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Effects of menopause on women's physical and mental health

Effects of menopause on women's physical and mental health

Published: 22 January, 2024 | 12'

Introduction

The hormonal changes that occur during female aging are more evident at the menstrual cycle level. Estrogen levels decrease and other hormones vary, causing changes in the ovaries as well as in other organs. Menopause is a natural stage in a woman's life cycle that represents the cessation of fertility. Although it is not commonly considered a "pathology," there are annoying symptoms that disrupt social and work dynamics, so their management should always be consulted with a specialist.

Definition of menopause

Menopause is the cessation of ovarian function and therefore, of menstruation. The age at which this change occurs is between 45-55 years old. It is important to differentiate natural menopause from menopause that occurs due to some physiological cause (e.g. removal of the ovaries), which can occur at any age.

The stages of the female reproductive system can be classified as follows:

  • Reproductive stage: from menarche (first menstruation) to menopause.
  • Perimenopause: which can last several years and is characterized by menstrual irregularities, mainly due to changes in follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels.
  • Menopause: is defined when there is absence of menstruation for 12 consecutive months, and there is a marked reduction in estrogen levels.
  • Postmenopause: which occurs after the final menstrual period.

During the perimenopause and menopause phases (or menopausal transition), the main symptoms occur:

Vasomotor symptoms: which are associated with circulatory and hormonal changes. Women experience them before, during, and after menopause, in over 55% of cases.

Vaginal dryness: the level of estrogen directly affects the structure of the vaginal mucosa. Reduction in estrogen levels leads to dehydration of the area and fragility of the tissue. Its incidence in menopausal women ranges from 27% to 60%.

Disruption of sleep cycle: due to hormonal variation, women may lose up to 25 minutes of nighttime sleep, and this is especially common during the postmenopausal period11.

Mood swings: different studies have found that women during the menopausal period are 3 times more likely to experience a negative mood episode11. These episodes may be related to estradiol and FSH levels.

General changes in the body

Body weight

Menopause is associated with metabolic changes that often lead to an increase in body fat. The energy metabolism of fats becomes imbalanced, resulting in greater accumulation of adipose tissue at the expense of muscle tissue, thereby altering body weight. Body fat, which is 26% at the age of 20, increases to 33% at the age of 40, and then rises to 42% at the age of 501.

Due to these metabolic changes, it is essential to adjust the diet and engage in physical exercise to maintain weight. These changes in accumulated fat not only have aesthetic implications but also significantly impact cardiovascular health.

Vaginal mucosa

The reduction in estrogen levels affects the tissues of the vagina, collagen, and blood vessels in the area, leading to progressive vascularization and dryness of the vaginal mucosa, reducing its elasticity, thickness, and making it more fragile and shorter. This condition is known as vaginal atrophy. Additionally, the labia minora, clitoris, uterus, and ovaries decrease in size. Changes in the vaginal mucosa can make sexual intercourse painful (dyspareunia).

To maintain the vaginal structure and overall pelvic area, here are three main suggestions:

Urinary tract

Estradiol also determines the structure and functionality of the bladder and the urethra, both of which experience a loss of elasticity, thickness, and in the case of the urethra, shortening during menopause. As a result, various urinary symptoms may arise:

  • Due to the shortened length of the urethra, microorganisms have easier access to the urinary tract, and some women are more prone to urinary tract infections.

  • The loss of elasticity in urinary tissues can lead to strong, frequent, and sudden urges to urinate (vesical tenesmus), involuntary urine leakage or incontinence due to urgency or exertion (such as coughing, laughing, or standing up), constant urge to urinate during the day or night (polyuria and nocturia), and burning sensation when urinating (dysuria).

Similar to vaginal atrophy, strengthening the pelvic floor muscles with Kegel exercises and using vaginal moisturizers can help alleviate symptoms of incontinence. In addition, measures such as restricting fluid intake, for example, before going out or 3 to 4 hours before bedtime, and avoiding foods that irritate the bladder (such as caffeine and spicy or salty foods) are beneficial.

