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Menopause: the most common problems
Menopause is the period in a woman's life when her fertile years end and menstruation ceases permanently.
In most cases it occurs around the age of 50 (with a normal range between 45 and 55 years).
You “officially” enter menopause after stopping your menstrual cycle for 12 months.
In the 5-8 years preceding menopause, the follicular reserve is exhausted and the ovary undergoes a slow decline, becoming increasingly smaller and atrophic.
Compared to other organs, the ovary has a lifespan halved, probably to protect women from the high risk of pathology associated with late-life pregnancies.
Failure of the follicles to mature is manifested by a significant decrease in endocrine activity, signaled by a sharp drop in measurable hormone levels in the blood, such as estrogen, androgens, inhibin B and anti-Müllerian hormone, and by the disappearance of cyclical progesterone production.
In response to this imbalance and in an attempt to promote follicular growth, the pituitary gland increases the synthesis and release of the gonadotropin FSH, but to no avail, since the few hundred remaining follicles are no longer sufficient to organize the menstrual cycle.
Depending on the age of onset, it is defined as:
• Premature when it starts before age 40
• Premature when it starts before age 45
• Late when it occurs after age 55
Menopause is usually spontaneous, but there is also a form of "artificial menopause" caused by surgery, cancer treatments, infectious or chemical agents, or metabolic diseases, enzyme defects, or autoimmune mechanisms, which often involve the adrenal gland and thyroid, as well as the ovaries.
Factors that influence its onset:
• Hereditary factors: daughters tend to show it at the same age as their mothers
• Ethnic factors: African women enter menopause earlier and Japanese women later than European women, while Italian women enter menopause on average around the age of 51
• Behavioral factors: the habit of smoking brings forward the age of menopause by 1-3.5 years because it has a toxic effect on the ovary, destroying a significant proportion of follicles
• Length of the menstrual cycle: a long cycle, and therefore less frequent ovulation, implies a lower consumption of follicles and a longer-lasting reserve, therefore tending to delay menopause.
An Italian woman today has a life expectancy of 84.6 years, which means that when menopause arrives (between the ages of 45 and 55) she has almost 30 years of active life ahead of her.
A woman in menopause can have children at a young age or very young and is often still in the prime of her working life.
Menopause is therefore no longer exclusively synonymous with aging.
Yet for many Italian women, menopause is still considered a negative phase of life: in fact, 61% say they feel worse than before the end of their menstrual cycle.
Pre-menopause, peri-menopause and post-menopause
The period leading up to menopause is divided into several phases:
• Pre-menopause: This period varies in duration and is characterized by the initial loss of fertility, even in the presence of nearly regular menstrual cycles. During this period, plasma levels of inhibin B decrease, and blood levels of FSH are higher at the beginning of the cycle because the follicular reserve is no longer viable. Estrogen levels also progressively change, leading to the absence of ovulation and progesterone deficiency.
• Perimenopause: a term that covers a long period and a broad spectrum of both physical and psychological changes, lasting approximately 5-7 years. It extends from the period of full fertility to the first year following the definitive cessation of menstrual flow, and its onset shows a clear correlation with the onset of menopause itself. A reduction in estrogen and progesterone and a notable increase in pituitary gonadotropins (FSH and LH) are observed.
• Postmenopause: Postmenopause is the period of life between menopause and the onset of old age, which begins on average around age 65. This phase of life begins approximately 12 months after the last menstrual cycle and is characterized by a further increase in FSH and LH and a definitive decrease in estrogen. The most notable difference between perimenopause and postmenopause is the reduction of the main menopausal symptoms experienced during the transition phase.
Symptoms of menopause
The Hot Flashes:
Hot flashes are the most characteristic symptom of menopause: a hot flash is a sudden, transient, subjective sensation of heat that spreads across the chest, face, and head, accompanied by redness and sweating.
Hot flashes represent a vasodilation induced by an alteration of the thermoregulatory center located in the hypothalamus.
