Menopause is the period in the life of a woman which coincides with a series of natural biological changes in their body.
The secretion of estrogens by the ovaries stops in all women at menopause, while the secretion of DHEA, the main source of estrogens and androgens after menopause, has already decreased by an average of 60% since the age of ~30.
The resulting hormonal deficiency can be responsible for a series of symptoms typical of post-menopause:
Postmenopausal vulvovaginal atrophy (VVA), a component of the genitourinary syndrome of menopause (GSM).
GSM and postmenopausal VVA represent a constellation of conditions and symptoms affecting approximately 50% of postmenopausal women and are often the underlying cause leading to female sexual dysfunction. GSM is defined as a series of symptoms and signs involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. The syndrome may include but is not limited to: genital symptoms of dryness, burning and irritation; sexual symptoms of lack of lubrication, discomfort and pain; urinary symptoms of urgency, dysuria and recurrent urinary tract infections.
Contrary to hot flashes which are usually temporary and eventually cease, the problems associated with VVA usually worsen with time if left untreated. GSM can seriously affect quality of life in a large proportion of the affected women and depression and anxiety can also be associated with VVA.
It is the combined hormonal deficiency of both estrogens and androgens, mainly made intracellularly from DHEA after menopause, which results in a thinning of the vaginal wall and a decrease in lubrication and elasticity. Despite their symptoms, less than 10% of affected women seek treatment with prescription medicines, consequently, most of the women who suffer from VVA symptoms are left without treatment for a large part of their lives.
Hot flashes (HFs) are the most commonly reported postmenopausal symptom and are mostly attributed to the decrease in sex steroids levels following menopause. They are described as feelings of intense warmth along with sweating, flushing, and chills. Sweating is generally reported in the face, neck and chest. HFs episodes usually last for 1 to 5 minutes, with some lasting as long as an hour. The median duration of symptoms is about four years, with some lasting as long as 20 years. In one U.S. study, 87% of the women reported daily HFs and about a third of those reported more than 10 per day.
Osteoporosis (Loss of Bone)
Osteoporosis is characterized by low bone mineral density (BMD), skeletal fragility and microarchitectural deterioration and is linked to a high risk of postmenopausal fractures. The prevalence of osteoporosis varies depending on whether it is defined by fracture incidence or by low BMD (a T score of −2.5 or less). Approximately 300,000 hip fractures occur every year in the United States, but there are close to 40 million women with low BMD. It is estimated that a 50-year-old white woman has a 15 to 20% lifetime risk of hip fracture and a 50% risk of any osteoporotic fracture. Hip fractures can result in poor quality of life, a dependent living situation, and an increased risk of death. Spine fractures are also associated with an increased risk of death, are strong predictors of future fractures, and may result in chronic pain, kyphosis, and a loss of self-esteem.