What is the normal age range for menopause. How can you identify early or premature menopause. What are the common symptoms of perimenopause and menopause. How do hormonal changes affect the female reproductive system during menopause. What strategies can help manage menopausal symptoms effectively.

The Menopausal Transition: Defining Perimenopause and Menopause

Menopause is a natural biological process marking the end of a woman’s reproductive years. It’s officially diagnosed when a woman has gone 12 consecutive months without a menstrual period. However, the journey to menopause often begins several years earlier with a phase called perimenopause.

Perimenopause is characterized by fluctuating hormone levels, particularly estrogen, which can lead to various physical and emotional symptoms. This transitional phase typically starts in a woman’s 40s, but can begin as early as the mid-30s for some.

Key Differences Between Perimenopause and Menopause

• Perimenopause: Irregular periods, fluctuating hormone levels, potential fertility
• Menopause: Complete cessation of menstruation, significantly reduced hormone production, infertility

Is there a specific test to determine if you’re in perimenopause? While there’s no definitive test, your healthcare provider can assess your symptoms and perform hormone level tests to get a clearer picture of your menopausal status.

The Normal Age Range for Menopause: What to Expect

Understanding the typical age range for menopause can help women prepare for this significant life transition. While individual experiences may vary, there are general patterns observed in the onset of menopause.

Average Age of Menopause

For most women, menopause occurs between the ages of 45 and 55, with the average age being around 51 years old. It’s important to note that this is just an average, and many women may experience menopause earlier or later than this range.

Can genetics influence the timing of menopause? Research suggests that there is indeed a genetic component to the age of menopause onset. Women often experience menopause at a similar age to their mothers or sisters.

Factors Influencing Menopause Timing

• Genetics
• Smoking (can lead to earlier menopause)
• Body mass index (BMI)
• Ethnicity
• Certain medical conditions or treatments

Do lifestyle choices impact the age of menopause? While some factors like smoking can lead to earlier menopause, many lifestyle choices have minimal impact on the timing of this natural transition.

Early and Premature Menopause: Causes and Implications

While most women experience menopause in their late 40s or early 50s, some may go through this transition much earlier. Early menopause occurs between the ages of 40-45, while premature menopause happens before the age of 40.

Causes of Early or Premature Menopause

1. Genetics
2. Autoimmune disorders
3. Chemotherapy or radiation therapy
4. Surgical removal of ovaries (oophorectomy)
5. Certain infections

Are there health risks associated with early menopause? Yes, women who experience early or premature menopause may be at higher risk for certain health conditions, including osteoporosis and cardiovascular disease, due to the extended period of lowered estrogen levels.

Recognizing the Signs and Symptoms of Perimenopause

As women enter perimenopause, they may experience a variety of symptoms due to fluctuating hormone levels. Recognizing these signs can help women seek appropriate support and management strategies.

Common Perimenopausal Symptoms

• Irregular periods (longer, shorter, or skipped cycles)
• Hot flashes and night sweats
• Mood swings and irritability
• Sleep disturbances
• Vaginal dryness
• Changes in libido
• Weight gain, especially around the midsection
• Thinning hair and dry skin

How long do perimenopausal symptoms typically last? The duration of perimenopause can vary significantly from woman to woman, lasting anywhere from a few months to several years. On average, women experience perimenopausal symptoms for about four years before reaching menopause.

Hormonal Changes and Their Impact on the Female Reproductive System

The menopausal transition is primarily driven by changes in hormone production, particularly the decline in estrogen and progesterone levels. These hormonal shifts lead to various physical changes in the female reproductive system.

Key Hormonal Changes During Menopause

1. Decreased estrogen production
2. Reduced progesterone levels
3. Increased follicle-stimulating hormone (FSH) levels
4. Fluctuations in testosterone levels

How do these hormonal changes affect the body? The decline in estrogen and progesterone can lead to various physical changes, including:

• Thinning of vaginal walls
• Decreased vaginal lubrication
• Reduced elasticity of pelvic floor muscles
• Changes in breast tissue
• Increased risk of urinary tract infections
• Bone density loss

Can hormone replacement therapy (HRT) alleviate these changes? For some women, HRT can help manage menopausal symptoms and potentially slow down some of the physical changes associated with lowered estrogen levels. However, the decision to use HRT should be made in consultation with a healthcare provider, as it may not be suitable for everyone.

Managing Menopausal Symptoms: Lifestyle Changes and Treatment Options

While menopause is a natural process, the symptoms can be challenging for many women. Fortunately, there are various strategies and treatments available to help manage these symptoms and improve quality of life during this transition.

