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Menopause: Impacts on Women, Symptoms, and Treatment.

We have all heard about menopause and the hot flashes typical of this stage, but have we stopped to learn what it is and how it is treated? First, let us start with the definition. Menopause is the physiological end of menstruation due to a decrease in ovarian function. We talk about menopause when a woman has no menstruation for at least 12 consecutive months. This absence of menstruation is known as amenorrhea.1 The cessation of ovarian function is caused by atresia of the ovarian follicles due to aging. The age at which menopause begins does not follow the rules. In some women, it may begin at 45 while in others at 55. However, smoking, eating poorly, or living at higher altitudes may quicken the process. 2

What Happens At Menopause And How Does It Affects Me? When we are in puberty, our ovaries react successfully to these hormones to produce estrogen and progesterone to carry out the menstrual cycle. As the ovaries age, their ability to respond to pituitary gland hormones decrease. Our ovaries begin to lose the ability to respond to luteinizing and follicle-stimulating hormones so that gradually estrogen and progesterone is no longer produced. At the onset of menopause, there is a decrease in inhibin levels, a hormone that down-regulates FSH synthesis, with normal or slightly low estradiol levels. These early hormonal changes result in a shortening of the estrogen-dependent follicular phase and shorter menstrual cycles. Gradually, as menopause approaches, menstrual cycles become shorter, irregular, and with just fewer ovulations. The number of viable follicles decreases considerably, and eventually, the remaining follicles stop working, and the ovaries stop producing estradiol. In a reproductive age woman, the predominant estrogen is 17 beta-estradiol (E2). Since estrogens are also produced by the fat or skin from androgens (e.g., androstenedione, testosterone), estrone replaces estradiol is the most common estrogen after menopause. Signs and Symptoms We can group them according to the organic area affected: Psychological: Due to a decrease in serotonin, there is emotional lability, mood changes, alterations in sleep and wakefulness decreased sexual desire. Genitourinary: As estrogen has decreased, there is no formation of all the cellular layers in the vagina; there is also a decrease in collagen, vascularization, and secretion, which causes fragility of the vaginal mucosa, pH alkalinization, and inadequate lubrication. Vasomotor: The mechanism is still unknown, but it is said that there are thermoregulatory imbalances in the hypothalamus. Hot flushes and excessive perspiration are due to this vasomotor instability leading to increased blood flow to the skin.

Treatment The current treatment in menopause is to fight the primary deficit: the lost hormones. First, a series of clinical examinations are needed considering the indications and contraindications of hormone therapy, according to experts of the Journal of Menopausal Medicine. Consultation with the primary care physician is fundamental in this first step. These essential examinations should consider smoking and drinking habits, mental or genetic diseases, breast or endometrial cancer, osteoporosis, diabetes, thyroid disease, cardiovascular disease, and venous thromboembolism. 3 Hormonal treatment should be started at the transition to menopause and should be done according to each woman's symptoms' intensity and frequency. Therapy can be combined with a levonorgestrel-releasing intrauterine system (LNG-IUS) 4 with oral or percutaneous estrogen, low-dose combined oral contraceptives estrogen-progestin therapy. 5 According to the symptoms, the therapy selection will depend on the primary care physician or gynecologist, as mentioned above. It is also possible to relieve symptoms by improving lifestyles through exercise, stress management, and psychological therapy.

Medications such as omega-3, vitamin E, Cimicifuga racemosa, isoflavone, and soy can be helpful but cannot replace hormonal therapy.

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