017.11217).
Also read below under Notes for more information about TRH.
In addition to HRT, there are alternative remedies (read under menopausal herbal medicine), in addition to those listed below:
– mild antidepressants, such as venlafaxine (Effexor). This medication helps to reduce hot flashes by 60% and can be purchased with a doctor’s prescription, however, it can have side effects (eg nausea, vertigo,…). Talk to your doctor.
In August 2013, paroxetine was extended in the US by the FDA to the indication for the treatment of hot flashes. The recommended dose is 7.5mg at bedtime (source: Pharmavista.net, 10/08/2013). Two clinical studies demonstrated the superiority of this drug compared to placebo.
– gabapentin (Neurotin). This medicine helps calm pain and can have a positive effect on hot flashes. Consult your doctor.
– treatments for osteoporosis (eg bisphosphonates)
– vaginal estrogens (in the form of tablets, ring, vaginal cream,…) to combat vaginal dryness that can disturb sexual intercourse. Estrogens will act directly on vaginal dryness, talk to your doctor about this. In addition, to combat it, you can also use a lubricating gel, which can be purchased at pharmacies without the need for a prescription.
In cases with significant menopausal symptoms, HRT remains a good option when used in low doses and for a short period of time.
Only your doctor can prescribe appropriate hormone-based treatments after having considered the full range of risks and benefits.
Notes on the THS:
When to take hormone replacement (HRT)
– Hormone replacement (or HRT) treatments in menopause got new recommendations during 2004 (renewed by a French study by Inserm, November 19, 2005). However, according to a new survey by Inserm (2005), HRT are not all identical, we also distinguish HRT with estrogen or HRT with combinations of estrogens and micronized progesterone (with an identical structure to natural progesterone). These two treatments (single estrogen and micronized hormones) would not pose any risk (or less risk) of causing breast cancer for patients compared to treatments with classic HRT.
– For classic HRT (association of estrogens with synthetic progesterones), doctors recommend taking hormones for menopause only if the patient experiences hot flashes. Furthermore, the patient does not need contraindications (>> see below) and should always be informed by the doctor of the pros and cons of hormone replacement therapy (HRT), and the duration of treatment should not exceed 3 years. It is also possible, with your doctor’s agreement, to look into a natural plant-based alternative.
– Such prudence in the prescription of HRT is due to the 40% increase in cases of breast cancer under HRT treatment. 40% may sound like a lot, but we are talking about 5 out of 1000 women aged 55 who will develop breast cancer with or without HRT. We can talk about 7 women, that is 2 more with HRT, which is too much and too little, hence the difficulty in deciding whether or not to take HRT in case of severe menopausal symptoms. But only your doctor can really inform you about this risk-benefit.
– Taking hormones to combat osteoporosis is not proven, so for this single indication it is not advised to take replacement hormones.
Once the decision to use HRT has been made, the type of hormone and the form of administration must be considered.
Estrogen is available in many forms: oral, transdermal, topical gel and lotion, intravaginal cream and capsules, and vaginal rings. In some countries, estrogen can be administered through subcutaneous implants. The most commonly used estrogens are oral and transdermal.
Oral estrogens: have a greater effect on the liver, increase the production of some liver products such as some globulins, triglycerides, HDL cholesterol, clotting factors, these products are minimally increased in transdermals.
Transdermal estrogens are used when the effects listed by the oral are not desirable. The transdermal can decrease fat mass and increase lean body mass.
The different types of estrogens have similar effectiveness.
The addition of progesterone to HRT treatment is recommended for women who have not had a hystectomy, which decreases the likelihood of endometrial cancer. But for women who have had a hysterectomy, the use of progesterone is not recommended.
The use of testosterone in cases of loss of libido can be considered, but it must be carefully studied, as it has several side effects.
Contraindications to taking replacement hormones
– Women who have not taken replacement hormones during the five years following the onset of menopause (for example, if a 60-year-old woman who had menopause at age 50 decides to take HRT, there is a contraindication, as it takes more than five years, in this case ten years, that she had no contact with hormones, hers or HRT);
– Tobacco, if the woman is a smoker;
– Hypertension ;
– HDL: cholesterol less than 0.9 mmol/l;
– Cholesterol higher than or equal to 6.2mmol/l;
– Triglycerides greater than or equal to 2.2 mmol/l
not complete list of all contraindications. For complete information please read the package insert of your THS.
2. TRH and are: interesting note
A study conducted by the American reference medical institution Mayo Clinic found that low-dose hormone therapy improved sleep quality in postmenopausal women. In this study, American scientists took into account 2 forms of hormone therapy, an oral estrogen preparation ( conjugated equine estrogen ) and a patch (17 beta-estradiol), to understand their use and effect on the quality of life. of sleep. A placebo was also given to participants. Scientists found that women who used low-dose hormone therapy for more than 4 years, cited above, had a better quality of sleep. Sleep improvement was 2 times greater with hormone therapy compared to the placebo group.
This study was published in the scientific journal Menopause: The Journal of the North American Menopause Society on August 21, 2017. It is important to consider, however, that a study published in 2005 by the University of Michigan reached a different conclusion, believing that the hormone therapy had no impact on sleep disorders.
Herbal medicine
The best-known and most effective herbal medicines against menopausal symptoms are those that contain phytoestrogens and one of their advantages is that they reduce the risk of breast cancer, however they are weaker than human estrogen.