Lifestyle Modifications for Symptom Relief

• Regular exercise
• Balanced diet rich in calcium and vitamin D
• Stress reduction techniques (e.g., meditation, yoga)
• Avoiding trigger foods for hot flashes (e.g., spicy foods, caffeine)
• Maintaining a healthy weight
• Quitting smoking
• Limiting alcohol consumption

What dietary changes can help alleviate menopausal symptoms? Incorporating foods rich in phytoestrogens (such as soy products, flaxseeds, and certain fruits and vegetables) may help some women manage symptoms like hot flashes. However, the effectiveness can vary among individuals.

Medical Treatments for Menopausal Symptoms

1. Hormone Replacement Therapy (HRT)
2. Low-dose antidepressants for hot flashes
3. Vaginal estrogen for vaginal dryness
4. Gabapentin for hot flashes and sleep disturbances
5. Osteoporosis medications to prevent bone loss

Are there natural alternatives to hormone replacement therapy? Some women find relief from menopausal symptoms through natural remedies such as black cohosh, evening primrose oil, or red clover. However, it’s important to consult with a healthcare provider before starting any new supplement regimen, as the efficacy and safety of these alternatives can vary.

Long-term Health Considerations for Postmenopausal Women

As women transition through menopause and enter their postmenopausal years, it’s crucial to be aware of potential long-term health implications. The hormonal changes associated with menopause can increase the risk of certain health conditions.

Common Health Concerns for Postmenopausal Women

• Osteoporosis
• Cardiovascular disease
• Urinary incontinence
• Weight gain
• Changes in cognitive function
• Increased risk of certain cancers

How can postmenopausal women protect their bone health? Regular weight-bearing exercises, adequate calcium and vitamin D intake, and in some cases, medication prescribed by a healthcare provider can help maintain bone density and reduce the risk of osteoporosis.

Preventive Health Measures for Postmenopausal Women

1. Regular health check-ups and screenings
2. Maintaining a healthy diet and exercise routine
3. Managing stress levels
4. Staying socially active
5. Keeping the mind engaged through learning and cognitive activities
6. Quitting smoking and limiting alcohol consumption

Is it normal to experience changes in sexual function after menopause? Many women do experience changes in sexual function due to hormonal shifts and physical changes. Open communication with partners and healthcare providers can help address these concerns and explore potential solutions, such as lubricants or hormone therapies.

Navigating the Emotional and Psychological Aspects of Menopause

While much attention is given to the physical symptoms of menopause, the emotional and psychological impacts of this transition are equally important to address. Many women experience mood changes, anxiety, or depression during this time.

Common Emotional Challenges During Menopause

• Mood swings
• Irritability
• Anxiety
• Depression
• Difficulty concentrating
• Changes in self-image and confidence

How can women cope with the emotional aspects of menopause? Strategies such as mindfulness practices, cognitive-behavioral therapy, support groups, and in some cases, counseling or medication can be helpful in managing the emotional challenges of menopause.

Positive Aspects of the Menopausal Transition

While menopause can bring challenges, it’s also important to recognize the positive aspects of this life stage. Many women report feeling a sense of freedom and empowerment post-menopause. This can be a time of personal growth, self-discovery, and new opportunities.

1. No more menstrual cycles or need for contraception
2. Potential for increased self-confidence and assertiveness
3. Opportunity for personal growth and new pursuits
4. Shift in priorities and values
5. Deeper appreciation for health and well-being

Can menopause impact relationships? The physical and emotional changes of menopause can indeed affect relationships. Open communication with partners, friends, and family members about these changes can help foster understanding and support during this transition.

In conclusion, menopause is a natural and inevitable part of a woman’s life journey. While it can bring challenges, understanding the process, recognizing symptoms, and implementing effective management strategies can help women navigate this transition with confidence and grace. Remember, every woman’s experience with menopause is unique, and what works for one may not work for another. It’s essential to work closely with healthcare providers to develop a personalized approach to managing menopausal symptoms and maintaining overall health and well-being during this significant life stage.

Aging changes in the female reproductive system: MedlinePlus Medical Encyclopedia

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Aging changes in the female reproductive system result mainly from changing hormone levels. One clear sign of aging occurs when your menstrual periods stop permanently. This is known as menopause.

The time before menopause is called perimenopause. It may begin several years before your last menstrual period. Signs of perimenopause include:

• More frequent periods at first, and then occasional missed periods
• Periods that are longer or shorter
• Changes in the amount of menstrual flow

Eventually your periods will become much less frequent, until they stop completely.

Along with changes in your periods, physical changes in your reproductive tract occur as well.

AGING CHANGES AND THEIR EFFECTS

Menopause is a normal part of a woman’s aging process. Most women experience menopause around age 50, though it can occur before that age. The usual age range is 45 to 55.

With menopause:

• The ovaries stop making the hormones estrogen and progesterone.
• The ovaries also stop releasing eggs (ova, oocytes). After menopause, you can no longer become pregnant.
• Your menstrual periods stop. You know you have gone through menopause after you have had no periods for 1 year. You should continue to use a birth control method until you have gone a whole year without a period. Any bleeding that occurs more than 1 year after your last period is not normal and should be checked by your health care provider.

