The word menopause refers to the last menstrual period, which is not actually confirmed until a woman has been menstrual-free for a year. From the time the first menstrual alterations and/or the first symptoms begin until this first year without a period has passed, is what is known as perimenopause, and what happens afterwards is the stage known as postmenopause.
If we take into account that the average age of menopause is around 50 years, and that the life expectancy for the female sex is a little over 85 years in our country, it will be deduced that women will spend more than a third of their lives in postmenopause.
For menopause to occur, the ovaries have to decline, until they cease, the production of eggs for possible pregnancies, and reduce the secretion of female hormones (mainly estrogen and progesterone). This implies, on the one hand, the loss of reproductive capacity and, on the other hand, a decrease in the level of hormones in the blood.
Estrogen deficiency is usually associated with the presentation of a number of symptoms and signs, most of which tend to gradually disappear over the course of a woman’s postmenopausal life.
Symptoms of menopause:
- hot flashes, sweating
- paliptations
- irritability
- depressive mood
- sleeplessness
- vaginal dryness
- decreased libido
- osteoarticular pain
- redistribution of fat
- periabdominal body fat
- genitourinary atrophy
- altered sexual excitability
- decrease in bone mass
- increased cardiovascular risk
However, estrogen deficiency lasts over time, and so do some of its effects. These include a marked tendency to lose bone mass, with an increased risk of osteoporosis; an increase in cardiovascular risk; and a degeneration of the tissues of the genitourinary system, known as vulvovaginal atrophy.
How does the hormonal deficit act in the evolution towards atrophy of the genitourinary system?
Estrogens maintain vascularization and proper irrigation of the tissues. When they decrease, this blood supply is also reduced, which implies, among other things, a reduction in the thickness of the epithelium lining the walls of the vagina, and in its functionality. The epithelium is responsible for vaginal lubrication in response to sexual stimulation, and for the production of glycogen, a substrate used by the microorganisms of the vagina, the lactobacilli, to maintain equilibrium and protect against exogenous infections.
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Microbial density can decrease in the vagina of a menopausal woman to 1%, lactobacilli cease to be dominant to give way to other microorganisms coming from contamination from the skin or intestine.
We already know that lactobacilli use the glycogen of the epithelium to produce lactic acid, which acidifies the pH, protecting against the colonization of other microorganisms that can cause infections; they also act by preventing pathogens from adhering to the walls, or by producing substances that help to eliminate them.
It is easy to deduce that with the decrease of lactobacilli, during the whole postmenopause, women will have a higher risk of suffering from vaginal and urinary infections, probably of repetition. Some retain an acceptable level, which may increase with the use of hormone replacement therapy (estrogen), but it is vitally important to take this peculiarity into account, because there is a lot of data in favor of lactobacillus supplementation as part of the treatment of urogenital infections, to avoid recurrences.
Vaginal health guidelines recommend the use of probiotic products, containing lactobacilli, for this supplementation. They are used orally and/or as vaginal ovules after specific treatment of the infection and have been shown to be effective in reducing infectious vulvovaginitis and urinary tract infections.
In addition, their preventive use is gaining popularity, as an alternative to the current antibiotic prophylaxis of recurrent urinary tract infections, especially in women with antibiotic resistance.