Physical Health and Menopause

Hormonal Changes

As mentioned earlier, hormonal changes mainly focus on FSH, LH, and estrogen. Let's briefly see how they occur.

The number of ovarian follicles (which directly determine fertility) progressively decreases with age, leading to increased FSH levels and decreased estrogen levels. Normally, during menstrual cycles, hormones directly act on the ovaries to lower FSH levels. However, as menopause begins and fewer follicles are available, inhibin levels decrease, estrogen levels reduce, and the gonadotropic hormone activates, stimulating an increase in FSH levels.

These changes occur before and after the last menstrual period, with FSH levels increasing 2 years before and estrogen levels decreasing 2 years after. These levels stabilize 2 years later. Estrogen levels during perimenopause range from 45-854 pmol/L and drop below 100 pmol/L during menopause. In addition, other hormones such as progesterone, testosterone (which is converted into estrogen), and serotonin also decrease.

Changes in hormonal activity affect various organs in the body (which we will discuss later), but we will outline 5 events that indicate the onset of menopause:

  • Hot flashes and night sweats, which can occur on average up to 7 years after menopause begins. They are characterized by skin reddening on the head, neck, and chest (due to the widening of blood vessels close to the skin). This is often accompanied by an elevated heart rate and intense heat sensation (flush), which ends with profuse sweating. Episodes can last from 30 seconds to 5 minutes and may be followed by chills. Some tips for alleviating these symptoms include avoiding the consumption of spicy foods and caffeine, taking care with clothing (preferably wearing cotton garments), learning proper breathing techniques, and losing weight.
  • Breast tenderness, caused by fluid accumulation in the breasts due to hormonal variations. This can cause a burning or stabbing pain, and the size and shape of the breasts may change. Maintaining a low-saturated-fat diet, reducing caffeine consumption, quitting smoking, or taking a hot shower are good tips for relieving this symptom.
  • Migraines, which occur due to reduced estrogen and progesterone levels. The sensation is that of a pulsating pain that may be accompanied by nausea, sensitivity to light and sound, or dizziness. Relaxation exercises, applying ice to the area, stress management, and massages may be comforting options to consider.
  • Sexual desire (libido) is affected by the relationship between androgen levels (testosterone) and estrogen levels, which synergistically affect female sexual response by directly interacting with the brain stimuli that activate it. Recommended measures include seeking professional help, as emotional factors are often involved, practicing pelvic floor exercises, using vaginal moisturizers, among others.
  • Pregnancy is still possible during perimenopause, so it is advisable to use contraceptive methods until 12 consecutive months without menstruation have passed.

Effects on the skeletal systemImpact of menopause on health

The balance in bone remodeling is maintained until the age of 40, after which age and menopause can tip the balance towards bone resorption (calcification loss). It is worth noting that genetic inheritance and nutrition influence whether this process is slower or accelerated.

The deficiency of estrogen during menopause increases decalcification and reduces bone formation, deteriorating bone mass. Bones become less dense and more prone to fractures. In fact, a follow-up study of over 3,000 menopausal women found that each year after the last menstrual period, bone mineral content decreases by 0.004 to 0.006 (g/cm2), and this factor can be increased by an additional 5% due to alcohol consumption, smoking, or being overweight13. Moreover, the reduction in bone mass accelerates after 5 years since menopause onset, decreasing by 1-3% annually.

During menopause, it is important to consume foods rich in calcium and vitamin D3 (which can be supplemented with food supplements) in amounts exceeding 1200 mg/day and 400 IU/day, respectively. Additionally, weight control, weight-bearing exercises, smoking cessation, and limiting alcohol consumption are suggested.