As hormone levels fall, other changes occur in the reproductive system, including:

• Vaginal walls become thinner, dryer, less elastic, and possibly irritated. Sometimes sex becomes painful due to these vaginal changes.
• Your risk for vaginal yeast infections increases.
• The external genital tissue decreases and thins, and can become irritated.

Other common changes include:

• Menopause symptoms such as hot flashes, moodiness, headaches, and trouble sleeping, which can persist for years
• Problems with short-term memory
• Decrease in breast tissue
• Lower sex drive (libido) and sexual response
• Increased risk for bone loss (osteoporosis)
• Urinary system changes, such as frequency and urgency of urination and increased risk for urinary tract infection
• Loss of tone in the pubic muscles, resulting in the vagina, uterus, or urinary bladder falling out of position (prolapse)

MANAGING CHANGES

Hormone therapy with estrogen or progesterone, alone or in combination, may help menopause symptoms such as hot flashes or vaginal dryness and pain with intercourse. Most women who have a uterus will require progesterone as well as estrogen. Women without a uterus may take estrogen only. Hormone therapy has risks, so it is not for every woman. Discuss the risks and benefits of hormone therapy with your provider.

To help manage problems such as painful sexual intercourse, use a lubricant during sexual intercourse. Vaginal moisturizers are available without a prescription. These can help with vaginal and vulvar discomfort due to the drying and thinning of tissues. Applying topical estrogen inside the vagina may help thicken the vaginal tissues and increase moisture and sensitivity. Your provider can tell you if any of these measures is right for you.

Getting regular exercise, eating healthy foods, and staying involved in activities with friends and loved ones can help the aging process go more smoothly.

OTHER CHANGES

Other aging changes to expect:

• Hormone production
• Organs, tissues, and cells
• Breasts
• Kidneys

• Menopause

Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Santoro N, Neal-Perry G. Menopause. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 227.

van den Beld AW, Lamberts SWJ. Endocrinology and aging. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 28.

White BA, Harrison JR, Mehlmann LM. Life cycle of the male and female reproductive systems. In: White BA, Harrison JR, Mehlmann LM, eds. Endocrine and Reproductive Physiology. 5th ed. St Louis, MO: Elsevier; 2019:chap 8.

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A. M. Editorial team.

What is menopause? | Jean Hailes

Menopause (your final period) happens to most women. In Australia, the average age of menopause is 51 years, but it’s normal to have menopause anywhere between 45 and 55 years – although some women have it at an earlier or later age. Perimenopause is the time leading up to menopause, and postmenopause is the time after your final period.

How do you know if you’ve reached menopause?

It can be hard to know if you’ve reached menopause, because your periods can be irregular during this time. It’s likely you’ve reached menopause if you haven’t had a period for 12 months.

What happens at menopause?

From about 35–40 years of age, you have fewer eggs left in your ovaries and don’t ovulate (release an egg from your ovary) as often. Menopause means your ovulation and periods stop.

Hormones and menopause

Hormones are chemicals made in your body that relay messages through your bloodstream. For example, your hormones tell your body to eat and sleep.

The three main hormones that change as you approach menopause are:

• oestrogen
• progesterone
• testosterone.

The change in hormone levels can lead to different menopausal symptoms.

Oestrogen

Oestrogen is produced from the cells around the eggs in your ovaries. It helps to maintain parts of your body. For example, your endometrium (uterus lining), cervix (where your uterus joins your vagina), breast ducts and bones.

Your oestrogen production increases and decreases in the lead-up to menopause. As you approach your final period, your number of eggs decreases and oestrogen levels drop by up to 90%.

Progesterone

Progesterone is responsible for things like mucus levels in your cervix, acidity levels in your vagina and milk cells in your breasts. It can also make you moody.

Progesterone is produced when an egg is released. It prepares your uterus for a fertilised egg and pregnancy. As you approach your final period, your progesterone levels decrease.

Testosterone

Testosterone is produced by your ovaries and other parts of your body.

You might think testosterone is a male hormone but it also plays an important role in women’s sexual desire, emotional wellbeing and bone and muscle strength.

Testosterone decreases gradually with age. In some women, levels fall by half between the ages of 20 and 40 years.

Watch a video and find out what happens to your body during menopause.

Perimenopause, menopause and postmenopause

Most women reach menopause between the ages of 45 and 55 years. In Australia, the average age for women to reach menopause is 51 to 52. Some women reach menopause as late as 60.

Perimenopause

Perimenopause is the stage before your final period (menopause). It’s when your body reaches the end of its reproductive years. Perimenopause is a natural part of a woman’s life.