Phytoestrogens are plant hormones, steroidal substances that occur naturally in plants, and that can exert effects similar to those of female hormones (estrogens) in a woman’s body. Countless phytoestrogens have already been discovered, mainly in grains such as soy, linseed and nuts, and in several medicinal plants.
The most potent of the phytoestrogens are isoflavones, which can be found in soybeans , chickpeas and lentils. Lignans, another phytoestrogen, are found in flaxseeds , grains, lentils, fruits and vegetables.
* attention: there are some studies that cite a positive effect of the use of soy isoflavones, while others are more critical (a 2011 study showed the ineffectiveness of the use of soy in the menopause), mainly among women diagnosed with breast cancer, see your doctor.
Depending on the symptoms of menopause, different plants can be used.
Cimicifuga racemosa (Saint Christopher’s Wort) remains, however, the most effective plant to treat menopausal disorders, having a global effect on the main symptoms (hot flashes,…).
A study published on June 21, 2016, in the specialized journal JAMA , showed that the use of medicinal plants such as soy, cimicifuga, red clover, certain plants of traditional Chinese medicine or molecules from plants such as isoflavones, which are phytoestrogens, was associated with a modest decrease in the frequency of hot flashes and lack of vaginal lubrication in menopausal women. In contrast, the effect of these plants or natural remedies on night sweats was negligible, according to the researchers.
This research work, notably carried out by the Erasmus University Medical Center , in Rotterdam (Netherlands), analyzed more than 60 published studies on this topic, totaling more than 6,000 women.
natural remedy
Tips
Advice on how to prevent menopausal symptoms
– Talk to your doctor about changes you have noticed in relation to your menstrual cycle, mood, pain, he will prescribe the correct medication, as well as request tests, and may even prevent diseases and later symptoms.
– Do not smoke , control weight, blood pressure, blood cholesterol levels, thus preventing cardiovascular diseases.
– Exercise regularly (walking, weight training, cycling, etc.)
– Balanced diet, rich in whole grains, skimmed or soy milk, yogurt, white cheese, chicken, fish, soy beans, tofu, linseed, lentils, fruits, chickpeas.
A study published in the journal Menopause in 2012 showed that postmenopausal women who consumed more fruits, vegetables and cereals had a decrease in weight and also a notable decrease in hot flashes.
Advice in case of weight gain and menopause
– During pre-menopause and menopause, a woman’s metabolism changes. Fat mass increases and energy expenditure is different.
To summarize and simplify, women will tend to gain weight even if they eat a lot of sugar.
That’s why it’s recommended not to eat sugar (fast sugar like chocolate, soft drinks) at night, since in that period there is little energy expenditure. Weight gain from eating sugar at night occurs because there is storage and transformation of sugar into fat, in addition to the absence of energy expenditure.
It is therefore advised to reduce the consumption of sugar at night, but this does not mean that one should no longer eat sugar (needed by the body), just that it is better to eat this type of food in the morning. On average, experts estimate that if the diet is very high in sugar, especially at night, a woman will gain 6 kg in a year.
Women gain an average of 0.5 kg per year from the age of 50, characterized mainly by a rapid increase in abdominal fat, from the third year after the onset of menopause. The same changes are observed among women from different regions of the world.
In 2008, in the United States, it was found that abdominal obesity affected 65.5% of women aged 40-59 years and 73.8% of women over 60 years. The accumulation of abdominal fat leads to an increased risk of developing diabetes and cardiovascular disease, which is the main cause of death in postmenopausal women.
– Adopt a healthy diet, rich in fruits and try to eat omega-3 regularly. A good food balance allows you to better regulate your weight. Eat more fruits, vegetables and grains. If possible, eat soy-based foods like tofu and drink soy milk daily instead of cow’s milk.
– Play sports or exercise regularly to limit weight gain.
– Avoid consuming hot drinks (during hot flashes), alcohol or spicy dishes.
– Regulate the temperature of your room, and if possible make the environment cooler.
– Consumption of 400 IU of vitamin E per day helps to reduce menopausal hot flashes, but be careful not to consume it in excess (consult your doctor or pharmacist).
– Periodically check your health. Studies indicate that more than 80% of menopausal women suffer from other diseases such as diabetes , hypertension and thyroid problems. Therefore, a periodic visit to the doctor is advisable.
Advice in case of hot flashes
In case of hot flashes, you can follow some practical advice:
– Avoid wearing certain types of clothing, such as clothing that is very hot or made of synthetic material, such as nylon-based clothing.
– Use ice packs on the body. You can also take a cold shower or apply cold water. The goal is for your surroundings to be as cool as possible. Try not to stay in overheated or hot rooms.
– Try to relax, do not hesitate to use relaxation techniques (such as breathing regulation).
– Avoid smoking (this can favor hot flashes)
– Practice sports or exercise regularly. According to studies, women who play sports more frequently have fewer and shorter hot flashes.
– If necessary, use plant-based therapies, such as medicines based on cimicufuga racemosa (action against hot flashes, among others).
Type 2 diabetes and the menopause
If you enter menopause before age 46 or after age 55 (see the Causes section above for more information) your risk of type 2 diabetes increases. To limit this risk, include(incorporate?) the fight against obesity and overweight, healthy eating and regular exercise. These are effective ways to prevent the onset of type 2 diabetes.
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