Effects on the cardiovascular system

Estrogens have effects on cardiovascular health, specifically on the health of blood vessels, promoting their elasticity, dilation, and regulation of inflammatory activity. As estrogen levels decrease during menopause, changes occur related to blood vessel constriction, resulting in elevated blood pressure, increased thickness and stiffness of the arteries. As mentioned earlier, lipid metabolism is affected by menopause, leading to increased levels of cholesterol (LDL, VLDL), which becomes a cardiovascular risk factor.

Cardiovascular risk gradually increases after 10 years since the last menstruation; however, it is important to highlight that a Spanish study that included over 5000 menopausal women demonstrated that this risk was nearly twice as high with smoking, with a vegetable consumption of less than once a week, with excessive sleep hours (≥9 hours/day), and nearly three times higher with sedentary behavior9.

We know that menopause will happen in our lives, so modifying our lifestyle is the key to future well-being. A diet based mainly on vegetables, legumes, dairy products, fish, lean meats, and regular physical exercise are factors that determine cardiovascular health. Different medical societies like the American Heart Association3 and the Spanish Menopause Society10 recommend Omega 3 consumption of up to 1200 mg/day, due to its beneficial effects on blood cholesterol levels, blood pressure, and blood vessels.cholesterol.

Mental Health and Menopause

Emotional Changes

Hormonal changes during menopause involve not only estrogen, but also gonadotropic hormones and serotonin, both involved in regulating emotions. Moreover, the perception of bodily changes, the feeling of lack of control over physical symptoms (such as hot flashes or urinary incontinence), can affect self-esteem, adding more "emotional burden" to that caused by hormonal variations.

Irritability, mood disorders, anxiety, apathy, and a feeling of fatigue occur during menopause. However, our body is gradually adapting to these hormonal changes and these symptoms may fade away.

The Spanish Association for the Study of Menopause1 provides some recommendations to alleviate these "emotional rollercoasters." Let's see what they are:

  • Normalize the situation, as it is part of the natural life cycle and you can continue enjoying the activities you are passionate about.
  • If you experience hot flashes, it's time to change your clothing and rejuvenate yourself.
  • Socialize with other people or friends who are in or have already gone through this stage, so they can share their experiences and suggestions.
  • Engage in regular physical exercise, as it stimulates serotonin secretion.
  • Practice relaxation techniques that allow you to control moods and stress.
  • Seek professional help.

In addition, it is essential to maintain a diet that promotes well-being for your heart, bones, and mind. This can be complemented with certain nutritional supplements containing magnesium, L-theanine, tryptophan, valerian, among others.

Effects on Sleep

As we mentioned earlier, sleep quality deteriorates during menopause, compounded by the aging process. The hormonal changes alone do not provide a complete explanation for the reduction in sleep quality, as hormone replacement treatments fail to improve this fact. Chronic sleep hygiene habits and mood disorders (anxiety and depression) further contribute to difficulties in falling asleep and/or early awakenings. Quality of life is also reduced as it leads to fatigue and daytime sleepiness.

The difficulties encountered in these sleep disorders include: non-restorative sleep (waking up tired and staying that way throughout the day), frequent awakenings during the night, and difficulty in falling back asleep; it affects sleep latency (difficulty in falling asleep), reduces the amount of deep sleep due to light sleep, causing fatigue, and sleeping fewer hours than the recommended 6-8 hours/night.

General recommendations focus on following a regular sleep schedule and associated routines; creating a relaxing environment, with good ventilation and low light; having a light dinner at night; sleeping in comfortable and breathable clothing; regularly exercising (yoga is ideal before bedtime); if you can't fall asleep, it's better to get out of bed and engage in an activity (excluding the use of electronic devices) in another room, among others. Some ingredients found in nutritional supplements that can facilitate falling asleep include melatonin, valerian, tryptophan, to name a few.

Menopause and Skin

Even though the skin is the largest organ of the body, it has been overlooked in managing menopausal symptoms, as evidenced by a survey17 conducted in 2018 where72% of women reported changes in their skin and half of them lacked sufficient information about these symptoms. Similarly, another survey17 among menopausal women revealed that 64% experienced skin issues, and around half of them indicated that menopause had caused changes in their skin, with skin dryness being the main symptom. Let's explore the changes associated with menopause and general recommendations.