Perimenopause usually happens sometime in your 40s. On average, it lasts four to six years, but it can last from one to 10 years.

During this time, your ovaries begin to run out of eggs. This causes hormone levels, particularly oestrogen, to fluctuate, causing different symptoms, like hot flushes and mood swings.

Changing hormones can also affect your menstrual cycle. For example, your periods may be irregular, shorter (or longer), lighter (or heavier), or they may not come for a few months.

Some months you may ovulate and other months you may not. You may even ovulate twice in a cycle.

Contraception in perimenopause

Even though fertility is lower in your 40s and 50s, it is possible to become pregnant. This is because you still ovulate during perimenopause.

The chance of pregnancy in women aged 45–49 years is around 2–3% per year. After the age of 50, it is less than 1%. While this is low, every woman’s fertility is different.

If you don’t want to become pregnant, you should continue to use contraception until you’ve had:

• one year without a natural period if you’re older than 50
• two years without a natural period if you’re younger than 50.

Menopausal hormone therapy (MHT) is not a contraceptive. You shouldn’t rely on MHT to prevent pregnancy.

Learn more about perimenopause

• Menopause – Understanding perimenopause
  Download pdf
• Navigating perimenopause
  Download pdf
• Perimenopause and menopause symptom checklist
  Download pdf

Menopause

Menopause is your final menstrual period. If you haven’t had a period for 12 months, you’ve reached menopause.

Postmenopause

Postmenopause is the time after menopause.

As your body adjusts to lower hormone levels, you may have less menopausal symptoms – or they may even disappear – but some women still experience menopausal symptoms for years after their final period.

What changes after menopause?

It’s important to look after your health after menopause, as changes due to ageing and lower levels of oestrogen can increase your risk of developing certain health conditions.

Heart health

Before menopause, women have a lower risk of heart disease than men. However, as women age and their oestrogen levels fall, their risk of cardiovascular disease increases. Heart disease is one of the leading cause of death for Australian women. Heart disease also claims three times as many lives as breast cancer.

After menopause, risk factors for heart disease increase. These include:

• high blood pressure
• an increase in total cholesterol
• an increase in LDL (‘bad’ cholesterol)
• a decrease in HDL (‘good’ cholesterol)
• an increase in blood fats, such as triglycerides.

You can reduce the risk of heart disease by having a healthy lifestyle.

For example:

• eat a healthy and nutritious diet
• do regular exercise
• maintain a healthy weight
• don’t smoke
• limit alcohol intake.

You can also see your doctor for a heart check. They will take your blood pressure and test your blood to determine your risk factors. If you have a high risk of heart disease, your doctor may prescribe medication for high blood pressure and cholesterol.

Bone health and osteoporosis

Osteoporosis is a condition where bones become weakened. This can cause bones to break (fracture) easily. About half of all women over 60 years of age will have at least one fracture due to osteoporosis.

After menopause, lower levels of oestrogen affect women’s bone health, which puts them at greater risk of developing osteoporosis.

On average, women lose up to 10% of their bone mass in the first five years after menopause. After this, the rate of bone loss slows.

It’s important to have regular bone health checks. Your doctor might ask about your medical history, check risk factors for osteoporosis and do a bone density test. Note that Medicare rebates for bone density tests are only available for women with particular risk factors or those over 70 years of age.

Learn how to reduce your risk of osteoporosis with a healthy diet and exercise.

Healthy weight

After menopause, you may notice extra body fat around your stomach. This can increase your risk of health conditions such as high blood pressure, diabetes, cardiovascular disease, dementia and some cancers.

It’s very important to maintain a healthy weight at this stage of life. You can do this by:

• eating a healthy diet rich in fruits, vegetables, lean protein and whole grains
• limiting your intake of processed foods, especially those high in fat and sugar
• getting regular exercise
• limiting alcohol intake
• drinking more water.

Learn more about healthy weight or open the menopause and weight fact sheet.

Bladder health

Lower levels of oestrogen after menopause can affect your bladder health, including:

• weak pelvic floor muscles
• loss of elasticity of the bladder
• thinning of the urethral and bladder lining, which could lead to urinary tract infections (UTIs)
• loss of elasticity in the pelvic tissues.

These factors can lead to incontinence (i.e. you might wee when you don’t want to). While this can be embarrassing, it is very common.

You don’t have to put up with incontinence. You can ask your doctor for a referral to a continence nurse or pelvic floor physiotherapist to help strengthen your pelvic floor muscles.

Vaginal and vulval health

Some vaginal and vulval symptoms continue into postmenopause.

Cervical screening (pap smear)

After reaching menopause, you still need a cervical screening test every five years until you’re 74 years old. You will usually be sent a reminder every five years if your results are normal. If your results are abnormal, you will need more frequent tests.

