Women are surprised by climacteric symptoms – 10/05/2023 – Balance

With her period late for more than a month, her abdomen enlarged and feeling nauseous, Luciana Oliveira was sure she was pregnant. She informed her husband and went to the gynecologist. At the office, the diagnosis was very different from what she imagined: “It’s the climacteric. You’re getting older”, declared the doctor.

“It was a shock. Until the term, climacteric, I didn’t know. For me, it was all menopause”, remembers Luciana, who at the time was 48 years old and mother of four children.

Cases like hers are not uncommon. As the end of a woman’s reproductive period is linked to a series of undesirable changes, such as weight gain, increased skin sagging and mood changes, many go their entire lives without talking about the subject and are surprised by the first symptoms.

The climacteric encompasses the entire transition phase from the reproductive to the non-reproductive period. It lasts from 40 to 65 years of age and is characterized by the progressive decrease in the production of sex hormones, especially estrogen.

The menstrual cycle becomes irregular, with months in which there is no bleeding. The flow can also vary greatly, becoming much weaker or much more intense. Menopause is only defined when there is no menstruation for at least 12 consecutive months.

As many women take contraceptive pills with estrogen, these symptoms can remain masked for a few years until the hormonal drop becomes more pronounced, explains José Maria Soares Junior, head of the Department of Obstetrics and Gynecology at FMUSP (Faculty of Medicine at the University of São Paulo) and executive secretary of SBRH (Brazilian Society of Human Reproduction).

“The use of the pill can continue until the age of 50, 55, without harm. As long as this woman can actually use it, there is no risk of thrombosis, for example. Therefore, it is very important to follow up with a gynecologist”, he states. The specialist.

Upon discovering that she was in climacteric, Luciana stopped taking the pill on medical advice and started using non-hormonal contraceptive methods, such as condoms.

Over time, the symptoms intensified. When menstruation started, the flow was very intense and lasted up to 20 days. She developed anemia and had to take medication to stop the bleeding and had to change her diet to control the condition.

He also began to feel the famous hot flashes. “There were waves of heat that felt like they were coming from my stomach to my head, I felt really bad,” she reports.

Hot flushes are part of the vasomotor symptoms, which are the most common in menopause, says Isabel Cristina Esposito Sorpreso, associate professor and full professor of the gynecology discipline at the Department of Obstetrics and Gynecology at FMUSP and coordinator of the menopause sector at Hospital das Clínicas da FMUSP.

In addition to hot flashes, there is excessive sweating, tachycardia, vertigo and even ringing in the ears, explains Sorpreso.

But that’s not all. Other very common manifestations are mood changes, such as irritability and depressive symptoms, insomnia, vaginal dryness, decreased libido, urinary incontinence, weight gain, hair loss and increased skin sagging.

Luciana says that her nails became weak and brittle and her skin gained some spots, which is why she sought out a dermatologist. She also felt very depressed and irritable. “A glass out of place was already a reason for a fight. The doctor reassured me and said that this phase would pass. But it was very difficult”, she says.

Her husband’s support was essential during this period. “Even though sometimes I told him to get away from me, when I was really nervous, he stayed firmly by my side.”

Menopause definitively arrived for Luciana at the age of 52. She says that since then her symptoms have improved a lot. The doctor did not recommend hormone replacement (non-recommendation is generally associated with the risk of breast cancer and thrombosis, among other conditions), but the thyroid was affected and she started taking medication for hypothyroidism – this could be a consequence of the drop in estrogen.

Today, at 57 years old, she says she feels great and has started to take better care of herself. She never misses Pilates and water aerobics classes.

“It’s like I’m in adolescence again, only in old age”, jokes Luciana, who has gone back to school and is studying her fourth semester at the social service college.

“Menopause changed my mentality a lot. Now I’m a much more reflective person, I talk more with my children and my husband. I’ve also started to take better care of myself and my body”, she says.

Clinical psychologist Cleide Guimarães, 59, agrees that the climacteric causes changes in women’s behavior. And the irritability and whirlwind of emotions of the early years can give way to a more serene phase when this cycle closes.

“The problem is that we are completely without support. And when the climacteric arrives, it usually coincides with other difficult periods”, he observes. “It’s at this time that children leave home, that our parents become older and more fragile. Many couples separate.”

She herself faced the first symptoms of climacteric at the age of 53, along with mourning the death of her father. And, even though she was a psychologist, she was unsure about what she was going through.

“My father had just died and I was depressed. It was very confusing. I already knew about the climacteric, but it was difficult to know what was causing what”, she says. “Luckily, I acted very quickly. I was already undergoing basic treatment for depression and I looked for a new gynecologist who was a specialist in the subject.”

As a psychologist, Cleide highlights that this phase can also destabilize family relationships, especially when the woman does not have much support. “Today it’s even funny to remember, but I thought I would never be able to wear a woolen sweater again in my life. I wanted to leave the window open even when it was cold. My relationship with my children and my husband is very good. But what about the woman who doesn’t Do you have all this understanding at home? How is it?”

Cleide takes hormone replacement therapy, but says she had to adapt to the medications. “I used a gel for a while, but it gave me rashes. Then I started using patches and today I’m fine.”

For her, in addition to the symptoms, there is a psychological issue that also ends up affecting women. “It’s a period in which aging accelerates. We see our skin change, become more flaccid. The face changes a lot”, she observes.

“In addition to vanity, there is a prejudice in society against everything that is old. And also the shame of admitting that you are going through this, losing your youth. That’s why women, in general, don’t like to talk about menopause.”

José Maria Soares Junior, head of the Department of Obstetrics and Gynecology at FMUSP, reinforces that climacteric is a multifactorial condition. Therefore, changes in lifestyle habits are fundamental to living this stage well.

“Regardless of the treatment recommended by the doctor, whether hormonal replacement will be performed or not, it is necessary to have a balanced diet and give preference to fresh foods, avoiding ultra-processed foods and very fatty foods”, he states.

Physical activity also needs to be part of your routine. “An average of 150 to 300 minutes of exercise per week, if possible with the guidance of a physical educator”, says the doctor, who also recommends drinking plenty of water to stay hydrated and wearing light clothing when you are going through the hot flashes phase.

The holistic approach is fundamental in the climacteric, highlights Isabel Cristina Esposito Sorpreso, associate professor at the Department of Obstetrics and Gynecology at FMUSP.

“The woman should be monitored by a gynecologist. The diagnosis is clinical, based on the symptoms, although the specialist may also order tests such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH)”, he says.

This specialist must recognize the patient’s individual needs and, when necessary, indicate that she also consults with professionals from other areas, such as a nutritionist, endocrinologist, cardiologist, psychologist, rheumatologist, among others, says the doctor.