Menopause (1)
How does it survive and what age?
WHAT IS PERIMENOPAUSE?
WHAT ARE THE SYMPTOMES?
What is the Precocious Menopause?
What is its impact on LONG-TERM HEALTH?
Dr. Claude Allouche, gynecologist
Ahuza Clinic, Raanana
058 726 02 64
How does it survive and what age?
Menopause occurs between 45 and 55 years of age with
average age around 52 years
- It corresponds to stopping the ovarian cycle.
- At birth, girls have an ovarian reserve of 1 to 2 million follicles. This stock, once and for all, does not renew and decreases over the course of female cycles.
From 400,000 to puberty, the number of ovarian follicles rose to 25,000 to 37 years and then dropped to 10,000 after 40 years.
At menopause, the ovarian reserve has less than 1,000 follicles.
Therefore, leovaries no longer secrete progesterone or estrogen.
Ino more ovulation therefore more risk (or chance) of spontaneous pregnancy.
Menstruation stops.
However, it cannot be said that menopause is permanently installed only when the patient has no more periods for 12 consecutive months before 50 years or 24 consecutive months after 50 years.
WHAT IS PERIMENOPAUSE? (2)
It is relatively rare that menopause suddenly settles overnight without any symptoms, even if possible.
Most often, menopause settles gradually.
It usually occurs after a period called perimenopause or premenopause.
This transition period may vary in duration from zero to four years. It translates into:
- Some irregular rules (alternation of short and long cycles); in Hebrew "mahzorim lo sdirim
- one increased premenstrual syndrome (with painful breasts and signs of irritability before menstruation);
- The onset of hot flushes intermittent in a few women.; in Hebrew "galey hom "
Symptoms of premenopause are not systematic and occur shortly before 50. Each symptom may occur either in isolation or in combination with others.
They are explained by a progesterone deficiency and can treat themselves with natural progesterone to alleviate symptoms and regularize cycles.
Treatment is not systematic, it will be decided after consultation between the doctor and the patient depending on the discomfort experienced by the patient.
Menopause (3) WHAT ARE THE SYMPTOMES?
The symptoms of menopause vary from woman to woman.
Generally, stopping menstruation is accompanied by climate disorders (all symptoms caused by estrogenic deficiency).
These symptoms are induced by estrogen deficiency
and progesterone can result in:
- hot flushes ; (
They may occur during the day or night. They are characterized by a feeling of warmth, of the whole body and extending especially to the neck and face with appearance of redness and sweat.
- night sweats ; (
They can occur in isolation without hot flashes. They tend to awaken the woman. They combine with a feeling of warmth.
- joint pain ; (
They can touch all joints, are often fluctuating in time and more marked in the morning (or after immobilizing, for example in a sitting position) with morning uninterference and improvement with physical activity.
- vaginal dryness ; (
It occurs and worsens with the duration of menopause and causes pain during sexual intercourse and consequently, a decrease in pleasure and desire
- urinary symptoms (
Urinary infections and irritations, loss of urine to exercise or urgent need to urinate.
Other signs may result from a so-called "domino" effect, secondary to the night awakening caused by hot flashes:
- chills, tremors, malaise and dizziness;
- palpitations;
- headache; (
- feeling tired; (
- loss of attention, memory loss
- sleep disorders; (
- irritability; (
- mood disorders
- depressed trend
Menopause is also accompanied, most of the time by a redistribution of fat that tends to settle on the belly, with weight gain that often starts before the confirmed menopause, hence the importance of preventive measures (food and physical exercise).
In general, these symptoms are transient but may sometimes last for more than 10 years.
On the other hand, the lack of estrogen can cause lasting pathologies such as:
- osteoporosis (loss of bone tissue with high risk of fractures);
- cardiovascular risks ( scientific studies have shown that, with equal risk factors, unmenopausal women have less cardiovascular risk than men, thanks to estrogen; This difference gradually fades over time once the woman is menopausal)
What is the Precocious Menopause? (4)
We talk about early menopause when it comes before age 40.
It is also called premature ovarian insufficiency.
The patient will have the same symptoms as natural menopause (absence or irregularity of menstruation, flushes of heat...)
