Dr. Pepa Manzano Villalba, assistant gynecologist at Clínica Juaneda, dismantles in this interview the clichés that still surround menopause. With a clear and didactic discourse, she explains why the last menstruation is only the starting point of a hormonal change that can be managed with rigorous information, self-care and personalized treatments.
What is menopause?
-To establish a framework, could you briefly explain what menopause is?
– Medically, menopause is defined as the last menstrual period. At that point the ovaries exhaust their follicular reserve; once ovulation ceases, production of estrogens, progestogen and even testosterone drops. This hormonal imbalance, rather than infertility itself, is responsible for most systemic symptoms. This is what we call climacteric, which is the set of symptoms derived from hormonal change.
-What are the most frequent symptoms you see in the office?
-The most recognizable symptom is hot flushing. It usually begins with a sensation of intense heat and is sometimes accompanied by a subsequent cold sweating. It often manifests itself at night, causing the woman to wake up feeling hot, nervous and, later, cold, due to the sweat that dries up. This problem disturbs the night’s rest and causes tiredness, irritability and restlessness.
In addition, there are other symptoms associated with the drop in hormones. Vaginal, skin, eye and mouth dryness. Body changes with a tendency to accumulate more fat in the abdominal area, causing loss of waistline. Many women also report difficulties in falling asleep, changes in their mood, anxiety and variations in memory.
La doctora Pepa Manzano explica a Mallorca Global Mag las terapias hormonales sustitutivas. Foto: Piter Castillo
-What other body changes stand out and how can they influence a woman’s overall health?
-When such profound hormonal changes occur, other glands can often be affected as well. The thyroid can become unbalanced and lead to hypo- or hyperthyroidism, or aggravate a previous tendency. The risk of type 2 diabetes is increased in part by changes in fat distribution and the appearance of excess weight, coupled with metabolic changes. Also, after menopause there is a greater loss of bone mass, which increases the risk of osteoporosis and fractures.
-And something very important that people are not aware of, menopause can increase the risk of cardiovascular disease. Before menopause there are 5 heart attacks in men for every one in women; after menopause, it is equalized. Cardiovascular disease is now the leading cause of death in postmenopausal women, more so than cancer.
– What role do women’s attitudes and self-care play in this process?
– It is essential to normalise menopause as a natural change, just as puberty once was. Accepting that the body evolves and adopting a healthy lifestyle are key: balanced nutrition, regular exercise (especially strength training for bone and muscle), and routine medical follow-up. These measures alleviate symptoms and reduce risks
It is important to normalize that this change is as natural as the transition from childhood to adolescence.
– Are there specific treatments for hot flashes and other symptoms?
– Yes. Phytotherapy compounds (e.g., black cohosh) have been used for hot flashes and may help in some cases. Centrally acting drugs, such as fezolinetant, have also been developed that block the neurons that trigger hot flashes. However, all treatments have potential side effects and should be discussed with the patient. In addition, methods such as meditation can help.
-What can you tell us about hormone replacement therapy?
–Hormone replacement therapy (HRT) consists of administering estrogens and, if the patient retains her uterus, also gestagens, to compensate for the drop in hormone levels. In the past, it was almost universally prescribed to prevent heart attacks and other risks; but in 2002, very solid studies emerged showing that it did not reduce heart attacks completely and, in addition, it was associated with a slightly increased risk of breast cancer in the long term. This led to a pendulum effect: from giving it to almost all women to demonizing it and giving it to none. Today, we are more cautious: it is indicated if the symptoms are very severe or there are clear benefits. The profile of each patient must always be assessed and the risks and advantages must be explained in a transparent way so that she can decide for herself.
Ilustración: @pikisuperstar
-How does menopause affect sexuality and what role do you see couple communication playing?-With the decrease in estrogen there may be vaginal dryness or discomfort during sexual intercourse, and many women feel that their sexual desire changes. However, female desire is very complex and does not depend on hormones alone. Sometimes good communication, exploring other forms of intimacy and, if there is pain, seeking specific solutions (lubricants, local treatment, couple’s therapy, etc.) is enough. The couple’s own aging also has an influence, so the key is open communication so that there is no distancing that worsens the situation.
Entering the menopausal stage clashes with the image of perpetual youth promoted by the media.
– How does social pressure influence the self-esteem of women going through menopause?
– Women of the baby-boom generation, now entering menopause, have more access to information than their mothers did, yet they face intense social, professional and family demands. This life stage collides with the media’s ideal of perpetual youth, so frustration and fear of ageing are common. Many women also shoulder multiple responsibilities and hesitate to share their discomforts. Open communication is essential to avoid experiencing meno- pause as a personal failure.
Pepa Manzano, ginecóloga en Juaneda, habla sin tapujos de la menopausia. Foto: Piter Castillo
-What fears do you detect in your patients and how do you help them?
-The first thing I notice is a diffuse fear of aging: many women associate menopause with the loss of attractiveness or the end of their sex life, but they do not know what they are afraid of. I invite them to recognize the biological reality – the years go by for everyone, including their partners – and to focus on what they can control: diet, exercise, rest and a redefined sexuality, not necessarily based on penetration. To empower them, I recommend readings such as Tu sexo es tuyo or Deseo, by Silvia de Béjar, and, above all, I personalize the approach, because each woman experiences the transition differently and deserves a plan adapted to her real needs, not to stereotypes.
-How do you assess the information circulating today about menopause?-My impression is that there is a lot of talk about the subject, but very little depth. There is a lot of information circulating on social networks, often contradictory. There are websites and profiles that offer misrepresented data or omit information. As a result, many people come to the consultation with a learned discourse, but without solid scientific backing, and this breaks the basic relationship of trust that should exist between doctor and patient.
Leave A Comment