Postmenopausal bleeding

Bleeding from your vagina after menopause is not normal. If you have any bleeding, spotting or staining after you reach menopause, talk to your doctor. They may recommend tests, including:

• cervical screening
• vaginal (internal) ultrasound
• biopsy
• curette (a procedure to gently remove the lining of your uterus).

Contraception

If you don’t want to get pregnant and you’re younger than 50 years of age, you should use contraception for at least two years after your final period.

If you don’t want to get pregnant and you’re 50 or older, you should use contraception for at least one year after your final period.

Please note that MHT is not a contraceptive.

There are many types of contraception available. Speak to your doctor to work out what option is best for you.

Breast health

The risk of breast cancer increases as you get older and is most common in postmenopausal women. About 79% of all new cases of breast cancer occur in women over the age of 50 years.

It’s important to know the normal look and feel of your own breasts. This will help you notice any changes. Check your breasts and armpits while showering. Look for changes in your breasts, nipples or skin, such as a rash or dimpling, a lump or discharge. Also note any new pain you might feel in the area. If you are concerned about any changes, see your doctor.

If you are 50 years or older and have no breast changes, you should have a breast screen, or mammogram, every two years. A mammogram is the best way to find breast cancer early. Contact your doctor for more information.

Learn more about breast health and breast checks.

Diagnosing perimenopause and menopause

You can ask your doctor to check if you are perimenopausal or have reached menopause. If you are at the expected age, have experienced some symptoms and have irregular periods, it’s likely you are perimenopausal. If you haven’t had a period for 12 months, you have probably reached menopause.

The best way to predict menopause is to keep track of your symptoms. If your periods are irregular and your symptoms are getting worse, it’s likely you are approaching menopause.

Blood tests

Blood tests to measure hormone levels won’t tell you if you are perimenopausal or when your final period is going to happen, because hormone levels vary widely at this time.

If you are younger than 45 years and your periods are irregular or have stopped, your doctor might measure your hormone levels to understand your situation.

A blood test to measure a hormone called anti-Müllerian hormone (AMH) is being studied to see if measuring egg or follicle activity can predict menopause. It is not standard practice to use this test, or other hormone level tests, in the diagnosis of normal perimenopause or menopause.

Saliva tests

Saliva tests are not an accurate way of predicting menopause, due to fluctuating hormone levels at this time.

When to see your doctor

Talk to your doctor if you are worried about:

• irregular periods
• heavy bleeding
• bleeding after menopause
• increased premenstrual syndrome (PMS) symptoms
• menopausal symptoms, such as hot flushes, that interfere with your daily life.

Related resources

Symptoms checklist

Symptoms of perimenopause and menopause are different for everyone. Tick the boxes to show which symptoms are bothering you. Take the checklist with you to your next medical appointment.

Get the checklist

Learn more about menopause

• Menopause fact sheet
  Download pdf
• Understanding menopause booklet
  Download pdf
• Menopause – Understanding perimenopause
  Download pdf
• Perimenopause and menopause symptom checklist
  Download pdf
• Menopause and weight – fact sheet
  Download pdf
• Menopause – Premature and early menopause
  Download pdf
• Yarning about menopause
  Download pdf
• Menopause in the workplace
  Download pdf

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This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2022.

TARGETED SKIN CARE AT DIFFERENT STAGES OF MENOPAUSE

Sharova Alisa Alexandrovna

Candidate of Medical Sciences, Cosmetologist, Geriatrician, Associate Professor of the Department of Reconstructive and Plastic Surgery, Cosmetology and Cell Technologies of the Russian National Research Medical University named after . N.I. Pirogova, Head of the Cosmetology Department, Scientific Director of the Chistye Prudy Center for Aesthetic Medicine (Moscow)

1].

Menopause – persistent cessation of menstruation due to age-related decline in hormonal and “switching off” the reproductive function of the ovaries. The date of menopause is estimated retrospectively: after 12 months of absence of menstruation. Perimenopause includes the menopausal transition plus 12 months after the last spontaneous menses. Postmenopausal — period after menopause [2].

If before the menopausal transition was a sacred phenomenon and experienced by a woman in the family circle, now this process often coincides in time with a period of active work and career growth. The average age of menopause around the world varies from 45 to 55 years, with significant fluctuations in this indicator depending on the geographical region of women’s residence [3, 4]. In Russia, the average age of menopause is 50–51 years [5]. Menopausal women are the fastest growing demographic in the workforce, according to the Office for National Statistics. It is expected that by 2030 the number of postmenopausal women worldwide will reach 1. 2 billion [1]. In addition, due to increased life expectancy, the postmenopausal period can account for up to 40% of a woman’s life [6].

In the workplace, menopause is often viewed as a taboo topic, although it can affect up to half of the workforce. The British Medical Association has found a strong correlation between women with more experience leaving the profession, as well as dismissal from leadership positions due to women’s inability to cope with menopausal symptoms and lack of support / tact from management or colleagues [7].

