Menopause can have up to 72 different signs. “If each symptom is analyzed separately, the woman may receive the answer that she has nothing”

For many women, menopause does not start suddenly and is not reduced to a single symptom, but is a complex picture of manifestations – up to 72 symptoms, from hot flashes, sleep disturbances and anxiety, to mental fog, palpitations or persistent fatigue. Most of the time, these signs are treated separately, as independent problems, although in reality menopause should be seen as a whole. This was the central message of the conference “Let's Talk About Menopause”, with the theme “72 manifestations of menopause”, held in Iasi in April, organized by the Queen Maria Health Network and Superage. Doctors within Menopause Center in Iasi, together with Ileana Badiu, co-founder of the “Sunt la Menopauza” Association and the initiator of the Superage project emphasized the need for a paradigm shift: understanding menopause as a natural stage in a woman's life, which involves more information, prevention and an integrated medical approach, which correlates all the symptoms and transformations the patient is going through.

Menopause marks the end of the fertile period and usually occurs between the ages of 45 and 55. It is medically confirmed after 12 consecutive months without menstruation and is determined by the progressive decrease in the level of estrogen and progesterone hormones.

“From a physiological point of view, menopause occurs against the background of the end of reproductive ovarian function and hormone production. The ovaries are no longer able to ensure sufficient hormone secretion, nor the development of the follicles necessary for ovulation and pregnancy. Regarding the age of onset, studies carried out on large cohorts show that menopause occurs, on average, around the age of 51 years, usually between 45 and 55 years old,” explained Dr. Alexandra Cristofor, Obstetrics – gynecology specialist, within the Queen Maria Iași Health Network (PHOTO), at the “Let's Talk About Menopause” conference.

What is perimenopause and why it lasts up to 10 years

In this context, doctors point out that the changes do not appear suddenly at the time of menopause, but are preceded by a transition stage that is less known, but essential for understanding the whole process, namely, perimenopause.

This is the period that precedes the onset of menopause and can begin several years before the definitive cessation of menstruation. During this time, ovarian activity becomes irregular and hormone levels fluctuate, which can lead to a variety of symptoms such as irregular menstrual cycles, hot flashes, sleep disturbances, mood swings or difficulty concentrating.

“In perimenopause, cycles begin to become anovulatory, against the background of relative ovarian insufficiency, which means that ovulation no longer occurs constantly. Hence the appearance of irregular menstrual cycles — more abundant, delayed or, on the contrary, at shorter intervals, sometimes even twice a month. All these changes are determined by the decrease in ovarian function. During this period, numerous symptoms can appear, in some classifications being described over 70 manifestations associated with perimenopause”, explained Dr. Cristofor.

The doctor emphasizes that this diversity of manifestations makes perimenopause a complex stage, with an important clinical significance, but still insufficiently recognized in medical practice. “It is a very relevant stage from a clinical point of view, but paradoxically insufficiently recognized in medical practice. The duration of perimenopause is variable, and can be, on average, between 4 and 8 years, sometimes even up to 10 years, from the moment of the onset of the symptoms and until the onset of menopause itself”, said Dr. Cristofor.

From mental fog to joint pain: what menopause really looks like

Beginning in perimenopause and continuing into menopause, symptoms can be multiple and varied, impacting multiple body systems. “Unfortunately, in the public discourse, menopause is still mainly reduced to hot flashes. In reality, however, we are talking about a whole syndrome, with multisystemic manifestations, which are found both in perimenopause and in menopause,” explained the gynecologist.

On the cardiovascular side, hot flashes, palpitations, night sweats or episodes of hypertension frequently occur. Neurologically, many people describe brain fog, difficulty concentrating, dizziness, vertigo, headaches or migraines. Rheumatological and musculoskeletal manifestations may also occur, such as shoulder, hip or back pain, joint stiffness and muscle pain.

At the urogenital level, vaginal dryness, burning or discomfort, pain during sexual contact, frequent urination, urinary urgency or recurrent urinary infections are common.

At the same time, the psychological and emotional component should not be ignored either, which can include anxiety, irritability, mood swings, sleep disturbances, mental fatigue and decreased energy or motivation.

