Menopause

Menopause is a normal stage of life for a woman that corresponds to the stopping of ovarian activity. It signals the end of the hormonal production of progesterone, the end of ovulation, and, thus, fertility, as well as the stopping of periods. Menopause generally occurs between the ages of 45 and 55. Hormonal fluctuations that precede it bring on various physiological changes accompanied by various physical and psychological disorders. They can also cause osteoporosis and cardiovascular diseases. To minimize the negative effects of menopause, it is recommended to practice a healthy lifestyle, particularly by having a balanced diet and exercising regularly. Substitutive hormonal treatments that compensate for hormonal deficiency may also be prescribed. In addition to the natural process of aging, menopause may have genetic, autoimmune, or medical causes, like ovary ablation or chemotherapy.

sagittal section

posterior view

Signs of menopause

Approaching menopause, 80% of women experience a certain number of physical and psychological issues, including hot flashes, night sweating, insomnia, mood swings, and irritability. Menopause also entails, at varying degrees, changes in the female body: stopping of periods; changes in skin, nails, hair, and mucous membranes; decrease in volume of mammary glands; greater susceptibility to urinary tract infections; sometimes incontinence. Before stopping, the menstrual cycle is irregular. Continuing to use a method of contraception during the first 12 months of amenorrhea is recommended.

anterior view

breast

anterior view

urinary system

Substitutive hormonal treatment

To minimize or eradicate the functional issues related to menopause, some women may be prescribed substitutive hormonal treatment (SHT). This hormone therapy, designed to replace the hormones that the ovaries cease to produce during menopause, generally combines estrogens and progestin. Estrogens combats the disagreeable symptoms of menopause. Progestin (natural or artificial substance) produces effects similar to those of progesterone and compensates for the negative effects of estrogens on the endometrium (risk of cancer).

There are several types of SHT that differ in dosage or method of administration (pills, transdermal patches, gels, nasal solutions).
Taking an SHT may be contraindicated, particularly in the event of liver disease, unexplained vaginal bleeding, or thrombosis or breast cancer antecedents. As SHT does not prevent ovulation, it cannot be used as a contraceptive.

Controversy surrounding SHT

SHT allows many women to limit the negative effects of menopause, like hot flashes, mood swings, vaginal dryness, and night sweats. This treatment also decreases the risk of colon cancer and osteoporosis. However, numerous studies put the beneficial effects of SHT into question. They claim that some types of SHT, especially those that are taken over the long term, can increase the risk of cardiovascular disorders (vein thrombosis, myocardial infarction, cerebral vascular accidents). They can also increase the risks of developing breast or ovarian cancer. Studies on a larger scale must corroborate these results, but, in the interim, a doctor can determine case by case the necessity of following the treatment and the existing risk factors. An adapted dose and medium-term treatment, supplemented by regular medical monitoring (gynecological exam, mammogram, colonoscopy, etc.), may present lower risks.