They suffer an obvious hormonal downturn with the end of their period. Them, a subtle but relentless decline. They have a lifetime left, and medicine seeks the most effective way to erase minor and andropausal symptoms.
Anna, a 50-year-old Catalan, is the executive secretary of a multinational company. From Monday to Friday, her life goes by at cruising speed, hanging on the phone and on last-minute urgent orders. One afternoon while he was getting ready to buy a soda, intense heat invaded his body. He felt nauseous and dizzy. Scared, she asked for help and called 112 convinced that she was having a heart attack. As he heard the ambulance siren approach, the heat dissipated and everything returned to normal. Then he realized: he had just had his first hot flash!
A known stage, but little studied
The heats that overwhelmed Anna affect many women. Its intensity is variable: from a terrifying drowning sensation that makes you think of the worst and call the ER to milder symptoms that are relatively normally endured. Millions of women go through menopause without much information. For scientists the study of this biological phase is also relatively new. It is not a disease, nor is it a synonym for old age. Menopause only marks the date of the last menstruation. Before, there are misalignments in the cycles that doctors call perimenopause. The stage after the disappearance of the rule is called postmenopause and the set of these three phases is defined as the climacteric. Except in sick women or women undergoing certain operations, menopause begins spontaneously. The ovarian circuits slow down as estrogen is depleted until it cannot guarantee ovulation each month. The number of follicles and the production of two other hormonal players are also reduced: androgens and progesterone. Only after a year without periods can a woman be sure that she is going through menopause. This happens, on average, at age 51.
Much earlier, in perimenopause, the female brain begins to be less sensitive to estrogen. This triggers a cascade of symptoms that vary from month to month and year to year: hot flashes, achy joints, sudden changes in sexual desire, distress and depression. During this stage, the vast majority of women suffer from hot flashes, a sensation of intense and sudden heat that extends from the chest to the face. It is accompanied by palpitations and bouts of anxiety. They can occur once a week or several times a day. No rules. Nor are there any for its duration, which ranges from 30 seconds to five minutes, sometimes it can even be extended … up to half an hour! They often say that they feel as if their body is on fire. In search of relief, they choose to remove some clothing, open a window, or take out the fan. However, it is not the internal temperature of the body that is altered, but rather that of the skin, which increases between 1ºC and 4ºC, and in the most extreme cases rises up to 7ºC.
X-ray of untimely sweats
Scientists don’t know exactly what happens during a hot flash. Estrogen plays a role, but it is already known that it is not the answer to all questions. Various studies have not found significant differences in the levels of this hormone between women who suffer from these hot flashes and those who do not. Another hypothesis assures that the decrease in estrogen may affect the hypothalamus, a region of the brain the size of a thimble that controls blood pressure, temperature, hunger, thirst and sex. In a normal situation, information reaches the hypothalamus from all parts of the body for processing, but during menopause fluctuations in hormone levels can confuse it.Before a woman is surprised by heatstroke, this limbic structure has received the wrong message that the dermis is too hot. So try to cool the area. The heart pumps faster, the blood vessels in the skin dilate to allow more blood to circulate, and the sweat glands open and release their contents.
Robert Freedman of Wayne State University in the United States has studied hot flashes for 25 years. In his latest work, he has looked at the female brain using the functional magnetic resonance imaging (FMRI) technique. Thus, he has seen that during a hot flash, the insular cortex, the brain structure involved in understanding all the internal events of the body, appears more active. Researchers have found no activity in the hippocampus. According to Freedman, “Menopausal women with hot flashes have a lower level of tolerance to small increases in body temperature.”In a normal situation, the body maintains its temperature in a range or thermoneutral zone that is comfortable for it.. When the body temperature exceeds the upper limit of this zone, we sweat. If it falls below the lower limit, we shiver.
When the body thermometer goes crazy
“Women who do not suffer from hot flashes of menopause have a wider thermoneutral zone. In those who do, this interval is very narrow, practically non-existent. As a consequence, small changes in temperature – even one tenth – can trigger a sudden sensation of heat and sweating “, says the American expert.
Why is the thermoneutral zone narrowing? In addition to the drop in estrogen, other studies point to the neurotransmitter norepinephrine, also known as norepinephrine. Its abundant presence in the brain, as shown in animal tests, reduces the
comfortable temperature range for the body.
As if that weren’t enough to suffer from hot flashes at the most inopportune moments, menopause also robs hours of sleep. Our rest is divided into REM and non-REM phases, which occur alternately during the night. The non-REM phase is subdivided, in turn, into four others that range from wakefulness to deep sleep. As we age, we spend less time in deep sleep and more in light sleep, where anything can wake us up. Changes in estrogen and progesterone levels are partly responsible for these alterations due to their effect on respiration, mood, and body temperature. Variations in norepinephrine and the neurotransmitter serotonin could also be related.
Visceral fat, much more dangerous
From the arms of Morpheus we pass to the arrows of Cupid. “Menopause is not the end of sexuality either, but it can lower libido”, explains Montserrat Manubens, gynecologist at the Dexeus Institute in Barcelona. At this time the lubrication of the vagina decreases, its walls thin, lose elasticity and bleed easily on contact. Pain during intercourse causes some women to never be able to orgasm again. Others simply stop feeling that they are attractive to their partner.