Why doctors don't see the big picture and what the patient is missing out on

Because of an often fragmented medical approach, each specialist tends to interpret symptoms through the lens of their own specialty. “The neurologist can notice “mental fog”, the psychiatrist sees that you have newly installed anxiety or cognitive difficulties, and the rheumatologist notices that you have muscle and joint pain, which they try to attribute to a distinct organic cause”, emphasized Dr. Cristofor.

Investigations are essential to rule out possible serious conditions, but specialists point out that the problem does not stop there. If the symptoms are analyzed in isolation, without being viewed as a whole, the patient is the one who ends up losing the most.

“If we limit ourselves to investigating each symptom separately, the patient often receives the answer that the tests are good or receives a short-term symptomatic treatment. For her, this can be extremely frustrating, because she goes home without a clear explanation and without a real solution,” he explained. dr. Irina Mihaela Abdulan, internal medicine specialist within the Queen Maria Iași Health Network (PHOTO).

What a proper consultation at the Menopause Center looks like

In this context, doctors say that it is important to change the way the menopausal patient is viewed, so that the symptoms are no longer addressed separately, but in relation to each other. “It is important to have an integrated approach to the menopausal woman and to bring all these symptoms together in one menopausal syndrome. Because it is not enough to treat, for example, only back pain”, Dr. Cristofor also conveyed.

In order to understand the practical implementation of this integrated model, Dr. Irina Mihaela Abdulan detailed the clinical course of the patient at the Menopause Center in Iasi. “The menopausal patient cannot be evaluated piecemeal. Our approach can begin with a gynecology or endocrinology consultation, but often begins with an Internal Medicine consultation, which involves an initial clinical assessment and a thorough history, thus achieving the global profile of the health state. Considering that menopause can associate up to 72 different symptoms, we guide the patient to specific interclinical consultations. Later, based on the interdisciplinary conclusions, we elaborate and we initiate a therapeutic scheme adapted to his needs”, pointed out Dr. Irina Mihaela Abdulan.

In the same direction, Dr. Călin Todoran, Obstetrics – gynecology primary physician within the Queen Maria Health Network in Cluj emphasized, during the event, the importance of treatment customization and collaboration between specialties, stating that “an individualized assessment, by a multidisciplinary team, is important, so that the therapy is adapted to each individual patient”.

Why some women have severe symptoms and others almost none

Experts say that the experience of menopause differs greatly from one woman to another, and this is due to what doctors call interpersonal variability. In other words, each body reacts differently to the hormonal changes specific to perimenopause and menopause.

“It's not always the absolute level of estrogen that matters, but mostly the hormonal fluctuations and how the body reacts to them,” explains Dr. Abdulan. Thus, two women can have the same level of estradiol, but completely different symptoms: one can have severe hot flashes, anxiety, insomnia, and mental fog, while the other can go through this period with minimal symptoms.

The difference is largely due to the instability of estrogen levels. In some women, hormones fluctuate a lot, and these sharp variations are associated with more intense symptoms. In addition, each person has a different sensitivity of estrogen receptors, which means that the body does not respond identically to the same hormone levels.

Genetic and neuroendocrine factors also play an important role. “Each woman has a unique biological profile, which makes it impossible to fit everyone into a single pattern of menopause,” the doctor added.

Lifestyle can also significantly influence the intensity of symptoms. Sedentaryism, smoking, obesity, lack of physical exercise, chronic stress or a disorganized lifestyle can accentuate the symptoms of menopause and aggravate existing health problems.

Often, behind the severe symptoms of menopause there is another silent accomplice: micronutrient deficiency. Low levels of vitamin D, B12, folic acid, iron, magnesium or calcium can overlap with the clinical picture of menopause, amplifying its effects. This is why a properly medically guided supplementation becomes essential. “In our view, the therapeutic target has evolved: we are no longer satisfied with just a “normal” value on the analysis sheet, but aim to achieve optimal serum levels, capable of truly reflecting the patient's well-being.”

Article endorsed by Queen Mary