Menopause and climacteric: When the female body changes

The adjustment process has several ‘side effects’. How can your gynecologist help make this period as smooth as possible?

The lack of estrogens in menopause leads to atrophic changes in the genitals. The amount of cervical mucus decreases as well as the secretions of other glands, which leads to dryness of the vagina and discomfort.

Any small and medium sized fibroids atrophy and thus we often avoid their surgical removal. Also, we observe atrophic lesions in the bladder and urethra, with consequent cystic disturbances. In addition, during menopause, the breasts shrink and relax.

During menopause, there is either a gradual decrease in blood flow and the duration of the period, or a more frequent period or menorrhagia. If severe vaginal bleeding occurs after a six-month break, the gynecologist should investigate it.

The most common symptom of menopause is hot flashes. The percentage of women who complain about them reaches 75%, whether they undergo normal menopause or surgery. Of these women, 80% have hot flashes for up to 18 months and 20% -25% for up to 5 years.

Also, women often complain of night sweats and insomnia, as well as depression by 25%.

Another problem observed by the lack of estrogens is osteoporosis. It is characterized by a decrease in bone mass without changes in the chemical composition of the bones. We observe it first in the vertebrae and then in the long bones.

Estrogens deficiency contributes to an increase in cardiovascular events.

Finally, there is a generalized thinning of the skin, accompanied by a loss of elasticity. This results in the appearance of wrinkles on the neck, face and hands. There is also varying degrees of pubic and armpit hair loss.

We rarely observe a slight degree of baldness, or a slight hypertrichosis .

How to treat menopausal symptoms

For every woman who is in menopause, the doctor must explain the changes that will occur in her body. He does it in order to eliminate any phobias and minimize the symptoms of anxiety, depression and sleep disorders.

When the symptoms of hot flashes and vaginal atrophy are severe, we prescribe estrogens. Estrogen stimulation has an effect on the body. They cause endometrial hyperplasia and eventually cancer if given without progesterone. No study is absolutely sure, though.

As for breast cancer, the results of the studies are contradictory. The only sure thing is that long-term estrogen intake increases the chance of the disease by 1.2% to 1.5%. Blood pressure does not appear to be affected by estrogen therapy, although women with hypertension need to be treated carefully.

An increase in the frequency of thromboembolic episodes has not been proven with certainty. There is an increase in the frequency of cholelithiasis with estrogen stimulation. There are some absolute contraindications to estrogen stimulation. These are: vaginal bleeding, acute thrombophlebitis, chronic liver failure. Others are history of thromboembolic events, ocular vascular disease, endometrial and breast cancer.

Tivolone is widely used in Europe and in countries other than the USA. It is a synthetic steroid whose metabolites have androgenic, estrogenic and progesterone activity. It reduces hot flashes and acts on osteoporosis, while having an effect on the symptoms of sexual dysfunction.

There is a risk of thromboembolic incedents