And some more statistics:

• 8 out of 10 menopausal women work;
• 3 out of 4 women complain of clinical symptoms characteristic of menopause;
• every 4th woman reports serious symptoms that significantly reduce the quality of life [7].

Since sex hormones are one of the most important regulators of all types of metabolism, in menopause (especially after menopause) there are complex processes of adaptation of the woman’s body to a gradual decrease in their level ( fig. 1 ).

Menopause occurs when the involution of the ovarian parenchyma gradually occurs, the depletion of their ovarian pool and, as a result, the production of estrogens and other sex hormones decreases. It is in response to estrogen deficiency that the level of gonadotropic hormones, primarily follicle-stimulating hormone (FSH), begins to rise. Simultaneously, the synthesis of progesterone decreases. The decrease in estrogen biosynthesis in the ovaries is not accompanied by a decrease in the production of androstenedione, the production of androgens (androstenedione and testosterone) in the adrenal glands is preserved. Therefore, women develop relative hyperandrogenism during menopause [8].

According to a number of studies, an additional factor underlying the observed menopausal symptoms in women is a change in the level of cortisol – the glucocorticoid hormone of the adrenal cortex. Cortisol plays an important role in the development of stress responses to psychobiological stress and regulates metabolism. The daily dynamics of cortisol is associated with sleep and wakefulness patterns, food intake, physical activity and the action of stress factors. Starting from the third decade of life, the level of cortisol in women and men gradually increases. In women, cortisol peaks during the late menopausal transition ( fig. 2 ) [9]

Symptoms of menopause vary widely depending on the age of onset of the menopausal transition and the general health of the patient (Table 1).

Table 1. Groups of symptoms in different periods of menopause [8]

The most obvious progression of age-related changes due to the menopausal decrease in the level of female sex hormones concerns the skin. A deep understanding of the observed phenomena and special care make it possible to maintain the proper structural and functional state of the skin during this critical period for the whole organism.

Menopausal skin changes

Menopause is a condition that greatly affects the way a woman looks. Guinot C. et al. studied the influence of external and internal factors on the formation of age-related changes in facial skin [10]. The study involved 361 women aged 18 to 80 years. Based on the assessment of 24 different parameters, French scientists developed the Skin Age Index (SAS, Skin aging score). According to the graph, the variability in the ratio of the true chronological age of the skin and the Skin Age Index in the age range up to 30 years and after 70 years is relatively small, that is, the chronological age of the skin in these age groups generally corresponds to the calculated according to the parameters of the Skin Age Index. In the age group after 30 years, the variability increases and reaches its maximum in the perimenopausal and menopausal period, and then gradually decreases after 65 years (an increase in the number of cases in which women look older or younger than their chronological age) ( fig. 3 ). Thus, the processes of formation of age-related changes in the skin are individual in nature and, according to the conclusions of scientists, depend on a number of factors. The main ones are:

• phototype;
• BMI;
• menopause ;
• severity of insolation during life;
• years of cigarette smoking.

As can be seen, menopause has a significantly significant effect. There are a number of prerequisites for this.

Almost all cells in the skin contain estrogen receptors, mainly β-receptors with high affinity for estradiol. β-receptors have a huge number of regulatory functions at the skin level (Table 2).

Table 2. Regulatory functions of estrogens and the consequences of their deficiency at the skin level

According to a number of studies, an increase in cortisol levels also negatively affects the condition of the skin:

• aggravates the violation of the barrier and protective function of the skin due to:
• reduce sebum secretion;
• disorders of keratinocyte differentiation;
• enhance transepidermal water loss;
• decrease in the level of IL-1 and TNF-α;
• reduce the expression of antimicrobial peptides;
• aggravates disturbances in the normal structure of the skin, since it negatively affects the synthesis of collagen and hyaluronic acid [11–13].

The most striking manifestations of skin aging are observed during the period of medium-term symptoms, however, each period of menopause is characterized by its own specific changes not only in the skin, but also in its appendages, as well as in the muscular, ligamentous, and bone apparatus of the face (Table 3).

Table 3. Manifestations of facial aging at different stages of menopause [8]

According to Brincat M. P. et al., at menopause, the skin loses 57% lipids, 30% collagen in the first 5 years, 1.5% elasticity per year in the early postmenopausal stage, 1.13% thickness each year in the first 15–18 years [15].

How do you prepare your skin for the menopausal transition?

The problem of menopausal changes in health is exacerbated by women’s lack of awareness of the menopause and, as a result, unpreparedness for it. According to a study by the Women’s founders fund (2020), only 36% of women feel ready for menopause.

Early preparation of women (at age 35) and a holistic model for the prevention of age-related changes and age-related diseases will help normalize the menopausal transition and improve the quality of life of a woman [6].