They manifest as a feeling of increasing heat in the chest and face, accompanied by flushing and sweating, followed by a feeling of coldness with possible chills, lasting a few minutes. When they occur at night, hot flashes can lead to sudden awakenings with sweating, potentially contributing to increased difficulty falling asleep or early morning awakening (insomnia).
Irritability and insomnia
Menopausal women often experience sleep problems, fatigue, and irritability.
However, some psychological problems, which are quite frequent during menopause, should not be underestimated:
• Depression
• Anxiety
• Panic attacks
• Difficulty concentrating
• Decreased sexual desire.
This happens because estrogen deficiency after menopause accelerates brain aging and psychological vulnerability: in this way, the functions that regulate a general sense of well-being tend to progressively become impoverished.
Skin and joints
Due to estrogen deficiency, in the first 5 years following menopause, collagen decreases by approximately 30%, creating problems in various organs and systems.
The dermis has less collagen and loses elasticity, so during menopause, skin tends to become dry and thin.
Bone and joint pain, which appears after menopause, and certainly alterations in the genital tissues, could also be attributed to a lack of collagen.
Collagen and skin thickness decrease with aging, but the loss is exacerbated during menopause: it is most rapid in the first years after menopause, and as much as 30% of the skin's collagen is lost in the first 5 years after menopause, causing a variety of symptoms.
There is a relationship between collagen content, skin thickness, and bone density.
Effects of collagen reduction
• Arthralgia
• Gingival atrophy and retraction
• Reduction of the alveolar bone
• Loss of skin elasticity
• Dryness of the tongue and oral cavity
• Dry and red eyes
• Vaginal burning, dryness, redness
Weight gain
Gaining excess weight, with uneven distribution throughout the body, is very common: it's a consequence of loss of muscle mass and increased fat tissue. Typically, waist circumference and abdominal fat increase during menopause.
The progressive loss of muscle mass also makes it more difficult to burn calories during physical activity and therefore increases the tendency to gain weight.
The drop in estrogen, general endocrine systems and the reduction in basal metabolism make it more difficult to lose weight and fight fat deposits on the body.
Osteoporosis
After age 45, the cells that form new bone are slower than those that remove bone: the result can be a decline in bone mass and the consequent development of osteoporosis. Normal bone is dense and strong, while osteoporotic bone thins, increasing the risk of fracture.
How to manage the negative effects of menopause?
Constant physical activity
Correct and constant physical activity has multiple beneficial effects:
• Stimulates bone remodeling
• Stimulates endogenous collagen production
• Promotes joint well-being
• Supports and increases muscle mass
• Helps maintain physical fitness
• Promotes good mood and reduces anxiety and depression
• Decreases the likelihood of developing cardiovascular diseases
It's crucial to remember that muscle mass is closely related to good health, so it's important to alternate aerobic exercise to promote cardiovascular health with resistance training to help maintain muscle mass. Muscle tissue is metabolically highly active, allowing for efficient calorie burning even at rest.
Correct and slightly hypocaloric diet
Especially during the transition period, but these indications would always be valid for the entire population at any time in life, a slightly low-calorie, varied and balanced diet would be preferable, which includes:
• Foods containing calcium and vitamin D, to promote bone health
• Antioxidants present in fruits and vegetables of different colors
• Vitamin C, essential for collagen synthesis
• A good protein intake, to support muscle mass
• A good supply of mono and polyunsaturated fatty acids, for cardiovascular well-being
• A good supply of fibre, to control the absorption of sugars and fats and to promote intestinal well-being
Supplements and Nutraceuticals
Angelica: The products obtained from the root and fruits of this plant are recommended for amenorrhea, during periods of irregular flow and to relieve menstrual cramps and the symptoms of menopause.
From a pharmacological point of view, these effects would be associated with the presence of phytoestrogens, substances that mimic the action of female hormones, but which act in a much milder way.
