The word 'menopause' comes from the Greek root mens, meaning month, and pausis, meaning cessation. This is why we describe menopause as the definitive cessation of menstruation and is understood to begin on the date of a woman's last period.
Menopause is another stage in a woman's life. Just as puberty is the period in which women reach sexual and reproductive maturity, menopause is the sign that they have lost their ability to reproduce. During this time, the ovaries stop their main function of producing oestrogens and hormone secretion.
Menopause is part of a stage in a woman's life known as the CLIMACTERIC, or perimenopause. Perimenopause is the time in a woman's life when her reproductive functions have become exhausted. It is an imprecise period of time that starts when the store of follicles in the ovaries diminishes and this causes delayed or missed periods (amenorrhea), alternating with sporadic or heavy periods.
The definitive disappearance of periods or menopause happens when a woman is around 50, although nowadays this is tending to happen later, perhaps because of improved modern lifestyles.
The huge drop in circulating oestrogens can give rise to various short and long term clinical conditions, especially skeletal and vascular. Vasomotor symptoms are among the typical short term effects of menopause.
Hot flushes begin with a feeling of discomfort, followed by a generalised vasodilation with an increase in skin temperature accompanied by an increase in heart rate. It is an unpleasant but temporary sensation that usually starts in the lower body and works its way upwards, with facial reddening and sweating on the upper body, neck and head.
From the age of 50, a higher incidence and prevalence of cardiovascular disease has been observed in women, although before this age it is more common in men. The higher levels of oestrogen in younger, fertile women have a protective effect. We could say that the menopause is a risk factor, as it is linked with a series of changes that favour arteriosclerosis, which is the most common cause of heart disease.
The lack of oestrogen also causes a overall atrophy of the genital areas. The skin and membranes of the breasts, vulva and vagina all experience thinning and loss of elasticity, there is less fatty tissue in the vulva and genital hair growth slows down. The vagina shrinks and becomes shorter. The loss of oestrogen makes the vaginal mucous membrane more vulnerable because of a decrease in acidity. Localised discomfort such as itching and soreness may occur, and there may be discomfort during intercourse (dyspareunia).
Hormone replacement therapy (HRT) was developed to alleviate the specific symptoms associated with falling oestrogen levels. At first it attempted to reduce vasomotor effects, such as hot flushes, but in recent years the approach has changed to a preventative one, especially with increased knowledge on the beneficial effects of HRT for the heart, circulatory system and bone density.
HRT, both in the long and short term, has its benefits, although the treatment may also have, to a lesser degree, potentially unwanted side effects, such as endometrial cancer, breast cancer, postmenopausal bleeding, etc.
This is an ongoing hot topic that will very soon be tackled for us by a highly reputable and trusted specialist.
Dr. D. Juan Antonio Andreo Ramírez
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