Changes in the Skin

Hormonal variations have effects on the skin, as there are processes in skin cells that are regulated by hormones. However, a significant portion of skin changes are also explained by natural aging. For example, wrinkles and skin discoloration are more affected by age, while skin sagging is related to menopause.

The hormones involved in these changes are:

  • Androgens: primarily affect the amount of sebum in the skin, which leads to greasy skin sensations during the early stages of menopause.
  • Estrogens: during menopause, the amount of sebum in the skin significantly decreases, resulting in drier and itchier skin with signs of sagging. This is due to the decrease in collagen and hyaluronic acid levels.
  • Cortisol: is produced during hot flashes, especially at night, and is responsible for poor skin renewal.

General recommendations for maintaining healthy skin during menopause focus on four basic aspects: a varied diet that includes antioxidant foods (e.g., fruits); good quality sleep; sun protection and skincare products that contain collagen, hyaluronic acid, amino acids, and vitamins; and supplementation with nutraceuticals that contain the aforementioned ingredients to promote beauty from the inside out.

Two studies14,16 combining nutraceutical ingredients, such as botanical products like soy and evening primrose, and vitamins (C, E, and B complex), amino acids, and collagen, report reductions in wrinkles and improvements in elasticity, hydration, and collagen production ranging from 10% to 30% (depending on the indicator). Similarly, cosmetic application of antioxidant ingredients (such as vitamin C), hyaluronic acid, and collagen helps maintain toned and firm skin.

Menopause and Hair

Changes in hair volume are influenced by both aging (especially thickness and hydration) and menopause (particularly, a shortening of the hair cycle).

Changes in Hair

The phases of the hair cycle are anagen (growth), catagen (regression), and telogen (rest), and their proper synchronization ensures healthy hair. Hormonal action is one of the factors that affects this synchronization, and during menopause, when hormonal variations are pronounced, changes occur that can lead to hair loss.

Estrogens prolong the anagen phase, promoting hair growth. What happens during menopause? Let's remember that the female cycle involves a balance of estrogens and androgens, with estrogens predominating. With menopause, this balance changes because estrogen levels decline rapidly, and androgen levels seemingly increase. Androgens, particularly the conversion of testosterone to dihydrotestosterone (DHT), are carried out by the 5-alpha-reductase enzyme. DHT has a negative effect on hair follicles, reducing their size, shortening the hair cycle, and consequently, causing hair to become thinner and of lower quality, leading to hair loss.

The nutrients we obtain from food provide the energy and elements necessary for the growth, repair, and maintenance of our scalp. Therefore, a balanced diet is essential for maintaining good hair health. Some ingredients that can be complemented with a healthy diet include saw palmetto berries, biotin, zinc, and sulfur-containing amino acids, among others, as they can help maintain hair volume.

Likewise, proper hair washing, gentle and frequent brushing with suitable brushes, protection against sun exposure, and the application of topical cosmetic products are also elements that definitely contribute to achieving firm, abundant, and shiny hair. Plant extracts such as grape stem cells, maca, and horsetail have demonstrated their positive effect on hair maintenance.

Conclusion

Menopause is a natural stage in a woman's life, characterized by hormonal changes that mainly affect the cardiovascular, skeletal, and nervous systems. However, the associated symptoms can be mitigated: first, by accepting this phase of the female cycle; second, by modifying our diet, physical activity, and hygiene habits; and third, by seeking medical guidance and social support.

There are also a series of natural ingredients contained in dietary supplements that can be consumed in addition to the general recommendations for well-being.

Remember that menopause is not the end of something but the beginning of another phase in which you can still live life to the fullest and face new challenges.

  References


Content written and reviewed by the specialists of the MARNYS Scientific Information team. This article is informative and does not replace the consultation of a specialist.



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