Menopause is a natural passage in the life of every woman: the term means “last menstruation” and therefore refers to the end of menstruation and female reproductive life. A woman is considered to be in menopause when 12 months have passed since her last menstruation. We talk about this topic with Dr. Elena Zannoni, specialist in Gynecology and Reproductive Medicine at Humanitas.

The age at which most women enter menopause is about 50 years, although this is not true for all women. Physiological menopause is therefore defined as menopause occurring between the ages of 48 and 52, early before the age of 47 and late when it occurs after the age of 52. The age of onset of menopause seems to be genetically fixed and has remained almost unchanged in recent centuries, despite the increase in the average lifespan of women.

This is an important consideration. In fact, if we consider that life expectancy in 1800 was about 50 years for a woman and today is about 80, it goes without saying that today a woman can live more than 30 years in post-menopause, a period significantly greater than in the past.



Menopause occurs when the ovaries, no longer possessing eggs, reach their functional exhaustion. Then the production of estrogen ends, the female sex hormones. Menopause is preceded by a period (called “premenopause” or “transitional age”) during which there is altered production of the same estrogens and which is generally characterized by menstrual irregularities resulting from the progressive decline of ovarian activity.

The fluctuation and subsequent drop in estrogen levels can trigger a series of physical and mental changes, so-called menopausal symptoms.


Hot flashes and night sweating

Hot flashes and night sweating are among the most characteristic symptoms of menopause. A sudden sensation of heat spreads from the chest and reaches the neck and face and can cause sweating during the night.

The exact causes of hot flashes are unknown. The most probable cause seems to be a loss of control of body thermoregulation by the hypothalamus, the gland located at the base of the skull, close to the pituitary gland. Through a feedback mechanism, the hypothalamus feels the end of ovarian activity, the consequent decrease in estrogen production and the stimulating action of the pituitary gland, which tries to restart follicular production by the ovaries.

All this translates into a sort of hyper excitation of the hypothalamus with loss of function of the temperature control center and this would result in the onset of flushes.


When hot flashes and/or night sweats are present, it is advisable to:

  • Dress with multiple layers of thin, breathable clothing.
  • Use cotton sheets.
  • Prefer fresh fruits and vegetables. Avoid spicy foods, spices, hot drinks, alcohol and fatty foods, especially in summer or evening.
  • Practice regular physical activity: Physical movement helps maintain an ideal body mass index, a useful factor in preventing the intensity and frequency of flushes.
  • Reduce smoking, which can increase the severity of flushes.
  • Practice relaxing activities such as yoga.


Palpitations and headaches

Heart palpitations may accompany the hot flashes. If this symptom is relevant, it is advisable to consult your doctor in order to check your heart’s state of health and rule out any cardiac problems.

Migraines and other forms of headache can also worsen with hormone fluctuations. If they persist, consult a specialist.


Vaginal dryness

The reduction of estrogen levels translates into a thinning (atrophy) of the mucous lining of the vagina, resulting in impairment of proper lubrication, which results in dryness of the vagina, a symptom that can make sexual intercourse very painful (we speak of dyspareunia in this case) and increase the risk of bladder infections (cystitis).

In these cases it is advisable to use lubricating creams during penetration or to use local therapies with preparations based on estrogens (if there are no contraindications to their use) or emollient creams (based on phytostimulants, hyaluronic acid, lactobacilli or ozone) in order to “soften” the vaginal tissues, making sexual intercourse easier (and therefore more satisfactory).

In some cases, the practitioner may recommend the local use of testosterone-based ointments (which increases libido, promoting, among other things, increased lubrication).

Recently, the use of a particular type of laser in the treatment of vaginal atrophy has been introduced. However, this therapy is expensive and not yet fully validated from the point of view of results, and should be suggested by the gynecologist when other therapies have not had the desired effects.


Skin and hair

The skin may appear dry, dull and inelastic; it is advisable to drink a lot to ensure proper hydration and not wash excessively.

Hair often becomes thinner, brittle, and saggier. Again, it is advisable to seek advice from a specialist to identify the most appropriate remedy.


Weight gain

One of the most frequent and often reported consequences of perimenopausal women is weight gain. The reduction of estrogen leads to a change in the basal metabolism with less energy consumption and consequent weight gain and redistribution of body fat.

In the menopausal age, except in rare fortunate cases, it is necessary to reduce dietary intake and increase physical exercise. There are no miracle pills for this problem and this must be made clear to our patients. Taking into account the body changes that are part of the passage of age, the woman must undertake a lifestyle that will allow her to maintain a pleasant physicality, while starting the physiological process of aging.