Menopause: the questions we all ask ourselves

We wait for it with more or less anxiety, we watch it as soon as we are in our fifties, we talk about it with our friends … rarely with our partner. Answers to the questions we all ask ourselves about menopause.

Menopause: when does it start?

There is no specific age for the onset of menopause, it varies between women. In some, it manifests at 45 years, in others at 55 years old and this has no relation to the age of puberty. Doctors note at most that, in a few families, women spontaneously go through menopause much earlier, without always knowing the cause. It is then necessary to consult. In France, the average age of menopause is 51, an age that remains stable and does not change with increasing life expectancy.

Can we know if it will be difficult?

There are hardly any clues. “Urban menopause is often more delicate than field menopause “, notes Dr Jamin who suspects that stress may play a role. “Women who have suffered from postpartum depression or who have mood disorders during menstruation are more likely to have a bad time during this period “, considers Professor Mounier-Véhier, cardiologist. In general, the state of health in which you approach this stage is important: if you have taken care of yourself (diet, sport, lifestyle, management of emotions), menopause will go even better.

Can delay menopause?

Impossible to extend the deadline. Each little girl is born with a stock of 1 to 2 million ovarian follicles, or fluid-filled cavities that each contain an oocyte. Each cycle, more than 600 follicles start to grow, but only one matures and ovulates, the others disappearing into the ovarian tissue. When this capital is exhausted, it is menopause. But, even if the menopause is genetically programmed, certain factors such as smoking advance its onset by one to two years.

Several months without a period, is that a sign that you are in menopause?

Yes, as long as you haven’t had any for at least a year continuously. Menopause is when estradiol, a hormone previously produced by the ovaries, disappears. With the consequence of more or less important disorders, dominated at the beginning by night sweats and hot flashes. Skin and vaginal dryness, bone and joint pain, bone demineralization, all of these symptoms appear more gradually.

When you are on the pill continuously, how do you know if you are postmenopausal?

There is only one solution for this: stop taking the pill and observe what happens. If the rules are coming back, it is not yet the time. Otherwise, after a few months without a period, the doctor may order a hormonal test to confirm menopause. If the dosage of FSH (follicle stimulating hormone) is high (greater than 20 IU / l), the woman is biologically menopausal and can therefore stop her contraception. Otherwise, it is preferable to continue using contraception, and this as long as a hormonal dosage has not confirmed the menopause. However, the fertility of a woman over 45 is often very low. And after 50, the probability of being pregnant is 1 / 1,000.

Once menopausal, no longer need contraception?

When menopause is confirmed, you are more likely to be pregnant. It is therefore quite possible to stop contraception. Be careful, however, this does not mean that you are protected from sexually transmitted infections and diseases. Thus, 28% of people over 50 who discovered their HIV status in 2016 had been infected recently. In the event of a new partner, you should therefore use a condom until you have the results of a blood test (HIV, hepatitis B and C, syphilis, chlamydia). To be reliable, this must be done at least three months after the first sexual relationship with this new partner and provided that you have not had other partners in the meantime.

If I have no symptoms, should I consult?

If all women go through the menopause box, the experience of the latter is very different from one to another. The vast majority will suffer from hot flashes, more or less intense, which will last several years, 40% from joint pain, 1 in 3 women from intimate dryness. In contrast, a recent study estimates that 28% will experience no signs. This is no reason to neglect prevention of the long term risks associated with menopause. “A complete metabolic assessment must be done, in particular to assess the cardiovascular risk and the bone risk”, insists Dr Jamin.

Can we start treatment during pre-menopause?

“Women often have a lot of symptoms in the months leading up to menopause,” says Dr Christian Jamin, gynecologist and endocrinologist. This is also the time when bone damage begins. Some practitioners therefore choose to start hormonal supplementation from perimenopause. “It’s a little complicated, concedes Dr Jamin, because the hormonal secretions do not stop suddenly. They stop, they start again … The treatment is” à la carte “When the woman feels signs of estrogen deficiency (eg hot flashes), she is taking her treatment. If she has tension in her breasts, bleeding or swelling, it means that her endogenous estrogen secretion has resumed… she then stops the treatment.

Which address ?

Apart from the center of Pre Trémollières, in Toulouse, and a few dedicated consultations such as the cardio-gynecological consultation set up by Professor Mounier-Véhier or that of Pre Gompel, there are few places specifically aimed at women at this pivotal period of life. Nevertheless, any gynecologist is theoretically able to support and refer his patients, if necessary, to other specialists (rheumatologist, cardiologist, urologist, etc.) for a more in-depth assessment.

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