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Menopause – All You Need to Know

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The reproductive period of women spans from menarche, initiation of menstruation, to menopause, cessation of menstruation. Menopause is a normal and spontaneous process, however, certain medication and surgical procedures may induce early menopause.

Menopause is associated with weight-related, cardiovascular, urogenital, bone, and mood-related symptoms. The article describes the causes, changes, symptoms, and strategies to improve the symptoms of menopause.

What is Menopause?

Menopause marks the cessation of the menstrual cycle and the end of the reproductive life of the woman. The cessation of menses shall occur for a minimum of 12 months to be termed menopause. In western countries, the average age of menopause is approximately 51 years, however, this may vary from woman to woman. Women undergoing menopause experience a variety of symptoms and also report physical changes. Menopause is also associated with health complications that require consultation with a physician.

What Causes Menopause?

The number of ovarian follicles declines as the woman grows older. Under normal conditions, the granulosa cells of the ovary produce the hormones estrogen and inhibin. Since estrogen and inhibin suppress the release of gonadotropins including follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Reduced levels of estrogen and inhibin increase the levels of LH and FSH.

Not only do lower estrogen levels disrupt the development of the endometrium, the inner lining of the uterus, but also affects the hypothalamus-pituitary-ovarian axis. Disruption of endometrium leads to the onset of irregular menstrual cycles, eventually leading to the permanent cessation of menses.

When Does Menopause Occur?

While natural menopause is a spontaneous process, menopause may also occur in association with health procedures and health conditions. Women who undergo surgical procedures such as bilateral oophorectomy and hysterectomy are also subjected to early onset of menopause. Hysterectomy and bilateral oophorectomy involve the removal of the uterus and ovaries respectively.

Women are administered antiestrogen medications for the treatment of breast cancer. These medications reduce the levels of estrogen and mediate the onset of menopause. Women undergoing chemotherapy are also likely to experience symptoms of menopause. The symptoms in these women are more severe than the symptoms of normal menopause.

Hormonal Changes in Menopause

The menopausal transition is linked with concomitant changes in the levels and functions of hormones. 4 hormones serve as biomarkers of menopausal changes. These hormones are FSH, anti-mullerian hormone (AMH), estradiol, and inhibin B. FSH is released by the anterior lobe of the pituitary gland, other three hormones are released by the ovarian follicles. Ovarian aging reduces the levels of inhibin B, AMH, and estradiol, leading to increased secretion of FSH. Reduction in the levels of these hormones, particularly, estradiol is responsible for the menopausal symptoms.

Physical Changes in Menopause

The menopause transition is associated with metabolic and body composition changes. The majority of these changes are a manifestation of estrogen deficiency. The accumulation of fat shifts from femoral and gluteal regions to abdominal regions in the presence of estrogen deficiency. Higher levels of androgens also contribute to the occurrence of central obesity. Increased levels of visceral fat increase the risk for cardiovascular diseases and increased resistance to insulin.

Hormonal and metabolic changes during menopause also elicit changes in the structure and function of bones. Estrogen deficiency elicits an imbalance in the osteoblastic and osteoclastic activity in the bone. There is a net loss of bone mass due to increased resorption of the bone tissue. This increases the risk for fractures and osteoporosis, contributing to a slight reduction in height.

Vagina also undergoes several changes as a woman undergoes menopause transition. The layers of the vagina include mucosa, muscularis, and adventitia. Reduced levels of estrogen cause the vaginal mucosa to undergo atrophy. This layer becomes drier and thinner than normal vaginal mucosa. The vagina becomes more fragile and loses its elasticity, which may even lead to painful intercourse. Menopause also causes women to have reduced sexual drive. Atrophy of the urethra causes painful urination.

Menopause is also associated with changes in the structure and function of arteries. Estrogen deficiency causes the vessel walls to constrict and also increases the levels of low-density lipoprotein (LDL) in the blood. Disruption of vessel structure and higher levels of blood cholesterol contribute to the onset of cardiovascular disorders.

