In these weeks in which women’s health regains special prominence, Dr. Clotilde Vázquez puts the spotlight on menopause. She believes that it is still a stigma, although less and less, and that this taboo is still “a little operational”. Currently, Ella Vázquez is the corporate head of Endocrinology and Nutrition at several hospitals, such as Fundación Jiménez Díaz, and is among the 100 best doctors in Spain by specialty, according to the Forbes list. This health worker born in Alicante, who does not want to reveal her age, assures that numerous patients who came for problems such as diabetes, obesity or cholesterol have passed through her consultation, and many had in common that they had begun to suffer from it in menopause.
With the idea of helping more women, Vázquez decided to write a book on menopause which he titled With hormones already crazy (Vergara), which was published last fall. “I want to explain why it happens and, above all, what might not happen, that it is not a fatum that has fallen to us women; that science nowadays gives us great possibilities to continue being well”, assures Vázquez. In it, he emphasizes the consequences of menopause: from the most popular, such as insomnia or hot flashes, to others not so named, such as the loss of estrogen, whose consequences increase the risk of starting diabetes or obesity.
Ask. What happens in the woman’s body so that so many changes occur during menopause?
Response. The two hormones produced by the ovary, progesterone and especially 17 beta estradiol, which is the most abundant estrogen produced by the ovary, have receptors throughout the body. The role they play in achieving a mature egg has always been known. But in addition, they have a role in the brain, in the blood vessels, in the bone, in the skin… In all the organs and systems of our body. Then, as a cessation occurs, because there will be no more ovulation, the whole body suffers from that lack.
Less than a century ago, life expectancy was very little beyond menopause. But now, the life expectancy of a woman is 30 or 40 years more [desde el climaterio]. Not having those hormones that are so necessary for all those systems and devices makes women more predisposed to having diseases during that time. Even if she lives longer, she can live dragging problems that can be avoided by giving replacement hormones since the ovary does not produce it.
“There is a lot of connection between mood, desires, the entire limbic system, with estrogens”
P. One of the great shocks that women face in menopause is the change in their physical appearance. Is it inevitable to gain weight?
R. If you don’t do something very active, yes, it’s inevitable. Estrogens increase energy expenditure. The lack of estrogen has many derivatives. So we would have to eat less to avoid gaining weight, but also in the central nervous system women have many estrogen receptors, that’s why we sometimes experience mood disorders after childbirth or sometimes some women, even in the premenstrual situation… There is a lot of connection between mood, desires, the entire limbic system, with estrogens. Then, we begin to experience the desire to eat things that we did not have before, seizures, whims, or the need for foods that make us fatter. With which, between the fact that we spend less and we may have that need to eat more due to the absence of estrogen, we normally gain weight.
It is avoidable, if measures are taken in time. I also insist a lot that it be without stress. That’s the good thing about knowing what happens to one. Some women will be able to have hormone replacement therapy, with which, that is greatly attenuated. It is also a time to clean up life in terms of more physical activity.
P. What is hormone replacement therapy?
R. It consists of providing the hormones produced by the ovary, either orally or transdermally or vaginally, so that we have levels in the blood that are not like those of the fertile period (when those levels go up and down). In this case, what we intend is to restore the levels as if it were at the beginning of a menstrual cycle, that is, very prudent physiological levels, but which are sufficient to alleviate all the symptoms in the short, medium and long term.
P. Is it the most effective solution to alleviate the symptoms of menopause?
R. A resounding yes. Another thing is that a person does not want or should not. There are some contraindications: family breast cancer, severe coagulation problems… but, if not, absolutely yes.
P. How does the decrease in some hormones affect people’s mood?
R. Normally, there are two types of symptoms that women experience. In some sadness prevails. Especially when there are sudden menopause, almost without having had symptoms before, in which it seems that the ovary “finishes” overnight and there is a very abrupt cessation. So, this sudden deficit usually produces sadness, tiredness and even authentic depression.
But more frequent than that are mood disorders, such as irritability, mood swings, going from crying to laughing. These oscillations, the lack of calm, are very frequent, along with insomnia.
“Not being able to rest is a real disease. Now we see that it is in turn related to the appearance of many other diseases, including obesity, diabetes, metabolic syndrome…”
P. Difficulty falling asleep or irregular sleep times are very common symptoms. What are the consequences of the lack of rest at these ages?
R. Not being able to rest is a real disease. Now we see that in turn it is related to the appearance of many other diseases, among others obesity, diabetes, metabolic syndrome… It can be total insomnia at the beginning, or it can be frequent awakenings due to hot flashes, or no hot flashes, but very irregular sleep, so that in the morning they are very tired. Here again is hormone replacement therapy. Perhaps the hormone that most helps sleep is progesterone; and melatonin, which basically is a hormone and an antioxidant, but it helps us. In most women who have symptoms, after a month or two of treatment, they feel much better.
P. What consequences does the decrease in some very important hormones for women, such as estrogens, have on health?
R. There are some short-term consequences, which are the ones that are most popular, such as hot flashes, insomnia, irritability, that kind of change in character and difficulties in relating to others. But more relevant than that is that the absence of estrogen has consequences on blood vessels, bones, muscles… So, women have a much higher risk of developing diabetes, obesity and disorders derived from alterations in the arterial wall, such as atherosclerosis. And heart attack, which is very rare in non-smoking women before menopause. However, after menopause, it equals or exceeds the rate for men. Taking care of the heart and bones in the long term is what makes the difference between a woman who has continued to have estrogen and progestogens at physiological levels, if this is the case in her body, or those who have not.
P. In your book you state that the genitourinary syndrome of menopause prevails in up to 90% of Spanish women, what does it consist of?
R. It is the set of symptoms derived from the atrophy of the wall of the vagina and the ureters. The loss of strength in the pelvic floor, which, after all, is muscle, and women from before menopause begin to lose muscle if we do not do much more physical activity, more strength exercise. That is why sport, from the age of 40, is not that it is a possibility, it is that it is the only option.
This entire area suffers from atrophy and sometimes from the appearance of infections, because the vaginal flora, with the decrease in estrogen, changes and bacteria and fungi appear more frequently. All this, together with what I have said about the pelvic floor, means that the woman may begin to experience urine escaping when she coughs, for example. She can be very serious, even having a prolapse of the uterus due to the weakness of the wall. Normally, most of us women go before [al médico]. It is not normal, although Concha Velasco announces it, to leak urine. If we can, we have to avoid them.
P. How is the perception of menopause?
R. The perception of menopause is quite wrong, it is full of ignorance, myths, incorrect thoughts and disqualifications. Most men have the feeling that the woman is hysterical, they do not understand the situation at all. The woman herself also experiences it with a feeling of “what is happening to me?”. She asks others or doesn’t ask herself why “it is what it is, it is what we have had”.
I always try to put the simile of another endocrine gland. A person with hypothyroidism, who would have, for example, loss of concentration, memory, hair and gain weight, would not be treated as a hysteric, but as a person who is lacking a hormone. This happens in menopause, the only truth is not known: there is an endocrine gland that is used for reproduction and to continue supplying two super-necessary hormones for life -progesterone and estrogen-, and when that ceases, if there is no drawbacks or contraindications, it must be replaced.
Then there is another aspect: menopause a century ago meant being very close to the end of life, and still, although this is not the case because women have the second stage of life left, [la mujer] She has the feeling that she is penalized. That is to say, he is already a person who is professionally out of the circuit, in terms of attractiveness, in terms of possibilities for development… That is why he tries to hide it, that is why he does not tell what is happening to him. This is a pending issue for men and women, that we look naturally at a period that has no mystery at all, it is simply physiological.