Early menopause occurs in about 1% of women
Causes may follow:
- surgical treatment (ablation of the ovaries);
- medical treatment (chemotherapy or radiotherapy);
- genetic anomaly (Turner's syndrome)
- autoimmune disease (insulin dependent diabetes mellitus);
- viral infection (e.g. mumps, varicella, rubella, etc.);
- endocrine dysfunction;
- fragile X-ray syndrome
- a prolonged stress situation;
- eating disorders such as nerve anorexia;
- excessive tobacco consumption;
- interference of endocrine disruptors.
In cases of early menopause, hormone replacement therapy is of great importance here.ar it makes it possible to compensate for hormonal deficiency and to prevent the risk of osteoporosis by maintaining a sufficient level of oestrogen in the body;
This treatment is called Hormonal Treatment of Menopause (THM) or Hormonal Substitute Treatment (THS), and in Israel by its name Hormonal Replace Therapy (HRT)
- It consists of oral or percutaneous administration (freeze or patch) of estrogen associated with progesterone to protect the uterus.
It is contraindicated in patients with a history of breast cancer.
In patients with early menopause, this treatment is recommended until at least 50 years of age. Beyond this, continued treatment should be discussed as in any postmenopausal patient at a normal age, depending on her wishes and symptoms.
MENOPAUSE (5): What is its impact on LONG-TERM HEALTH?
At the beginning of menopause, these are essentially the functional signs indicated in the previous sheet Menopause No. 3 " The symptoms of menopause"
Hormonal estrogen deficiency also has other effects which, in some women, may favour the occurrence of real diseases (see below).
These include:
- acceleration of bone loss. She
exposes women to an increased risk of osteoporosis and fractures;
- increased insulin resistance with predisposition to type II diabetes;
- of development of atherosclerosis which may promote the occurrence of an angina or even a heart attack.
In the longer term, the consequences of menopause can therefore be:
1. Genital atrophy and VAGINAL SECHERESSE
which worsen with the duration of menopause. (
2. LOSTEOPOROSE post-menopausal:
It is a diffuse skeletal disease, characterized by a decrease in bone resistance leading to an increased risk of fractures.
She's touching 1 in 4 women after menopause.
The most common fractures are: vertebral fractures, wrist (Pouteau-Colles fracture), as well as later in life, fractures of upper end of femur. Fractures of the ribs or upper tip of the humerus may also occur.
Detection of the risk of osteoporosis is possible by measuring bone mineral density (BMD) by osteodensitometry (tsfifout etsem
The risks are greater if you are approaching your menopause with already reduced BMD and/or if you have fracture risk factors: if you have already fractured or had a history of hip fracture in your mother or father, or if you are lean.
Long-term menopause or menopause before the age of 40 is stopped by more than 6 months, certain treatments (GnRH agonists (decapeptyl, enanthone), corticosteroids, anti-aromatases, etc.) are also risk factors for osteoporosis.
Talk to your doctor who will guide you towards the realization of an osteodensimetry.
3. CARDIOVASCULAR DISEASES:
(
they are the consequence of the atherosclerosis, especially at the level of the coronaries, which exposes you to a risk ofMyocardial infarction.
Before menopause the woman is less likely to have a heart attack than the man.
After menopause, this risk increases, and catches up with man
The increase in the incidence of coronary heart disease in postmenopausal women is underpinned by a number of disturbances, themselves related to estrogenic deficiency:
- Metabolic disturbances with increased total cholesterol and LDL fraction that represents bad cholesterol, increased insulin resistance and triglycerides. Some coagulation factors change in the direction of hypercoagulability.
- Direct vascular wall damage: changes in blood resistance with increased blood pressure; endothelial dysfunctions...
A number of studies appear to confirm the favourable effect of oestrogen treatments in menopausal women in the prevention of l-atherosclerosis if this treatment is given early, in the so-called "therapeutic intervention window" period, i.e. in the first 10 years of menopause.
4. THE ALTERATION OF COGNITIVE FUNCTIONS :
Estrogenic deficiency is suspected to cause a deterioration in cognitive functions after menopause (memorization capabilities, verbal performance, abstract reasoning) and in the onset of Alzheimer's disease.
However, it is very difficult to do what is due to menopause and aging.
Early menopause is accompanied by an increased risk of cognitive decline and dementia and treatment with estrogen at least up to 50 years of age cancels in epidemiological studies of observation of this over-risk.
Similar studies suggest that early hormonal treatment after menopause may reduce the risk of Alzheimer's disease, but no randomized studies are available to demonstrate this with certainty.