Vasomotor symptoms are important features of the menopause transition, experienced by the majority of menopausal women. Vasomotor symptoms include night sweats, palpitation, hot flashes, and migraines. The symptoms are exacerbated upon consumption of alcohol, stress, exertion, and eating. Hormonal changes also give rise to tension and cluster headaches.

Mood Changes in Menopause

Women undergoing menopause transition are more likely to experience mood changes and suffer from mood disorders. These disorders include stress, anxiety, emotional distress, and depression. Women also experience sleep problems such as insomnia. Mood disorders are closely associated with sleep and weight problems. This association is evident by the fact that estrogen is involved in the activity of neurotransmitters that regulate cognition and mood.

Estrogen protects the brain from oxidative damage and prevents the onset of depression symptoms, therefore, estrogen deficiency during menopause is associated with mood disorders.

Management Strategies

Menopausal hormone therapy plays an important role in the management of symptoms of menopause. Estrogen and progesterone are important components of hormone therapy. Menopausal hormone therapy improves the quality of sleep, and vasomotor symptoms such as hot flashes, memory, and mood. Hormone therapy also aids in the management of pain during intercourse and urination by improving vaginal and urethral atrophy.

This therapy also improves bone-related symptoms of menopause including joint pain and post-menopausal osteoarthritis. It also mediates insulin resistance and reduces the risk of developing diabetes mellitus type 2.

Hormone therapy is certainly helpful in managing menopausal symptoms, but it is not the only treatment option.
Nonpharmacological options that have been shown to be effective for treating vasomotor symptoms include several dietary supplements, herbs, cognitive-behavioral therapy (CBT), and hypnosis. Treatments to prevent bone loss or improve sexual activity may also be offered.

In this articles – Treatment of Menopause we will discuss all treatment options.

Conclusion

Menopause is an inevitable and spontaneous process, which marks the end of the reproductive potential of a woman. Estrogen deficiency is a significant hormonal change observed during menopause. This is responsible for the onset of menopause-related symptoms including vasomotor changes, mood disorders, obesity, sleep changes, urogenital alterations, and changes in the structure of bone. Menopausal replacement therapy, in combination with following a healthy lifestyle, facilitates improvement in these symptoms and enhances the quality of life.

References

  1. Ali, S., Buluwela, L., & Coombes, R. C. (2011). Antiestrogens and their therapeutic applications in breast cancer and other diseases. Annu Rev Med, 62, 217-232. doi.org/10.1146/annurev
  2. Gava, G., Orsili, I., Alvisi, S., Mancini, I., Seracchioli, R., & Meriggiola, M. C. (2019). Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina (Kaunas), 55(10). doi.org/10.3390/medicina
  3. Kozakowski, J., Gietka-Czernel, M., Leszczyńska, D., & Majos, A. (2017). Obesity in menopause – our negligence or an unfortunate inevitability? Prz Menopauzalny, 16(2), 61-65. doi.org/10.5114/pm.2017
  4. Palacios, S., Stevenson, J. C., Schaudig, K., Lukasiewicz, M., & Graziottin, A. (2019). Hormone therapy for first-line management of menopausal symptoms: Practical recommendations. Women’s Health (Lond), 15, 1745506519864009. doi.org/10.1177/1745
  5. Peacock, K., & Ketvertis, K. M. Continuing Education Activity.
  6. Secoșan, C., Balint, O., Pirtea, L., Grigoraș, D., Bălulescu, L., & Ilina, R. (2019). Surgically Induced Menopause-A Practical Review of Literature. Medicina (Kaunas), 55(8). doi.org/10.3390/medicina55
  7. Su, H. I., & Freeman, E. W. (2009). Hormone changes are associated with the menopausal transition. Minerva Ginecol, 61(6), 483-489.

 

The information in this site will not replace a medical examination or relevant medical advice. We do our best to make the most reliable and orderly information available. Still, as reliable as it may be, this information can not be a substitute for any other medical recommendation received by a qualified physician after an individual examination.
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