Menopause: A stage in a woman's life
Menopause is a stage in a woman's life characterized by estrogen deficiency, with signs and symptoms (climacteric): vasomotor (hot flashes, sweating, palpitations), urogenital (dryness, incontinence, dysuria, urinary tract infections, sexual dysfunction), and psychological (climacteric dysphoria). This hypoestrogenism also increases the risk of osteoporosis, cardiovascular disease, dyslipidemia, and alterations in sugar metabolism, and promotes weight gain and a higher risk of colon, breast, and endometrial cancer.
With age, energy expenditure and the metabolic activity of lean tissue decrease, as does the progressive decline in physical activity, resulting in a positive energy balance and weight gain. Age and hypoestrogenism lead to an androgen/estrogen imbalance that induces changes in the gut microbiota, resulting in a chronic inflammatory response and a shift in fat distribution, with a predominance of abdominal fat and an increase in visceral fat. This shifts from the typical gynoid (pear) fat distribution in women to an android (apple) shape, which facilitates insulin resistance regardless of body mass index (BMI).
Lifestyle changes, reduced calorie intake, and exercise improve insulin resistance, help maintain weight, and prevent bone loss. The severity of symptoms, risk factors, BMI, and waist circumference should be considered to determine the most appropriate treatment for managing menopause and preventing related chronic diseases and cancers.
Estrogen replacement therapy should be adjusted to the lowest effective dose, via the appropriate route of administration, and within the therapeutic window period (the first 10 years). Its adverse effects have led to low adherence, prompting the use of other medications based on individual needs. Phytoestrogens (plant estrogens) are well-accepted alternatives, and the use of probiotics has been shown to correct intestinal and vaginal dysbiosis, improving symptoms and enhancing the positive effects of the hormone therapy used.
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