Red cloverRed clover belongs to the legume family and is known to be a valuable ally during menopause. This is due to the presence of flavonoids, with powerful antioxidant properties, and isoflavones, which resemble estrogen in both structure and function.
Red clover is also rich in minerals (chromium, magnesium, calcium, silicon, phosphorus), potassium and vitamins (niacin, thiamine and vitamins A, B12, E, K, C), which contribute to the general well-being of the body.
Red clover is able to reduce the typical symptoms of menopause thanks to an action similar to that of estrogen and helps to combat the typical disorders of menopause, in particular:
• hot flashes
• sleep disorders
• tachycardia
• heachache
• mood swings
• vaginal dryness
Black cohoshThe most significant components of the plant are triterpene glycosides (actein, 27-deoxyactein, cimicifugoside), phenolic acids (caffeic, fukinolic and isoferulic), quinolizidine alkaloids (cytisine, methylcytisine), flavonoids and resins (cimicifugin) for 15-20%.
The mechanism of action is still unclear, although recent studies seem to highlight brain activity. Specifically, they have shown how the Black Cohosh phytocomplex and some specific compounds appear to work together to combat the various symptoms of menopause by regulating the concentrations of specific substances in the brain (involved in the regulation of the dopamine, serotonin, GABA, and μ-opioid pathways) that are altered by the hormonal changes typical of menopause.
These brain changes are linked to the onset of symptoms typical of this stage of life.
For example, let us remember that alterations in the concentration of serotonin, the neurotransmitter of good mood, and noradrenaline, not only promote anxiety, irritability and a tendency towards depression in menopausal women, but can be associated with anomalies in body thermoregulation, favouring the onset of hot flashes and night sweats, as well as an increased appetite.
Chaste treeThe part used for phytotherapeutic purposes is the ripe, dried fruit of the plant, a reddish-black berry containing four seeds. Its main components are essential oils, alkaloids, flavonoids, and iridoids. Thanks to its phytocomplex, chasteberry is highly effective during menopause.
The action of Agnus castus is given by the sum of the active ingredients.
Its hormonal mechanism occurs in the anterior lobe of the pituitary gland, where it inhibits the production of prolactin by stimulating LH (luteinizing hormone), modifying its blood levels.
Vitamin DThe biological function of vitamin D is to increase the intestinal absorption of minerals such as calcium, phosphorus and magnesium, and to regulate bone metabolism and the immune system.
The 2 most important forms of this vitamin are:
1. Vitamin D2 (ergocalciferol): of plant origin and produced by plants
2. Vitamin D3 (cholecalciferol): produced by mammals
The drop in estrogen that occurs after the end of the fertile period, in fact, also leads to a reduction in calcium that is fixed in the bones, which thus become more fragile and at risk of fractures.
Furthermore, scientific studies are increasingly warning us about the close relationship between vitamin D deficiency and the increased risk of developing diseases such as diabetes, hypertension, or excess cholesterol in the blood.
The link between the presence of vitamin D and the production of an estrogenic steroid hormone called estradiol, important for a woman's well-being during menopause, is now well known.
Collagen: Collagen intake stimulates the regeneration of cartilage tissue by increasing the synthesis of its compounds and reduces joint disorders.
Collagen is the primary structural element of bones, cartilage, tendons, and ligaments; it promotes recovery and prevents arthritis and osteoporosis. Hydrolyzed collagen is rapidly absorbed in the intestine and reaches the tissues where it plays an important structural role. Furthermore, thanks to its interaction with Peyer's patches, it can stimulate endogenous collagen production, thus serving a dual beneficial function.
Where can we find these components?
ESTROGREEN It is indicated for women in the pre-climacteric period, it contains angelica (dong quai), red clover and black cohosh which help to counteract menopausal symptoms, combined with passionflower, useful for a physiological relaxing effect, and chasteberry, useful for counteracting menstrual cycle disorders.
COLLAGENIAL 5000 It is a food supplement of hydrolyzed marine collagen, hyaluronic acid, resveratrol and vitamins in ready-to-drink vials, with a fresh green apple flavour.
