Menopause is the period of time that elapses after the last menstruation, in which several important and assorted physiological changes occur that can interfere with the normal life of a woman. This last menstruation is only ascertainable after the event, and one year must go by without menstruation for us to be able to say that a woman has the menopause.

The changes that appear are due to the diminishing of ovarian function, with the reduction of oestrogen production. As such, changes do not suddenly appear. Some years before the last menstruation –menopause - some can arise. Menstrual disorders are commonplace (more frequent cycles, more abundant menstruation), and in other cases, the lack of menstruation is produced, which causes fear of the possibility (however rare) of pregnancy. The abovementioned changes can be: hot flushes, night-time sweats, insomnia, mood swings, irritability, skin dryness, variations in hair distribution, osteoporosis, urogenital atrophy, vaginal dryness, dispaureny (pain during sexua intercourse), the appearance of cardiovascular disease, etc.

All of these disorders do not happen to every woman, and if they appear, their intensity can vary. In some cases medical treatment is necessary and in others, hygiene and dietetic measures are called for.

Once this critical age is reached it is important to go to the gynaecologist as it is a good time to have a complete physical check-up, evaluating your current symptoms, preventing the alterations that can occur and at the same time, trying to prevent most frequent cancers for your age group.

Where symptoms indicate that it is important that treatment take place, we try to remedy the normal ovarian function by what is called Hormone Replacement Therapy or HRT. This is based on two hormones: oestrogens and gestagens, using them together or separately according to clinical circumstances.

This medication comes in different forms (tablets, patches, gels) and as the guidelines of the treatment are different (continuous or cyclical), the treatment can be easily adjusted to the needs of each patient. First of all we carry out a study to make sure that there are no circumstances which make the treatment unadvisable.

In cases where the study suggests HRT treatment is inappropriate or where the patient is afraid to take hormones, there are alternative treatments, and although they do not have the same effect as HRT they can reduce symptoms. This treatment uses phitoestrogens which are natural compounds that are contained in some foods: Isoflavones which are the most powerful ones and which are almost exclusively found in pulses. Soya is the pulse containing the largest amount of isoflavones.

Osteoporosis consists of a disorder in the bones due to the loss of calcium which reduces the osseous mass and density thereby altering the microstructure of the bones. Therefore, the bones become more fragile and the risk of fracture is higher.

There are several procedures that enable us to evaluate the osseous density: radiology, ultrasound scans, osseous densitometry DXA where the latter being the most reliable one. Its results show us the osseous mass level, which will be an indicator of the risk of fracture.

There are risk factors that can encourage the appearance of post-menopause osteoporosis which can not be helped (premature menopause, thin constitution, nuliparity, short height, ethnic origin, etc.), but there are other ones which we can change (tobacco consumption, physical inactivity, low calcium ingestion, alcohol abuse, caffeine abuse).

When an osteopeny (decalcification) appears in the densiometry, it is time to start treatment and to intensify hygiene and dietetic measures, which should be part of a woman’s normal life. There are several medical treatments and the doctor will determine which one is the most appropriate (calcium supplements, vitamin D, biphosphonate, etc).

When menopause is reached, it can be a good moment to relieve common problems of this period and to prevent other illnesses in order to improve quality of life (prevention of cardiovascular disease, early diagnosis of breast cancer, cervical cancer and colo-rectal cancer).

Life-style changes are important: giving up smoking, reducing alcohol consumption, exercising, keeping yourself at your ideal weight which are all factors in determining the health of every woman.

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