Menopause means the cessation of ovarian function, both the secretion of female sex hormones (estrogen and progesterone) and the ovulatory function. Menopause means the absence of menstruation for one year.
Menopause occurs by “consuming” the number of follicles in the ovaries. We are born with a fixed number of primordial follicles, we lose many until puberty, then, monthly, through ovulation. Therefore, we genetically have a different number of follicles and, therefore, the age at which menopause begins is variable.
How does menopause manifest itself?
On the basis of which information menopause is diagnosed
What tests are performed on menopausal women?
When does menopause occur?
The minimum age of onset is considered to be 40 years. Before this age, menopause is considered premature, and its pathology is a separate subject in endocrinologists and gynecologists.
The cases of women who menstruate even after 55 years are also to be followed due to the risk of endometrial hyperplasia (uterine lining) and breast cancer.
How menopause occurs?
Menopause can occur naturally, but also after some surgical interventions: the best-known example is the surgical removal of the uterus (total hysterectomy for uterine fibroids), hysterectomy with bilateral ovariectomy for various oncological or non-oncological pathologies. Menopause also occurs due to reversible hormonal causes such as “chemical castration”.
Menopause can set in suddenly (absence of periods all at once) or gradually (infrequent periods, every 2-3 months, or, on the contrary, more frequent periods, every 2-3 weeks). The premenopause period can last for 2-3 years.
How does menopause manifest itself?
Frequent symptoms and signs are determined by the decrease in the amount of estrogens (the main female hormones), with effects on all devices and systems:
- Changes in the hair (hair, skin and nails) – dry hair, without shine, breaks easily or falls out; brittle and lackluster nails, dry and rough skin, which requires more moisturizing cream.
- Changes in the mucous membranes – vaginal dryness, dyspareunia (embarrassment during sexual contact), stinging when urinating with excessive urinary infection, involuntary loss of urine when laughing, sneezing or with exertion caused by the decrease in the tone of the pelvic muscles and the bladder detrusor
- Adipose tissue otherwise distributed – predominantly abdominal and quite significant weight gain in certain cases
- Edema of the eyelids and of the hands, i.e.: “swollen eyes” in the morning, the accentuation of bags and dark circles
- Pain in the small joints (hands and feet), sometimes with morning sickness, i.e. a harder start in mobilizing
- Increase in blood pressure, some people become hypotensive to hypertensive (BP of 140/95 mm Hg)
- Sleep disorders – insomnia when falling asleep or waking up and poor quality sleep
- Mood changes, depressive attitude, easy crying, suicidal thoughts, low self-esteem, nervousness, anxiety, and panic attacks up to the onset of severe psychiatric pathologies such as severe depression
- Hot flashes, characterized by heat waves – increase in core temperature followed by profuse sweating (excess) lasting a few seconds or minutes. These can be repeated several times a day or an hour. It is associated with increases in blood pressure, pulse, panic attacks, general discomfort
- The general condition can be affected, the woman complaining of fatigue, general illness, dizziness, even loss of consciousness, headache, muscle cramps, numbness of the lips or hands – a corollary of symptoms that can confuse the patient and even the doctor, in the absence of a correct and complete history (patient history)
On the basis of which information menopause is diagnosed
Regarding the anamnesis, it is good to know the age at which the mother, grandmother, and sister had menopause – the genetic inheritance also has an impact; therefore it must be mentioned in the anamnesis if there were cases of oncogenital diseases, oncomas or osteoporosis. It is important to know the age of the first menstruation, the number of pregnancies and birth weights, the duration of breastfeeding and the type of contraception used. A patient who comes to the office for one or more of these problems must be approached globally, following a general clinical consultation, on devices and systems. In addition, the endocrinological examination focuses on the inspection and palpation of the thyroid gland and the breasts.
Affecting the thyroid gland in pre-menopause or menopause is not at all rare, on the contrary, and the symptoms can be confused with those determined by menopause – suffocation, lump in the throat, anxiety, sweating, nervousness.
Breasts are again a key point in clinical consultation – for example, the appearance of more depigmented areas suggests an older estrogen deficiency, while the presence of normal pigmentation and breast “tone” still suggests estrogen secretion. A nipple discharge or a self-palpated mass or a lump detected by a doctor should be urgently investigated. Malignant breast pathology is very common in this period of a woman’s life and, therefore, a systematic and rigorous screening is required.
The gynecological consultation is mandatory every six months for any sexually active woman, and the premonition of menopause should not keep the woman away from the gynecological table, on the contrary. Bimanual palpation, valve consultation, Babes Pap smear cytological examination is necessary.
What tests are performed on menopausal women?
The usual screening panel: blood count, lipid profile, blood sugar, transaminases, renal function, including urine summary. In cases of preclimax disorders, the level of sex hormones (estrogens, progesterone) and gonadotropins (FSH, LH, prolactin) is measured.
The end of ovarian function is indicated by FSH and LH with high values, over 70-100, and low estrogen values. If estrogens are still present, depending on the patient’s desire, progesterone derivatives can be administered orally to maintain menstruation for a while longer.
Thyroid hormones and antibodies are also dosed to detect a thyroid disease – very frequently autoimmune.
The imaging indicated for a patient with pre-climax or already established climax disorders (ie the absence of menstruation for a year) consists of mammography and/or bilateral breast ultrasound, transvaginal utero-ovarian ultrasound and, possibly, thyroid ultrasound.
Transvaginal ultrasound can show the absence or decrease in the number of ovarian follicles, the appearance of the uterus (thickness of the endometrium – hyperplastic or atrophic) and possible associated pathologies.
Mammography is usually indicated as breast cancer screening after 40 years, especially for people with large breasts, in association with breast ultrasound. Mammography can be done before this age in case of important changes in the ultrasound or significant heredity of breast cancer.
General recommendations
Until menopause is fully established, contraception must be followed by local protection or an intrauterine device if previously available, as there is still a risk of unwanted pregnancy.
Osteoporosis appears progressively, but in the first years after menopause, bone mass is rapidly lost, so measures must be taken.
Weight gain can be controlled through strict diet and exercise.
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