When menopause sets in around age 50, many changes occur.
Beyond the disappearance of periods and the decline in fertility, major characteristics of menopause, other symptoms and phenomena occur during this period of transition in women. Dr Alain Tamborini, gynecologist, explains to us what happens at this new stage in women’s lives.
The end of ovulation and fertilization
Every woman has a capital of ovarian follicles at birth. The latter develop each month under the action of FSH (follicle-stimulating hormone) and secrete estrogens, the hormones of femininity, which cause the thickening of the uterine mucosa, the regular desquamation of which constitutes the period. At premenopause, the ovaries become less sensitive to the action of FSH. THE cycles shorten or lengthen and ovulation occurs so irregular then not at all. The cycles eventually stop when the minimum threshold of follicles is reached. “There is therefore no more ovulation, no more transformation of the follicle into the corpus luteum and, consequently, no more production of progesterone, the maternity hormone.” The endometrium is no longer prepared to accommodate a fertilized egg and becomes less and less thick, the rules are getting shorter then disappear.
A redistribution of fat mass in the stomach
At menopause, the metabolism changes. Changes in body composition often occur at the time of menopause and can distort and “weigh down” the silhouette: “4 out of 5 women will gain weight unevenly before and during menopause. It is often more a problem of centimeters than of kilos”, specifies Dr Tamborini. So, lipoprotein lipase activity decreases and the lipolytic response to norepinephrine of abdominal adipocytes is reduced. These changes in the metabolic activity of adipose tissue result in a redistribution of fat mass toward the abdomen. “There is also usually a gap between medical standards and the idealized and desired body image imposed by fashion.”
An increase in waist-to-hip ratio
Weight gain, which probably begins at the time of perimenopause and disruption of cycles, is therefore accompanied by menopause by a modification of the distribution of fats in an android manner, with an increase in the waist/hip ratio, correlated with a increased cardiovascular risk. “If body fat increases with age, it increases as a percentage of total weight after menopause.” At the same time, abdominal adiposity increases while lean mass decreases, especially at the femoral level (thighs). These changes in body composition are also observed in obese women.
“Weight gain during menopause is better prevented than treated”
“All women must be warned of the high probability of these changes,” he concludes, “in order to take the necessary (sometimes drastic…) lifestyle and dietary measures to combat them or better, prevent them.” Indeed, weight gain during menopause is better prevented than treated and abdominal fat is, at this time of life, an area that often resists dieting. All women can therefore benefit from advice aimed at avoiding errors and overeating:
- limit and balance intake,
- better distribute the ration over the three meals,
- ensure a calcium diet,
- fight against a sedentary lifestyle,
- promote regular physical exercise,
- increase muscle mass.
A hormone replacement therapy Proper conduct combining a natural estrogen and natural progesterone or a progestin close to progesterone should not lead to iatrogenic weight gain or aggravate the weight gain common during this period. Hormonal treatment for menopause (THM) must be effective on menopausal disorders (hot flashes, night sweats, insomnia, etc.) but also and mostly well toleratedbecause it is usually a long-term treatment over several years. “In all cases, with or without THM, it is appropriate to adopt strict lifestyle and dietary measures in order to preserve your weight and figure at menopause. It is often a difficult battle but it is possible ” he concludes.
The question of osteoporosis
It affects approximately 1 in 4 women and represents the main long-term complication of menopause. From the age of 40, bone mass naturally decreases. In women, there is an acceleration of bone loss at menopause. “When bone mass has decreased significantly, it can lead to fractures (vertebrae, wrist and later femur). The first fracture is most often the collapse of a lumbar vertebra, occurring around the age of 65. Subsequently, other vertebral compressions may occur and increase pain and disability. specifies Dr Tamborini. L’bone density assessment by bone densitometry (totally painless and very low radiation examination) at the start of menopause is particularly interesting for identifying which women are at risk. Means exist to preserve bone health, notably through calcium diet : a diet rich in calcium, a sufficient intake of vitamin D which promotes the absorption and fixation of calcium (1,200 mg/day or 3 to 4 dairy products), and the practice of regular physical activity. “Dietary calcium intake in middle age is often insufficient even though needs are increasing. diet rich in calcium is therefore recommended : dairy products, cheeses (comté, emmental, cantal), yogurts and white cheeses (some are judiciously enriched with calcium and vitamin D), mineral water with a high calcium content. An additional calcium intake can also be very useful. he insists. For prevention, in the years following menopause, hormonal treatment is particularly indicated because it slows down or even stops this bone loss.
The skin, the nails… also change
Menopause with its estrogen deficiency contributes more or less, depending on each woman, to skin aging and very variable skin changes (decreased content of collagen, hyaluronic acid, dryness, appearance of wrinklesreduction in skin thickness, etc.). “Our patients often talk aboutan “old look” at the time of menopause or, perhaps, rather middle age, the age at which the stigma of skin aging is expected and feared in a Western socio-cultural environment that is not very forgiving, even cruel, which gives a “bonus” to youth and increases their perception.” emphasizes Dr Tamborini. The basis is to preserve skin hydration through the use of specific “anti-aging” products and ranges and to ensure sun protection all year round. Sometimes nails can become more fragile and brittle.
Hair growth decreases
Both hair and body hair can also be affected by these physiological hormonal upheavals: in the more or less long term, the activity of the skin’s androgen receptors and the production of sebum decrease. There growth of limb hair slows down while the pubic and armpit hair becomes rareror even disappears. “Less often and in the absence of any abnormal androgen secretion, we can see a chin hair growth and/or the upper lip related to electric hair removal or, the aggravation of a alopecia started in perimenopause” he concludes.
Thanks to Dr Alain Tamborini, gynecologist (Paris)