Early preparation for women (at age 35) and a holistic model for the prevention of age-related changes and age-related diseases will help normalize the menopausal transition and improve a woman’s quality of life.

Hormone replacement therapy is a pathogenetically justified method of treating menopausal symptoms and has a proven beneficial effect on the state of the neurovegetative, cardiovascular and skeletal systems, on psychoemotional manifestations, and also improves skin condition [8].

However, age-related skin changes accelerated by the onset of menopause are not an indication for hormone replacement therapy, which is associated with certain risks of side effects and complications. Although the available clinical experience indicates that the use of topical forms of estrogens leads to an increase in the level of collagen, elastin, epidermal thickness, skin hydration, however, the good absorption of estrogens from the skin surface, the ambiguity of the results and insufficient knowledge do not allow the widespread use of topical estrogens. Estrogens can increase pigmentation when applied topically, especially to sun-exposed areas of the body, and also increase the risk of melanoma. Therefore, the interest of scientists turned to another group of substances – phytoestrogens, substances that, in their three-dimensional structure, are similar to estrogens, but are not their complete analogue.

Phytoestrogens have an affinity for estrogen β-receptors, but it is much less than that of natural estrogens, therefore, no pronounced effect has yet been achieved with their help.

The question of treatment of estrogen deficiency conditions remains open. Efforts continue to be made to use topical agents to address estrogen deficiency symptoms to help women feel comfortable and look younger.

Vichy has its own take on this issue.

Neovadiol line of products – maintaining skin health and preventing age-related changes during menopause

Neovadiol line of care products (Vichy Laboratoires, France) was developed collegially by dermatologists, gynecologists and endocrinologists to support the physiological regeneration of the skin during menopausal aging. This line includes day and night creams of two types: for women in perimenopause and for those who have already entered the menopause, as well as a universal concentrated serum (Table 4).

Table 4. Neovadiol line (Vichy Laboratoires, France) for perimenopausal and postmenopausal skin care

The Neovadiol line is recommended for patients with reduced skin density, facial deformity, dry skin and wrinkles. Can be used on its own or in combination with aesthetic treatments.

Conclusion

Today’s menopausal women don’t want to look younger, they want to look good for their age. There is a need to move from the anti-age paradigm to the pro-age concept: you need to become supporters of aging and use the opportunities that it provides, live with your age, not fight it, and make the most of the accumulated knowledge and experience.

The severity of menopausal changes in a woman’s body largely depends on the state of her health at the time of the onset of the menopausal transition. Early preparation and a holistic model for the prevention of age-related changes and age-related diseases will help normalize the menopausal transition period and improve the quality of a woman’s life.

Neovadiol skin care products prepare the skin for menopause and support its health during a difficult period of hormonal changes.

Article published in the journal “Cosmetics and Medicine Special Edition 2022” No. 1/2022

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Literature

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3. Schoenaker A.J.M., Jackson C.A., Rowlands J.V., Mishra G.D. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol 2014; 43(5): 1542–1562.
4. Afshari F., Bahri B., Sajjadi N., et al. Menopause uncertainty: the impact of two educational interventions among women during the menopausal transition and beyond. Menopause Rev 2020; 19(1): 18–24.
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8. Sharova A.A., Zelenskaya E.M., Dobrokhotova Yu.E. A systematic approach to rejuvenation in menopause. Cosmetic effects of hormone replacement therapy. Plastic surgery and cosmetology 2011; 4.
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Menopause tests

Menopause is a physiological state characterized by the end of a woman’s reproductive function. This
the last menstruation in life, which can only be assessed after 12 months (one calendar year) of the full
absence of menstrual bleeding

The normal age of menopause is between 46 and 55 years, with an average of 50-52 years. decline
the age limit characterizes early menopause, and the age of onset above 55 years is late. As in
one, and in another case, an untimely violation of hormonal activity occurs, the process can lead to
various pathological changes in the body of a woman.

How does a normal female cycle proceed?

In reproductive age, under the influence of follicle-stimulating hormone (FSH) from the pituitary gland in the ovaries of a woman
follicles (eggs that are surrounded by epithelial cells) mature and produce
estrogen. Also in this phase of the cycle, under the influence of estrogens, the proliferation of the endometrium occurs – the mucosa
uterus. In the middle of the menstrual cycle, under the influence of pituitary hormones – FSH and LH (luteinizing hormone),
the follicular membrane is destroyed and the egg is released, that is, ovulation, with the formation in place
a ruptured follicle of the corpus luteum producing the hormone of the second phase – progesterone. In case of non-occurrence
pregnancy there is a gradual reduction of the corpus luteum, a decrease in the level of progesterone, and begins
menstrual bleeding.

What happens during menopause?

