What Is Menopause?

Menopause is a transitional stage in every woman's life. It is good to know how it occurs and what symptoms accompany this process.

Written and verified by la médico Sandra Golfetto Miskiewicz.

Last update: 31 May, 2023

Over the years, every woman eventually reaches menopause. But what is menopause exactly? Read on and find out.

Physiologically, the pituitary gland (a gland located in the brain) secretes, among other hormones, FSH (follicle-stimulating hormone) and LH (luteinizing hormone). These hormones, upon reaching the ovary, stimulate it to secrete female sex hormones: estrogens and progesterone.

In the menopausal period, there’s an involution (regression) of the ovaries, which causes a progressive decrease in their function. As a consequence, the number of estrogens is reduced.

Low levels of estrogen in the blood stimulate an increase in FSH. As a result of these changes, alterations occur in the menstrual cycle and it also decreases until the woman’s fertility disappears.

Important concepts about menopause

To understand this process, we must define certain medical terms:

• Premenopause: This is the period before menopause. It lasts for 2 to 8 years before menopause.
• Menopause: This is the medical term that refers to the definitive cessation of menstruation. It’s characterized by the absence of menstrual bleeding for at least 1 year after the date of the last menstruation. Generally, it occurs between the ages of 40 and 55.
• Postmenopause: This is the period after menopause, that is, after the year of the last menstruation. It usually lasts from 1 to 8 years.
• Climacteric: This period covers the three previous periods. It lasts 2 to 8 years before menopause until 2 to 6 years after the last menstruation.
• Menopausal transition (perimenopause): This includes the period before and near menopause, when biological and endocrine changes begin. It occurs in your late 40s and early 50s.

As we can see, there’s a difference between menopause and climacteric, even though they’re usually used interchangeably in practice.

Types of menopause

Different forms of menopause have been determined:

• Natural or spontaneous: Caused by ovarian aging.
• Late: Occurs after 55 years.
• Premature or precocious: When menopause occurs at the age of 40 or earlier. It can be natural (due to premature ovarian failure) or induced (after a procedure). The latter gives rise to the following two presentations.
• Surgical: After a bilateral oophorectomy, which is the removal of both ovaries with or without a hysterectomy.
• Iatrogenic: As a consequence of chemotherapy or radiotherapy treatment.

Symptoms of menopause

Just as the time of onset of menopause is different for each woman, the symptoms that women may present are also variable. The following are the most common signs:

• Irregular menstrual cycles in quantity and frequency
• Vasomotor symptoms, such as hot flashes or a sensation of intense and sudden heat
• Tachycardia and palpitations
• Insomnia
• Depression, irritability, nervousness, emotional instability
• Decreased libido

Genitourinary syndrome of menopause

Some women may experience more severe symptoms, associated with the so-called genitourinary syndrome of menopause. This involves both the vaginal mucosa and the urethra and bladder.

There’s vaginal dryness and irritation and a burning sensation in the genital area. Pain also appears during sexual intercourse (dyspareunia), often associated with the dryness we’re discussing.

Clinical management of menopause

There are natural and pharmacological methods to help you cope with menopause, both physically and mentally.

Natural methods

Every day there’s more emphasis on lifestyle changes, in order to prevent overweight and obesity from the beginning of the premenopausal phase. Some measures are as follows:

• A balanced diet in quality and quantity, adjusted to the woman’s needs. It should be low in easily absorbed carbohydrates and reduced in saturated and trans fats.
• Walk 150 minutes a week (30 minutes a day about 5 times a week).
• Specify exercises with light weights to strengthen bones and muscles, preventing osteoporosis and cardiovascular diseases.

If the person is a smoker they should stop immediately. You’ll also have to adapt sexual intercourse to the physical changes that appear, using vaginal moisturizers and lubricants.

As for hot flashes, alternative methods that favor environmental modification are recommended. It can be the use of fans, dressing lightly, bathing more frequently with cold water, or ingesting cold food and drinks.

Pharmacotherapy

Also known as hormone replacement therapy, the pharmacological approach to menopause improves vasomotor symptoms. It consists of supplementation with estrogens or the combination with progestogens:

• Estrogens: Can be administered orally, topically, or transdermally.
• Progestogens: They can be used in case of any contraindication for the use of estrogens.
• Bioidentical hormones: Their composition is similar to those made by the body. They’re used when the risk of hormone treatment with estrogens or progestogens outweighs the benefit.

The Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Gynecology and Obstetrics (SEGO) and the Spanish Association for the Study of Menopause (AEEM), with the methodological support of the Ibero-American Cochrane Center (CCIb), in their Clinical Practice Guide on Menopause and Postmenopause, assesses and explains the risks and benefits of hormone therapy in menopausal women.

When evaluating the risk/benefit, the aforementioned experts recommend that asymptomatic patients refrain from its use and, if its application is necessary, it should be started with the lowest effective dose and for the shortest possible time.

When to stop contraceptives?

In view of the fact that premenopausal women can become pregnant if they don’t use contraceptive methods, these should be continued until the following conditions described by the World Health Organization (WHO) are reached:

• Non-hormonal contraceptives must be maintained for at least 12 months from the last menstrual period.
• Hormonal methods should be substituted for a non-hormonal one, followed by a 12-month period of amenorrhea for final discontinuation.
• Removal of the copper intrauterine device (IUD) is recommended after 12 months of the last menstruation.

Why does menopause affect some women more than others?

Each woman goes through the climacteric in a different way, depending on her character, her upbringing, and her expectations. Some have a tendency to emphasize the negative aspect of this phase of their life, and it isn’t easy for them to recognize that they are aging. Others consider it natural and temporary.

This condition must be assumed as a period of adaptation. The psychic and physiological changes presented are part of the life cycle, as happened with adolescence, for example.