Today, October 18, is World Menopause Day. We have world days for everything, some absolutely expendable, and others as necessary as this one.
Menopause remains a taboo subject. It is a great unknown for the population, but above all it is for those who live it: women. We arrive at this vital stage without information, without understanding what is happening to our body, our mind and our state of mind. That is why days like today are so important to give it the necessary visibility not only for women, but also men, health professionals and the media.
Promoted by the International Menopause Society and the World Health Organization, this year’s theme is dedicated to mental health, as one in three women will experience significant psychological changes during perimenopause.
There are several terms and concepts that it is necessary to review and understand in order to have a more global vision of what happens in this vital stage. Let’s see some of them.
The climacteric is the stage of the aging process in women that marks the transition from the reproductive to the non-reproductive phase. In general, this does not happen from one day to the next, but there is an evolution of years in which the ovaries reduce the production of hormones and ovules until the depletion of the ovarian reserve occurs, that is, it no longer more eggs are formed and menopause is entered.
The concept of perimenopause is often used as a synonym for climacteric, since it goes from the previous years in which endocrine, clinical and biological changes begin to the first year after menopause. Regardless of whether we speak of climacteric or perimenopause, within this stage another one is included called transition to menopause and which refers to the last years immediately after menopause and in which the woman experiences important alterations in the menstrual cycle.
Menopause is defined as the permanent cessation of menstruation as a result of this loss of ovarian follicular activity. Natural menopause is confirmed a posteriori after twelve consecutive months without menstruation, since there is no biological marker that tells us that this was the last period, so we will have to wait for the full year to pass to confirm the date. That is why it is so important that we continue to keep track of our periods, even if they appear every few months. Once menopause has occurred, a woman enters postmenopause.
There are cases in which menopause is not natural, but occurs as a result of a surgical procedure in which both ovaries are removed (regardless of whether the uterus is also removed or not) or due to the effects of treatments such as chemotherapy or radiation therapy. It is what is known as induced menopause and can give the same symptoms as the natural one.
There are also women who experience premature menopause, where menstruation stops naturally before the age of 40. The causes are not known exactly, but it is important for these women to know that the risk of cardiovascular disease, osteoporosis or cancer increases compared to women who go through menopause at the conventional age, so it is essential that they become aware and take the necessary measures necessary to take care of yourself in consultation with a health professional.
Menopause plays a relevant role in women of the current time. In the year 1900, the average age of menopause was 51 years and the average age of death in women was 59. Those women spent about 8 years without menstruation until they died. Currently, the average age of menopause remains the same, 51 years, but the average age of death in women is 83 years. This means that a woman spends about a third of her life in menopause. It’s too serious to ignore.
Many of the symptoms caused by a lack of estrogen can be confused with other pathologies, from depression and anxiety, to fibromyalgia, severe migraines or memory problems. That is why it is essential that the health professional delve into the medical and personal history of the woman, because that is when other problems arise that the patient does not give importance to, either due to ignorance, shame or normalization, such as hot flashes, vaginal dryness, insomnia, mood swings, or low libido.
With a saturated public health system and a lack of awareness and information about menopause in many health professionals, we find ourselves with misdiagnosed women, with inadequate treatments that do not resolve their symptoms and with tremendous economic consequences derived from sick leave, decreased productivity or early retirement.
Specifically, in the case of mental health, the guidelines are clear: there is no evidence that treatment with antidepressants improves symptoms related to psychological changes. That is why antidepressants should not be the first treatment option in these cases, since hormonal changes are responsible for the symptoms.
Thus, when psychological symptoms affect quality of life, hormone therapy for menopause should be considered as the first option. On the other hand, it may be beneficial to seek help from a psychology professional, in addition to following a diet adapted to the woman’s vital moment, practicing physical exercise, combining strength training with cardiovascular and balance training, learning to manage stress, improve rest and maintain and strengthen social relationships. A third of our life is too long to ignore and we deserve to live it healthily and fully.
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