The end of menstrual bleeding is associated with impaired follicular activity in the ovaries. Into menopause
the synthesis of estrogens is disrupted, and the gonads do not respond to the increased content of follicle-stimulating
hormone in the blood. At the same time, there is no proliferation of the endometrium, jumps in sex hormones and menstruation, respectively.

What can clinically accompany menopause?

The period of menopause itself is characterized by one clinical symptom – the absence of menstrual
allocations within 12 months. At the same time, together with pre- and postmenopause, it constitutes menopausal
period, which is often accompanied by serious complaints from women. Since, starting from
premenopausal period, there is a decrease in estrogen levels, then the main symptomatology is associated with a deficiency
this hormone.

The most disturbing manifestations in the climacteric period are hot flashes, excessive sweating. Often
because of the sharp hot flashes at night, the patients suffer from insomnia. In addition, women have an increased
irritability, anxiety, mood swings, memory loss. Physiologically
atrophic changes occur in the reproductive organs – thinning of the endometrium, atrophy of the vaginal mucosa
etc. The mucous membrane of the bladder and urethra also suffers. All this leads to pain during sexual intercourse.
act, when urinating, in some cases, pain occurs even in the absence of an irritating factor.

Late symptoms of hypoestrogenism include osteoporosis, which causes fractures.

What tests should be done when menopause occurs?

Diagnosis of menopause is not particularly difficult, as it does not require additional instrumental and
laboratory research. However, during menopause, a number of changes occur in the body, which
require laboratory evaluation. The following tests are carried out:

1. Blood test for hormones

The main test that, together with the clinic, can confirm menopause is a hormone test.

Which hormones should be tested for?

1. Follicle Stimulating Hormone

FSH is a hormone produced in the first phase of the menstrual cycle. Its formation occurs in the anterior lobe
pituitary gland (adenohypophysis). In reproductive age, under its influence, the formation and maturation of
follicles, and estrogens are produced. FSH and estrogens are linked in a negative feedback manner.
is, the higher the level of estrogen, the lower the FSH, and vice versa. So, in menopause, the level of follicle-stimulating
hormone exceeds its indicators relative to the early follicular phase in menstruating women by at least 2
times. This is due to insufficient concentration of estrogens and the response of the pituitary gland to hypoestrogenism.

2. Estradiol

Another hormone studied is estradiol. It is the main female sex hormone. In menopause, its level
significantly reduced.

These two tests are of particular importance in premenopause, as the cause of the change in character is not always obvious.
menstruation (especially during early menopause), and it is the study of these hormones that allows us to state
gradual loss of ovarian activity.

3. Thyroid stimulating hormone (TSH) and thyroxine (T4)

Hot flushes and sweats are prominent symptoms during menopause, which may raise suspicion
for thyroid pathology. Therefore, among other things, it is recommended to take an analysis for TSH of the pituitary gland and thyroxine. At
Hyperthyroidism reduces TSH levels in response to high T4.

The remaining studies are aimed at assessing the general condition of the female body in menopause.

2. Biochemical analysis of blood for lipids

The study of the lipid spectrum in menopause and after is one of the main studies. During the period of decline
activity of female sex hormones increases the risk of developing atherosclerotic plaques and complications associated
with their education. Cholesterol and various fractions of lipoproteins are subject to research. During the menopause
increased levels of cholesterol, low-density lipoprotein (LDL) and their
relation to HDL (high density),
which often requires medical treatment.

In addition to the study of lipids, biochemical analysis involves the evaluation of other indicators of biochemical reactions,
changes in which may indicate a problem with any organ system. Investigate protein fractions, enzymes
liver, creatinine and urea, bilirubin, electrolytes and other indicators
need.

3. Coagulogram

The coagulogram is a study aimed at assessing the blood coagulation system. Its holding
into menopause is of greatest importance when prescribing hormone replacement therapy, since it is often
promotes thrombosis. The following indicators are evaluated: prothrombin and thrombin time,
activated partial thromboplastin time (APTT), INR and fibrinogen. At the same time, an increase in the level of fibrinogen
and a decrease in other indicators indicates an increased risk of developing thrombotic complications, and changes in
the other side, on the contrary, is characterized by a tendency to bleeding.

4. Cytological examination of the cervix

In menopause and after, as well as throughout most of a woman’s life (starting from 18 years), it is recommended to conduct
examination of cervical cells. Since changes in the mucous membranes occur during the menopausal period, then
the cells obtained for the study differ from those in the reproductive period. Cells occupy a large volume
intermediate and basal layers of the epithelium. The predominance of surface cells is typical for women with good
estrogenic activity, and in menopause is an unfavorable sign, as it may indicate
development of the oncological process.

At the onset of menopause, any clinical manifestations of climacteric syndrome, change in condition
reproductive system, be sure to consult a gynecologist.