Menopause

What is menopause?

Menopause is defined as the permanent cessation of menstruation, confirmed after 12 consecutive months without a period. It results from the natural decline of ovarian function and the corresponding drop in oestrogen and progesterone production. The average age of menopause in France is 51, though it can occur anywhere between 45 and 55.

The perimenopause is the transitional phase leading up to menopause, often lasting several years. During this time, hormone levels fluctuate unpredictably, causing irregular cycles and the onset of menopausal symptoms.

Common symptoms

The drop in oestrogen affects many systems in the body. Symptoms vary greatly between individuals in type, severity, and duration:

• Vasomotor symptoms — hot flushes and night sweats are the most frequently reported symptoms, affecting up to 75% of women. They can range from mildly uncomfortable to severely disruptive
• Sleep disturbance — difficulty falling asleep, frequent awakenings, and night sweats leading to chronic fatigue
• Mood changes — irritability, anxiety, low mood, and difficulty concentrating. Perimenopausal women have a higher risk of depression
• Urogenital symptoms — vaginal dryness, itching, discomfort during intercourse, and recurrent urinary tract infections (genitourinary syndrome of menopause)
• Joint and muscle pain — stiffness and aching, often worse in the morning
• Weight changes — tendency to gain weight, particularly around the abdomen
• Skin and hair changes — dryness, thinning hair, and reduced skin elasticity

Long-term health considerations

Beyond immediate symptoms, oestrogen deficiency has important long-term health implications that should be monitored and addressed:

• Bone health — accelerated bone loss in the first 5–10 years after menopause increases the risk of osteoporosis and fractures. Bone density screening (DEXA scan) is recommended
• Cardiovascular health — the protective effect of oestrogen on blood vessels diminishes, increasing the risk of heart disease and stroke. Lipid profile and blood pressure monitoring become particularly important
• Cognitive health — emerging research suggests oestrogen plays a role in cognitive function; management of modifiable risk factors is encouraged

Hormone replacement therapy (HRT)

HRT remains the most effective treatment for menopausal symptoms and provides additional benefits for bone and cardiovascular protection when started early (within 10 years of menopause onset or before age 60).

• Oestrogen — available as transdermal patches, gels, or sprays (preferred routes as they avoid first-pass liver metabolism and carry a lower risk of venous thromboembolism)
• Progesterone — required alongside oestrogen in women with an intact uterus to protect the endometrium. Micronised progesterone (natural progesterone) is the preferred option
• Tibolone — a synthetic steroid with oestrogenic, progestogenic, and androgenic activity; an alternative to combined HRT
• Local vaginal oestrogen — for urogenital symptoms specifically, available as creams, pessaries, or a vaginal ring. Can be used alone or alongside systemic HRT, and is safe for long-term use

Non-hormonal alternatives

For women who cannot or prefer not to take HRT, several effective alternatives exist:

• Neurokinin B receptor antagonists (fezolinetant) — a newer class of medication that targets the thermoregulatory centre in the brain, shown to significantly reduce hot flushes without hormonal effects
• SSRIs and SNRIs — certain antidepressants (e.g., venlafaxine, paroxetine) can reduce hot flushes by 40–60%
• Gabapentin or pregabalin — may help with hot flushes and sleep disturbance
• Cognitive behavioural therapy (CBT) — evidence-based approach for managing hot flushes, sleep problems, and low mood
• Lifestyle measures — regular physical activity, maintaining a healthy weight, stress reduction techniques, and avoiding triggers (spicy food, alcohol, caffeine) can all improve symptoms
• Vaginal moisturisers and lubricants — non-hormonal options for vaginal dryness and discomfort during intercourse

A personalised approach

There is no one-size-fits-all solution for menopause. Dr. Maazouzi takes the time to listen to each patient’s experience, assess individual risk factors, and co-create a management plan that aligns with personal health goals and preferences. Regular follow-up ensures that the chosen approach remains appropriate over time.