Menopause and its symptoms: How to treat and live will with it?

What is menopause ? 

Menopause is a natural biological process that corresponds to the loss of ovarian functions in women. It is characterised by the permanent cessation of ovulation and menstrual cycles, due to the depletion of the stock of ovarian follicles, and the interruption of sex hormones secretion (oestrogen and progesterone) by the ovaries.

For the majority of women, menopause occurs when they are in their fifties. However, it can occur earlier or later, and it can also be induced.

What are the symptoms of menopause ?  

Symptoms related to menopause are also called climacteric. Every woman experiences them in a different way, and will not necessarily have all of the symptoms. Here are the most common ones:

• Hot flashes, sometimes accompanied by facial flushing, rapid pulse, excessive sweating, chills, tremors and dizziness,
  
• Changes in menstrual cycle, periods are irregular and become either lighter or heavier,
  
• Sleep disturbances, insomnia, problems with memory and attention,
  
• Mood disturbances, hormonal changes and sleep disturbances generate mood swings, anxiety and irritability, sometimes with episodes of depression.
  
• Vaginal dryness, caused by the cessation of oestrogen production by the ovaries, provoking a decrease in vaginal lubrication and modification of the vagina walls, which has an impact on sex life and libido,
  
• Urinary disorders, pelvic floor can be affected due to decreased muscle tone, which can provoke urinary incontinence.

Many other symptoms exist, such as fatigue, headaches, muscle and joint pain, weight gain, dry skin and hair, etc.

One of the serious complications of menopause is osteoporosis. It can be explained by the fact that the risk of bone demineralization is higher.

In addition, the risk of cardiovascular disease increases.

Different treatments are used to help relieve these symptoms, until they go away and the body gets used to the changes.

How is menopause treated?  

Symptoms vary a lot at the onset of menopause, and for some women treatment is not necessary. The care plan should thus be adapted to every woman. In addition, any risk of underlying condition must be ruled out before prescribing any treatment.

The first approach consists of delivering recommendations concerning diet and healthy lifestyle, such as no smoking, moderate alcohol consumption, having a balanced diet, avoiding spices and hot drinks, enriching your diet with calcium (milk and dairy products, mineral water rich in calcium, etc.), good-quality sleep and regular physical activity.

In terms of treatment, there are different types of it, for each specific situation:

For hot flashes

Menopause hormone therapy, intended for women whose menopause affects their quality of life, and is used to prevent the risk of osteoporosis.

Hormone replacement therapy, or HRT, specifically prescribed for women with primary ovarian insufficiency, POI, (also known as premature ovarian failure).

These hormone therapy treatments are prescribed by the patient's gynecologist or attending physician if there are no contraindications related to a history of breast cancer and stroke. The treatment consists of the combination of oestrogen, administered cutaneously or orally (Oestrogel Pump-Pack®, Evorel®), and a progestogen.

These treatments carry risks that should not be ignored, such as a high risk of developing breast, endometrial, or ovarian cancer, as well as stroke and thrombosis. Follow-up care for women who take these drugs should be meticulous.

Despite the possibility of a very harmful impact on the patient's health, these two treatments remain the best option when it comes to treating severe climacteric disorders and preventing osteoporosis. However, they are no longer prescribed systematically, each woman has a choice and many are tempted by alternative solutions.

Antidepressants, from the class of selective serotonin reuptake inhibitors (Lustral®, Fluoxetine®) and selective norepinephrine reuptake inhibitors (Venlafaxine®, Duloxetine®).

Centrally acting antihypertensive drugs, such as Moxonidine®.

For vaginal dryness 

Lubricating gels, used to locally treat vulvovaginal dryness and improve sexual comfort, also effective against cystitis, vaginitis and urgent needs to urinate.

Vaginal moisturizers, to soothe unpleasant sensations not related to sexual intercourse.

Taking oestrogen vaginally, in the form of a ring, tablet or cream, to hydrate and lubricate the tissues of vagina and vulva.

For urinary disorders 

Physiotherapy sessions to strengthen pelvic floor, gain better bladder control and resolve incontinence problems.

For depression 

Anxiolytics, like Oxazepam®, to relieve anxiety.

Antidepressants, like Cipralex®, to treat long-term depression.

Some over-the-counter medicines are also available: 

Beta-alanine, a pure amino acid, which can be used to relieve hot flashes. It is found in Numeta®.

Herbal medicine, the active ingredients of which come from various plants (sage, hawthorn, chaste tree, hops, black cohosh, red clover, etc.). They are available in capsules, in the form of a herbal tea or essential oil and may help reduce hot flashes, or even make them disappear.

Homeopathy, for hot flashes and other disorders associated with menopause, granules of aconitum napellus, sepia officinalis, lachesis mutus are said to be among the most effective.

Vitamins and trace elements, studies suggest that magnesium, zinc, vitamin E and vitamins B9 and B6 could limit hot flashes and sweating.

Food supplements can be used to relieve menopause symptoms: there are phytoestrogens such as soy isoflavones, effective against hot flashes, or DHEA, a naturally produced hormone which, when taken in the form of tablets or capsules, could stimulate the production of oestrogen and therefore relieve menopause symptoms. However, health authorities have reservations about these two supplements. They could lead to risks similar to those caused by HRT oestrogen, but are at the same time less effective. Official recommendations advise women with a history of breast or uterine cancer not to take these types of medications.

Is there a non-drug treatment for menopause?  

Some women are able to manage their climacteric symptoms with alternative therapies such as acupuncture, hypnosis, meditation, yoga, and Ayurvedic treatments. These methods help reduce anxiety and stress, the latter being a trigger of hot flashes in many women.

Others change their lifestyle and adopt a specific diet - rich in fiber, good protein and micro-nutrients, in order to control weight and prevent menopause symptoms. The majority of women are affected by a change in morphology, which causes the increase in volume of the abdominal part of the body.

Some tips to limit the discomfort would be to sleep in a cool room, use less heating in winter and a fan in summer, wear several layers of clothing to be able to remove or add them depending on the time of day, and change the type of bed-linen.

It is also suggested to have a regular sexual activity, which acts as a thermoregulator.

This difficult period for women is often seen as inevitable, the hormonal upheavals linked to menopause are even more taboo than menstruation because it is associated with the notion of aging, the loss of femininity and fertility. On the medical side, the challenge is to discover treatments with zero risk, in order to allow all women to accept this transitional phase, which in fact leads to a sort of freedom, with no more periods, no more contraception and less constraints.

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