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How many women really have a regular menstrual cycle? Marta never had it. Since adolescence, its rules were unpredictable. Inés was removed from the ovaries after cancer, so she no longer bleeds. Clara underwent an endometrial ablation because each menstruation left her exhausted. And Lucia, like many others, uses hormonal contraceptives.
These stories reflect a reality that affects a significant portion of the population: approximately 40% of patients who experience menstrual irregularities face moderate to severe vasomotor symptoms during the transition to menopause, known commonly as hot flashes. This alarming statistic comes from a recent study published in The Lancet Diabetes & Endocrinology, which warns that many women could be poorly diagnosed or remain clinically unnoticed if changes in their menstrual patterns are the only focus.
According to María Jesús Cancelo, vice president of the Spanish Society of Gynecology and Obstetrics (SEGO) and a gynecologist at the University Hospital of Guadalajara, it is essential to make a clinical diagnosis . “The woman will explain to us that she has an absence of menstruation and how she feels,” she states, emphasizing the importance of patient input.
Menopause is defined as the last menstruation a woman experiences, occurring one year without bleeding . The periods leading to this final menstruation are categorized as perimenopause, while the time afterward is termed postmenopause. Understanding these stages is crucial for effective management of menopause-related symptoms.
Key: Identify the Limiting Symptom
At the University of Monash, Susan David leads the Amy’s study (Australian Women’s Midlife Years), the largest of its kind, analyzing the symptoms of over 8,000 women aged between 40 and 69 in Australia. This research explores symptoms associated with menopause across various stages, moving beyond mere reliance on menstrual cycle regularity.
The findings indicated that during perimenopause, women may experience hot flashes , night sweats, fatigue, mood alterations, and vaginal dryness. Among these, hot flashes emerged as the most prevalent and reliable indicator of menopausal transition, affecting 37% of women in the perimenopausal stage.
This information is particularly significant for women with irregular menstruations, as they may leave consultations without a clear diagnosis or solutions for their distress. “The current trend is to identify which is the more limiting symptom for women. Listening is crucial.” Cancelo emphasizes that vasomotor symptoms such as hot flashes can significantly impact quality of life.
Menopause Should Not Be Traumatic
Fortunately, various treatments are available for alleviating vasomotor symptoms and enhancing women’s quality of life. “The first step is to conduct an individualized evaluation : understanding how discomfort impacts the woman and then determining the most appropriate therapeutic option,” says Cancelo.
For women experiencing intense discomfort, hormonal therapy with estrogen may be recommended since their body has stopped producing it naturally. Also beneficial can be combined hormonal contraceptives (estrogen and gestagen), particularly for women who wish to avoid pregnancy. These not only alleviate hot flashes but also help regulate the menstrual cycle and avoid heavy or irregular bleeding.
However, not all women can or want to use hormonal treatments. Alternatives include Intrauterine Devices (IUDs) that release Levonorgestrel, mimicking the action of progesterone to control menstrual bleeding, or even non-hormonal pharmacological treatments . “The important thing is to know that effective and accessible options exist,” Cancelo notes, urging women not to endure symptoms that can be managed.
Easily Treatable Discomfort
Another significant finding from the study is that vaginal discomforts, which can be effectively treated, often persist without adequate attention. Conditions like genitourinary atrophy cause stinging, itching, burning , and discomfort during sexual relations due to the loss of elasticity and lubrication in the vaginal and vulvar tissues.
Fortunately, there are straightforward and effective solutions, such as local estrogen applications or the use of moisturizing and lubricant creams. Cancelo mentions that these measures significantly alleviate ailments and prevent a cycle of sexual avoidance that can lead to relationship tensions. There are also oral treatments available as needed.
“Many women do not bring up these issues in consultations, often out of modesty or due to cultural beliefs that menopause is something one must endure,” Cancelo explains. “However, menopause does not have to be a traumatic phase. It’s about knowing that there are effective tools to navigate this stage with well-being.”