by Dr. Salvatore Garsia – Gynaecologist – Columbus Clinic Center

After 48 years of age, any problem a woman may have is going to be blamed on the menopause. Feeling tired? Got a sore knee? In a bad mood? Ah! It’s the menopause!!

It’s talked about as if it were a horror film. But in actual fact, it’s really just a particularly important moment that every woman goes through, and the changes that take place should be seen as both natural and physiological.

It’s a complicated time of life and a variety of problems, some serious, others less so, mean that over 50% of women find it unpleasant. Making sure a woman is well informed about the hormonal, physical and psychological changes that she will go through will help her live this period of her life with a more positive attitude and with a better understanding of what’s happening.

It’s important to evaluate the risks of each individual: the cardiovascular system, and metabolic, oncological, osteoporotic and cognitive problems (two-thirds of degenerative brain disorders are experienced by women). Many disturbances related to the menopause can compromise a woman’s quality of life: hot flushes, disrupted  sleep patterns, vaginal dryness, and, above all, short-term memory loss.

Knowing precisely at what stage the woman is at is essential, and understanding exactly when she goes into menopause will help identify this. She must be encouraged to take part in screening programmes for cervical, breast and colon cancer. Vaginal ultrasound to examine the ovaries and measure endometrial thickness can also be helpful.  A healthy diet and physical exercise, together with smoking and drinking less are the best strategies to adopt.

Seventy-five percent of women in pre- or full menopause will suffer hot flushes, which in 20% of cases can go on for years if nothing is done to help. Problems of the circulatory system are due to the brain being more sensitive to the  reduction in hormones, above all oestrogen, and are related to an increased risk of some chronic pathologies (cardiovascular diseases, osteoporosis, etc.). As long as there are no contraindications, and after a careful evaluation of the possible risks and benefits, a woman with  symptoms that have a negative impact on her quality of life can start a personalised hormone treatment.

If she prefers not to have replacement hormone therapy, or if there are reasons why this wouldn’t be suitable for her, pharmaceutical and other complementary products are available, such as DHEA-stimulating phytoestrogens, resveratrols, acupuncture, etc. It must be remembered, however, that these therapies do not have the same weight of scientific research behind them. Once menopause has started, genitourinary syndromes can be frequent, characterised by bladder problems and vaginal burning, vaginal dryness, problems and pain during intercourse, an increased need to urinate (with or without incontinence), dysuria, and cystitis.

Therapy should be started before the vaginal and vescical mucosa undergo any changes (as these are full of hormone receptors) and should be continued over time. CO2 laser and radiofrequency biostimulation seems promising in cases in which hormone therapy is not appropriate or proves inadquate.

In menopause, age-related osteopenia is significantly increased and often develops into osteoporosis with an increased risk of fractures. Replacement hormone therapy with Vitamin D and calcium supplements are the treatment of choice when started early. Possible non-hormonal therapies, when needed, include pharmaceutical products that target the bones, such as biphosphonates, denosumbab, SERMs, and teriparatide.

Special attention must be given to early and perimenopause, and these require a separate, detailed chapter.

So, this is a complex and, for more than 50% of women,  unpleasant time of life. Adopting the right approach and dealing with menopause in an appropriate way can make all the difference for the woman going through it.

The history and the treatment of menopause is, still today, full of taboos, of symptoms that nobody talks about or that women are exasperated about, and unfortunately, medicine itself has contributed to creating a grey area that makes it difficult for her to choose which treatment is best for her. It’s important, therefore, to change how people perceive the menopause. By increasing women’s awareness, we can  help them deal better with this particular period of their life through appropriate life-style changes and, where necessary,  targeted therapies.