2024-03-19 16:57:11
Despite a growing body of new research into menopause, it seems increasingly difficult to find clear information on the subject. Indeed, the media, the Internet, caregivers or scientists do not all systematically agree.
To further add to this confusion, a series of articles recently published in the prestigious medical journal The Lancet has called into question certain aspects that we thought were taken for granted concerning not only the symptoms of menopause, but also the effectiveness of hormonal treatments (also called “hormone replacement treatments for menopause”) in relieving some of them.
What are the symptoms that reliably indicate the onset of perimenopause or menopause? And what is the real benefit of hormonal treatments? Here’s what the science says.
What is menopause?
To put it briefly, menopause is the complete loss of female fertility.
This is the period in the life of a woman (or people whose birth sex was female) during which periods (menstruation) stop permanently. Menopause is diagnosed after 12 months without a new period (except in the case of removal of the ovaries, which causes surgically induced menopause). Then begins the postmenopausal period.
Perimenopause begins when menstrual cycles vary by seven days or more for the first time. It ends when there has been no period for 12 months.
Perimenopause and menopause are difficult to identify if a person has had a hysterectomy but their ovaries are intact, or if natural menstruation is suppressed by treatment (such as hormonal contraception) or illness (such as eating disorder).
What are the most common symptoms of menopause?
During our work, we analyzed the scientific literature in order to take stock of the recommendations for the management of menopause and perimenopause based on the most demanding standards. We were thus able to identify the internationally recognized symptoms:
hot flashes and night sweats (known as vasomotor symptoms);
sleeping troubles ;
musculoskeletal pain;
decreased sexual function or desire;
vaginal dryness and irritation;
mood disturbance (low mood, mood changes or depressive symptoms), but without clinical depression.
None of these symptoms are specific to menopause, however, meaning they could have other causes.
Symptoms that vary in severity from person to person
Our study of Australian women found that 38% of pre-perimenopausal women, 67% of perimenopausal women and 74% of post-menopausal women under the age of 55 reported experiencing hot flashes and/or night sweats.
But the severity of these symptoms varies widely. Before perimenopause, only 2.8% of women reported experiencing moderately to severely bothersome hot flashes and night sweats, compared to 17.1% of perimenopausal women and 28.5% of postmenopausal women younger than 55 years old.
Hot flashes and annoying night sweats therefore seem to be reliable indicators of perimenopause and menopause. However, these are not the only symptoms. Nor are these phenomena only affecting Western women, contrary to what has sometimes been suggested: women in Asian countries are also affected.
Not having night sweats or hot flashes does not mean you are not in menopause. Maridav/Shutterstock
Depressive symptoms and anxiety are also often linked to menopause, but these symptoms are less specific than hot flashes and night sweats because they can occur throughout adult life. However, current recommendations consider that the appearance of mood disorders can in itself constitute the manifestation of hormonal changes linked to menopause. In other words, a woman who does not have hot flashes or night sweats may still be in perimenopause or postmenopause.
It is still unclear to what extent the hormonal changes of menopause could be linked to problems with memory, concentration or difficulty thinking (symptoms frequently grouped together and called “brain fog”). Some studies suggest that perimenopause may impair episodic verbal memory, but that this disorder may resolve on its own as women go through menopause. However, it seems that executive brain functions (strategic thinking, planning) are not affected.
In what cases are hormonal treatments useful?
The articles of Lancet suggest that hormone replacement therapy for menopause relieves hot flashes and night sweats (“vasomotor” symptoms). However, the likelihood of such therapy improving sleep, mood, or “brain fog” appears to only concern women who are bothered by these vasomotor symptoms.
Hormonal treatment is also recommended for the management of mood disorders associated with menopause. In other words, being prescribed such therapy does not require having hot flashes or night sweats.
Often, menopausal hormone treatments are prescribed in combination with topical estrogen to treat vaginal symptoms (dryness, irritation or frequent urination).
You don’t need to experience hot flashes and night sweats to take hormone therapy. Monkey Business Images/Shutterstock
However, none of the current international guidelines recommend the prescription of hormonal treatment with regard to the management of the cognitive symptoms responsible for “brain fog”.
Furthermore, the effectiveness of this type of treatment in treating musculoskeletal pain, which constitutes the most common menopausal symptoms in certain populations, must still be studied.
Finally, certain national recommendations consider that hormonal treatment is effective in limiting the risk of osteoporosis or fractures, but not in preventing other diseases.
What are the risks of hormonal therapies?
The main concerns about hormone replacement therapy for menopause have been the potential increased risk of breast cancer and deep vein thrombosis (which can cause a clot to form in the lungs).
Today, it is considered that hormonal treatments using estrogens alone cause little or no change in the risk of breast cancer.
Estrogen taken with progestin, necessary for women who have not had a hysterectomy, has been associated with a small increase in the risk of breast cancer (but like any risk, this appears to vary depending on the type of breast cancer). treatment used, dose and duration of use).
Estrogens taken orally have also been associated with an increased risk of deep vein thrombosis, with said risk varying depending on the formulation used. This problem can be avoided by using estrogen patches or gels prescribed in standard doses.
What if I don’t want hormone therapy?
If you can’t or don’t want to take hormone therapy to help with hot flashes and bothersome night sweats, effective non-hormonal therapies are also available by prescription.
In Australia, most of these options are ‘off-label’, however fezolinetant, a new drug, has just been approved to treat postmenopausal hot flashes and night sweats.
(in Europe, this drug obtained marketing authorization in December 2023. It was approved in the United States in May of the same year, editor’s note)
Taken in tablet form, fezolinetant acts in the brain by blocking neurokinin 3, the molecule responsible for the inappropriate thermal response causing hot flashes and/or sweating.
While we can deplore the fact that the effectiveness of most over-the-counter treatments is zero or not scientifically proven, it should be noted that cognitive-behavioral therapy and hypnosis can help relieve certain symptoms.
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