In particular, vitamin C contributes to normal collagen formation for the normal function of the skin and, together with zinc, contributes to the protection of cells from oxidative stress.
Niacin and biotin contribute to the maintenance of normal skin.
COLLAGEN NUTRIPEP It is a food supplement of hydrolyzed bovine collagen, hyaluronic acid, zinc and vitamin C.
The product comes in a water-soluble powder form, with no added sugar or flavor. It can therefore be dissolved in any hot or cold beverage. The product provides a daily dose of 10 g of collagen. It provides a beneficial skin treatment.
Dr. Sara Bernardi
Nutritionist Biologist and Pharmacist
Bibliography:
Menopausal Symptoms and Their Management.
Santoro N, Epperson CN, Mathews SB.Endocrinol Metab Clin North Am. 2015 Sep;44(3):497-515. doi: 10.1016/j.ecl.2015.05.001.
Bacon JL.Obstet Gynecol Clin North Am. 2017 Jun;44(2):285-296. doi: 10.1016/j.ogc.2017.02.008.PMID: 28499537 Review.
Menopause transition: Physiology and symptoms.
Talaulikar V.Best Pract Res Clin Obstet Gynaecol. 2022 May;81:3-7. doi: 10.1016/j.bpobgyn.2022.03.003. Epub 2022 Mar 16.PMID: 35382992 Review.
Managing menopausal vasomotor symptoms in older women.
Stuenkel CA. Maturitas. 2021 Jan;143:36-40. doi: 10.1016/j.maturitas.2020.08.005. Epub 2020 Aug 26. PMID: 33308634 Review
Lialy HE, Mohamed MA, AbdAllatif LA, Khalid M, Elhelbawy A.BMC Womens Health. 2023 Jul 8;23(1):363. doi: 10.1186/s12905-023-02515-9.PMID: 37422660
Botanicals and Their Bioactive Phytochemicals for Women’s Health.
Dietz BM, Hajirahimkhan A, Dunlap TL, Bolton JL.Pharmacol Rev. 2016 Oct;68(4):1026-1073. doi: 10.1124/pr.115.010843.PMID: 27677719
Danggui Buxue Tang (Astragali Radix and Angelicae Sinensis Radix) for menopausal symptoms: A review.
Lin HQ, Gong AG, Wang HY, Duan R, Dong TT, Zhao KJ, Tsim KW.J Ethnopharmacol. 2017 Mar 6;199:205-210. doi: 10.1016/j.jep.2017.01.044. Epub 2017 Feb 2.PMID: 28163116
A systematic review of herbal medicinal products for the treatment of menopausal symptoms.
Huntley AL, Ernst E.Menopause. 2003 Sep-Oct;10(5):465-76. doi: 10.1097/01.GME.0000058147.24036.B0.PMID: 14501609
Mohsen A, Fatemeh K, Leila N, Mona P, Mohammad Z, Mozafar KJ Tradit Chin Med. 2021 Aug;41(4):642-649. doi: 10.19852/j.cnki.jtcm.20210324.001.PMID: 34392659
Black cohosh (Cimicifuga spp.) for menopausal symptoms.
Leach MJ, Moore V.Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD007244. doi: 10.1002/14651858.CD007244.pub2.PMID: 22972105
Naseri R, Farnia V, Yazdchi K, Alikhani M, Basanj B, Salemi S.Korean J Fam Med. 2019 Nov;40(6):362-367. doi: 10.4082/kjfm.18.0067. Epub 2019 May 9.PMID: 31067851
Wu J, Yu M, Zhou Y.Int J Rheum Dis. 2017 Jul;20(7):903-910. doi: 10.1111/1756-185X.13052. Epub 2017 Mar 5.PMID: 28261929
Calleja-Agius J, Muscat-Baron Y, Brincat MP. Menopause Int. 2007 Jun;13(2):60-4. doi: 10.1258/175404507780796325.PMID: 17540135