This is all due in part to testosterone, the powerful fuel for the sex drive. During menopause, women have already lost up to 60% of the levels they had in their 20s. So why do some, far from losing their sexual appetite, have more desire than ever? The answer must be sought in the variations in hormonal levels typical of menopause that cause peaks in testosterone that increase sexual desire in many women. On the other hand, not having to worry about possible pregnancies and other gynecological problems frees them up. “Each woman experiences this stage in a different way depending on her character and her personal circumstances,” adds Rosa Porqueras, a gynecologist at the Barcelona institute.
During menopause the metabolism slows down and it is common to gain a few kilos. These reserves accumulate in areas considered typically male: the belly, neck, chin or abdomen. Curves are no longer necessary to attract male attention and the female body is rounded. Sagging also makes an appearance. As we get older we become more sedentary and burn fewer calories. In the long run that means less muscle and more fat.
Fighting this tummy is much more than a matter of vanity. Part of the weight gained during menopause is stored as subcutaneous fat in the thighs and abdomen. The other is stored as visceral fat close to vital organs. Subcutaneous and visceral fat not only differ in their body location, since several investigations have shown that visceral fat cells are more active and that there is an association between their high levels and the risk of suffering from certain diseases. If we consume excess calories, we will probably accumulate visceral fat.
Too much estrogen increases the risk of cancer
The risk of developing cancer increases with age and hormonal imbalances. In the case of breast tumors, the danger is related to continued exposure to estrogen. Those women who had their first period before the age of 12 and those who reached menopause after 55 are more likely to develop this cancer. Those who have never been pregnant, those who had their first child after 30 or those with a family history are also at higher risk. Thus,specialists recommend that from the age of 40, annual mammograms be performed. At this time the breasts become less dense and it is easier to detect abnormalities.
Estrogen also supports the growth of the endometrium, the innermost layer of the uterus. Instead, progesterone triggers the shedding process of this layer if fertilization has not occurred. This is the menstrual cycle. A woman taking estrogen to treat hot flashes also needs a progesterone supplement so that her endometrium does not grow too large and develop a malignant tumor.
Menopause is also a stage of emotional changes. ? Many women see the opportunity to recover activities that they had abandoned to take care of their children or to resume life as a couple. Some even start new relationships. However, others experience these changes in a negative way and may even develop a depressive picture. Low levels of estrogen have been shown to change the amount of serotonin, dopamine, and norepinephrine available to the brain and are associated with a good mood and sense of well-being.
A decade ago, experts strongly recommended taking hormones to relieve symptoms of menopause. All of this changed in 2002 when theNational Institute of Health of the United Statesdecided to stop the Women’s Health Initiative study on hormone replacement therapy in its tracks. The first results showed that women treated with estrogen and progesterone had a higher risk of breast cancer, heart attacks and thrombosis than those who did not follow this therapy or only took estrogen.
Although it was later shown that this increase was not statistically significant, many physicians rectified their positions. Millions of women dropped out of treatment, and since then, HRT has become unpopular and many people turned to natural remedies.
Solutions to relieve vaginal dryness
At this time the indications for hormone replacement therapy are clear:? Only for cases of early menopause, climacteric syndrome, vulvovaginal atrophy or for women with recent menopause and a high risk of osteoporosis, although in the latter case there are alternatives that should consider ?, explains Dr. Manubens. For a woman who only suffers from hot flashes or vaginal dryness, it is more convenient to resort to pills, patches, small doses of estrogen applied directly to the vagina or other treatments. How do you know which is the most appropriate procedure? “For the first years, when most of the symptoms persist, and as long as there are no contraindications, hormonal therapy at low doses and for the shortest possible time is recommended.. Then you can go on to other treatments to prevent, for example, osteoporosis, “says Dr. Manubens. In general, it is better not to extend the treatment for more than five years. Specialists consider it very important to follow a diet rich in calcium, without excess fat, and moderate physical exercise.
There are many non-hormonal medications and treatments that are also effective. This is not the case with bioidentical hormones, very popular compounds in the United States, but which have not yet received the approval of specialists or scientific societies. “There are no medical or scientific reasons to recommend bioidentical hormones. Personalized hormonal preparations have not been studied and their purity and risk are unknown,” the International Menopause Society said in a statement.
What is proven is the impact of phytoestrogens, present in foods such as soy, on the symptoms of menopause. They are known to act on estrogen receptors and mimic the action of this hormone. In addition,? They are antioxidants, provide cardiovascular benefits and slow down the loss of bone mass ?, adds Dr. Porqueras.
Natural therapies, but also double-edged weapons
Both gynecologists agree that natural therapies for menopause have side effects. Other techniques, such as acupuncture, appear to be effective for hot flashes, as do respiratory physiotherapy and relaxation techniques, although why and how they work is unknown.
For many women, delaying menopause would be the most desired sleep. Recently researchers at the University of Guelph, in Canada, have succeeded … but only in rats. Scientists have prolonged the activity of the ovaries by blocking the genes that control cell death. Is it really a bargain to delay menopause? ? It might seem beneficial, it would delay osteoporosis and there would be less cardiovascular risk, but subjecting the breast and endometrium to a continuous boost of estrogen could increase the risk of cancer ,? concludes Manubens.
The lack of studies that clarify the mystery of menopause is evident. Meanwhile, women, husbands and children have to learn to live with the symptoms of this phase of female life. In the absence of effective and safe treatments, the best therapy consists of affection, a sense of humor, and patience.
How is the male menopause?
Soule Marcos
