Menopause: A Physiological Stage and a Guide to Be Healthy

In Mexico, menopause is still a taboo subject. When most patients go for a consultation at this stage, it is because they present complications and severe symptoms, warns Aline García Cortés, an academic at the Faculty of Medicine (FM) of the UNAM.

This happens because, in our society, the absence of menstruation is usually related to aging, loss of functionality, etcetera. And when they go to the doctor it is because they present problems such as pain during sexual intercourse, unbearable hot flashes, emotional lability, or even the presence of fractures.

This process must be recognized as a physiological stage, of changes that can be difficult to face, but if they are handled in the best way, women can have a completely good life, always accompanied by a specialist.

On the occasion of World Menopause Day -which is celebrated on October 18- she adds that the best way to commemorate this date is to go to the gynecologist to explain the changes that your body will have, and the guidelines you should follow to be healthy and have well-being.

It is worth mentioning that this commemoration, promoted by the World Health Organization and the International Menopause Society, aims to help raise awareness of the importance of evaluation and prevention in women's health during this period.

What is menopause?

Menopause is a unique moment in a woman's reproductive life. It is the definitive absence of menstruation; to define it, a year must pass since the menstruation has stopped. However, postmenopause is a longer period, in which we will spend a third of our lives and for which we must be prepared, explains Aline Garcia.

Data from the 2020 Population and Housing Census indicate that in Mexico there are approximately 14 million 847 thousand women aged 50 and over; and the average age at which menopause occurs ranges from 45 to 48 years old. Meanwhile, life expectancy in our country for women is 78.1 years, according to figures from the National Institute of Statistics and Geography. These figures are indicative of the number of women and how long they will live in that state.

Postmenopausal symptoms can be diverse, the main one being the absence of menstruation, to which others can be added, such as vasomotor symptoms (hot flashes); sleep disorders, such as insomnia; and psychological symptoms (anxiety, depression), headaches or general malaise.

Also, weight gain, after several years in this condition, alterations of the urogenital system may occur, such as vaginal and urinary infections, as well as vaginal dryness. Also, libido decreases and this affects sexual life and has repercussions on the relationship with a partner, among the main ones.

The prevalence of depression and anxiety increases considerably in the perimenopause (period from the beginning of the biopsychosocial events that precede menopause, up to one year after it); and in the postmenopause (stage from the last menstrual period) due to estrogen hormonal depletion and social factors. Without treatment, they can last for years, and even decades, he warns.

In addition, in those who no longer menstruate there is a higher incidence of metabolic alterations (metabolic syndrome and insulin resistance) and hypothyroidism, so they can aggravate the condition.

That is to say, during this period psychiatric conditions can occur; cardiovascular, since it increases the risk of an acute myocardial infarction; arterial hypertension; hypothyroidism; metabolic syndrome; insulin resistance; diabetes; hypertension; osteoporosis, and breast and endometrial cancer. "Yes, it can be serious."

There are also cases of premature ovarian failure due, for example, to the surgical removal of both ovaries, among other causes, which lead to menopause before the age of 40; there the symptoms are dangerous if not treated, since from a young age these women exponentially increase their cardiovascular, osteoporosis and fracture risk. Therefore, if a young woman stops menstruating for a long time and has associated symptoms, she should consult a gynecologist for evaluation.

Likewise, Aline Garcia stresses that during perimenopause she can still get pregnant, even have a twin pregnancy, because during this period hormonal changes can induce double ovulation within the same cycle. "You have to be careful with contraceptive methods if a woman does not want babies."

Solutions for menopause

Although there are no medications to delay menopause, there is a treatment for its symptoms, appropriate for each patient. From perimenopause, when menstrual cycles begin to shorten and lengthen, hormone replacement with estrogen and progesterone can be initiated if the woman has significant symptoms.

Each case must be individualized, because the treatment could include, in addition to hormones, antidepressants, or medications for osteoporosis; in other words, specific attention to the needs of each woman.

The main indication for hormonal treatment is when vasomotor syndrome is present; that is when the patient reports moderate or severe discomfort due to hot flashes and hot flashes.

It is recommended if she suffers from insomnia, a significant cardiovascular risk, or osteopenia (loss of bone tissue) since the hormonal treatment is intended to reverse these symptoms and delay osteoporosis.

Aline Garcia considers that facing menopause in the best way has to do with prevention. "It is necessary to educate women about all the reproductive stages they are going to go through in their lives, and to be prepared years in advance".

A basic and important element is to eat a good diet, exercise, and visit the gynecologist at least once a year for pertinent studies: pap smear, ultrasound, breast check-up, or serum studies (glucose, lipid, and endocrinological profile, etc.). In addition, smoking and other factors that predispose to diseases such as hypertension or diabetes should be avoided.

The university professor suggests that their partners should take more interest in their health and accompany them in this stage of change, to help them face it in the best possible way. To the children, to take care of their mothers and, in the same way, to support them.

Women who are living it or will start it, should not be frightened but informed and enjoy every episode of their lives. We must take care of ourselves and prepare for this period, recommends Aline Garcia.