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What do we understand by menopause?
The World Health Organization (WHO) defines physiological or natural menopause as the permanent cessation of menstruation , after 12 consecutive months of amenorrhea, without pathological causes and as a result of the progressive loss of ovarian follicular activity, with the consequent decrease on estrogen levels in the body. The age of presentation is between 45 and 55 years , with a mean of 51 years (WHO, 1996). During this stage, between 60 and 80% of women experience, among others, a series of very characteristic symptoms, known as vasomotor symptoms or hot flashes , which may or may not need treatment. We will go into this a little later. Menopause, in addition to physiological causes, can occur due to external causes such as undergoing ovarian removal surgery (oophorectomy), chemotherapy or radiotherapy, and what is known as primary ovarian failure: premature cessation of ovarian function due to genetic or autoimmune causes. This early menopause , which can be seen even in women in their early twenties, should be clinically evaluated and it is advisable to treat patients with hormone replacement therapy until they have reached the age at which physiological menopause should occur. (www.fisterra.com).
What clinical manifestations does it present?
Focusing on the symptoms and clinical manifestations of physiological menopause, the reduction in estrogen levels causes the appearance of a series of manifestations of highly variable intensity from one woman to another: from asymptomatic patients to severe symptoms with a significant affectation of the quality of life. These clinical manifestations, according to the National Institute for Health and Care Excellence (NICE), could be classified into 5 blocks (NICE, 2015): vasomotor symptoms, genitourinary syndrome, cardiovascular conditions, osteoporosis and other symptoms (sleep and mood disturbances). ). Well, having said that, and due to the complexity of each clinical block, in this series of blog posts we will focus exclusively on the first one: vasomotor symptoms . As we mentioned previously, these symptoms are also referred to as known as hot flashes or hot flashes , and it is not for less. Women who suffer from them experience sudden and unexpected changes in body temperature, night sweats, and flushing of the face, neck, and chest. In their most serious form they can seriously affect the quality of life of the patient. These symptoms can begin to be experienced throughout the climacteric and usually stabilize after 5-8 years from the last menstruation (although in some patients they can persist up to 70 years of age).
From an epidemiological point of view, in Europe and North America, 2 out of 3 women suffer from one of the aforementioned vasomotor, genitourinary or mood-related clinical manifestations and 1 out of 5 find these manifestations really difficult to deal with. There are also ethnic groups such as the African or habits such as smoking and pathologies such as overweight and obesity that predispose to suffer, to a greater extent, these alterations . On the contrary, there are other ethnic groups, such as the Asian, where only 16% of women report significant symptoms during this period (Thurston RC, 2011; Avis NE, 2015).
Vasomotor symptoms associated with menopause: causes and treatment
Currently, there is no clear consensus on the physiological pathways involved in the appearance of vasomotor symptoms associated with menopause. It is known that estrogen deficiency or complete withdrawal plays an important role in the symptoms, affecting the hypothalamic-pituitary-adrenal axis, the exacerbated secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and the neurotransmitters involved in hypothalamic thermoregulation such as norepinephrine, serotonin and endorphins (Lethaby et al., 2013). To deal with these symptoms, there are different formally established lines of action. As a therapeutic ladder, the North American Menopause Society (NAMS) recommends first considering lifestyle changes to alleviate symptoms. mild symptoms . These changes include avoiding highly seasoned foods, avoiding exposure to high temperatures, engaging in regular and moderate physical activity and exercise, and avoiding tobacco, alcohol, overweight, and obesity. If with all this it is not possible to control the symptoms, we would proceed to the use of pharmacological measures : hormone replacement therapy as the first choice and antidepressant, anticonvulsant or antihypertensive drugs as the second line. Far from what many people may think, hormone replacement therapy is a safe and effective treatment if administered at the indicated doses for no more than 5 years and without the patient exceeding 60 years of age (NAMS, 2015; Marjoribanks et al., 2017).
However, in addition to conventional treatments, many women have used, for different reasons, complementary therapies to combat these symptoms, being herbal food supplements or medicines based on
plants the most used (followed by yoga and other relaxation techniques). A review published in 2013 found that between 32% and 50% of women in the West regularly used complementary therapies during menopause (Posadzki et al., 2013). On the other hand, in different surveys carried out on postmenopausal women between 2002 and 2006, it was determined that around 61% of the participants believed that a natural treatment was more effective and safer than hormone replacement therapy and that 70% of those surveyed did not inform a healthcare professional about the natural treatment they were taking (Newton et al., 2002; Chao
et al., 2006). Having seen all this, could it make sense to use medicinal plants to alleviate vasomotor symptoms associated with menopause ? This is the question that we will try to answer in the following installments of this series of articles.
conclusions
- Menopause is a stage in a woman's life that can be caused by physiological, pathological or iatrogenic causes, which presents with complex symptoms and, in many cases, difficult for patients to bear. • Vasomotor symptoms are clearly defined clinical manifestations, and aetiologically still to be agreed upon, which can seriously affect the quality of life of postmenopausal women. • The current drug treatment of choice for vasomotor symptoms is hormone replacement therapy. This is safe and effective at the indicated doses within the treatment window period and for no more than 5 years from the start of treatment. • A significant percentage of postmenopausal women are attracted to the use of complementary therapies, specifically phytotherapy, for the relief of vasomotor symptoms associated with menopause.