Ogni donna la vive in modo diverso, chi soffrendo fisicamente, chi emotivamente, chi accettandola come una fisiologica tappa della vita. Ma cosa succede davvero al nostro corpo? Come avviene la transizione da organismo predisposto alla procreazione ad organismo che ha espletato le sue funzioni biologiche?

C’è chi la aspetta per non avere a che fare con le seccature delle mestruazioni, c’è chi la teme perché è un passo irreversibile verso la senilità, la menopausa da sempre ha costituito una tappa fondamentale nella vita delle donne. Per menopausa si intende la cessazione definitiva dei flussi mestruali: costituisce uno spartiacque nell’ambito del climaterio, un lasso di tempo compreso tra pre e post menopausa. La pre-menopausa costituisce quel periodo di tempo tra l’inizio dell’involuzione della funzione ovarica e l’interruzione del flusso, dura solitamente cinque anni, si manifesta con anomalie mestruali quantitative e qualitative. La post-menopausa, invece, è un periodo di tempo assai variabile durante il quale, si assiste a modificazioni endocrino-metaboliche responsabili di tutti i fastidiosi sintomi avvertiti dalle donne; al termine di questo periodo è sancito l’inizio della senilità, intorno ai 65 anni.

La menopausa è sancita dall’esaurirsi del patrimonio follicolare (determinato già alla nascita) e dalla insensibilità dell’ovaio agli stimoli delle gonadotropine. L’età in cui più frequentemente si assiste a questo “spegnimento” biologico è tra i 45 e i 50 anni. Andando ad analizzare gli ormoni che circolano nel sangue di una donna, durante questo periodo, vedremo che con la riduzione della funzione ovarica si avrà un calo nella produzione di estrogeni, perdita dell’attività ciclica da parte dell’ipotalamo, che diventerà costante a causa di un effetto a “feed-back negativo” a causa del deficit di estrogeni. Il quadro clinico che corrisponde a queste alterazioni endocrine è molto complesso, ma soprattutto caratterizzato da una grande variabilità interpersonale: il corpo di ogni donna vive la menopausa a proprio modo. Con l’avvicinarsi della menopausa compaiono turbe dell’equilibrio psichico e neurovegetativo: ansia, depressione, cefalea, affaticabilità e insonnia; a questi sintomi si accompagna un’alterazione ancora più marcata dei flussi residui.

In post menopausa invece, a causa del crollo estrogenico, si verificano tutta una serie di manifestazioni cliniche, che ora andremo ad osservare insieme:

  • Fenomeni vasomotori: le classiche “vampate” di calore, seguite da sudorazione, palpitazioni ed eventualmente dolore al torace, nella zona precordiale. Questi fenomeni sono dovuti ad un’alterazione del metabolismo delle catecolamine (ndr. Adrenalina e noradrenalina) ed ad una diminuita funzionalità del sistema oppioide endogeno. Più ci avviciniamo alla fine del climaterio, più questa sintomatologia tenderà ad attenuarsi.
  • Fenomeni psichici: I più frequenti sono depressione, insonnia, irritabilità, apatia. Non dobbiamo dimenticarci che, sono estremamente variabili e condizionati anche dal contesto sociale in cui si vive.

    Sintomi principali della menopausa
    Sintomi principali della menopausa
  • Fenomeni trofici: Questi si manifestano a carico dell’apparato genitourinario, osteoarticolare e cutaneo: analizziamoli uno alla volta. Per quanto riguarda l’apparato genitourinario, la cessazione dello stimolo estrogenico causa una netta riduzione di volume di utero, ovaie, mammella, una riduzione dell’ampiezza dei fornici vaginali, un restringimento dell’ostio vulvo-vaginale, un assottigliamento dell’epitelio vaginale con secchezza della mucosa (e conseguente dolore durante i rapporti sessuali), una predisposizione a vaginiti ricorrenti (per aumento del pH vaginale), disturbi della minzione (per lassità dell’apparato di sostegno), incontinenza. L’apparato osteoarticolare è uno dei più colpiti, la cessazione dello stimolo estrogenico causa una riduzione dell’assorbimento del calcio a livello intestinale, e, contemporaneamente, aumenta la risposta degli osteoclasti al paratormone, favorendo, in definitiva, la mobilizzazione del calcio dalle ossa, per renderlo disponibile in circolo: a peggiorare la situazione si assiste ad un abbassamento dei livelli ematici di calcitonina, l’ormone che contrasta, parzialmente, l’azione del paratormone e gli osteoclasti; l’insieme di questi fenomeni comporta il prevalere dei fenomeni di rimodellamento e distruzione ossea su quelli di ricostruzione, con conseguente rarefazione ossea e comparsa di dolore articolare, seguito, in ultima analisi, da un’aumentata incidenza di osteoporosi e fratture spontanee. La cute è un’altra vittima della menopausa, diviene secca e meno elastica, si ha un aumento di rughe ed un rilasciamento generale dei tessuti (purtroppo, c’è da aggiungere che gli estrogeni tenevano a bada il testosterone prodotto dall’ovaio stesso e dal surrene, mancando questi può succedere che l’aumento di testosterone circolante causi la crescita di peluria a livello del labbro superiore o del mento)
  • Fenomeni metabolici: Si assiste a modificazioni radicali dell’assetto lipidico e glucidico, si ha, infatti, un incremento di trigliceridi e del colesterolo totale, ad eccezione dell’HDL che diminuisce (ndr. L’HDL è il colesterolo “buono”), favorendo l’insorgenza di lesioni aterosclerotiche molto pericolose e l’aumento ponderale (che di per sé è un fattore di rischio cardiovascolare). Aumentano il cortisolo ed il TSH, causando una ridotta tolleranza al glucosio e quindi un aumentato rischio di sviluppare il diabete.
  • Fenomeni vascolari: Diminuiscono le prostacicline (vasodilatatrici ed antiaggreganti), causando un aumento della pressione arteriosa e del rischio di trombosi.

Essere donna protegge da numerosissime patologie fino alla menopausa: è il più importante fattore cardioprotettivo, si ha un rischio significativamente minore di avere un infarto o un ictus, di sviluppare ipertensione o eventi trombotici. Inoltre diminuisce le probabilità di avere il diabete, di sviluppare malattia autoimmuni o alcuni tipi di neoplasie. Purtroppo nulla dura per sempre, e dopo la menopausa gli indici mostrano che le donne sono esposte allo stesso rischio, se non maggiore, degli uomini per quanto riguarda le suddette patologie. E’ importante che si faccia prevenzione, evitando di aggiungere altri fattori di rischio (fumo, alimentazione ipercalorica, sedentarietà). Può inoltre essere utile, in alcuni casi, un supporto psicologico, per evitare che la donna possa sentirsi “inutile” una volta espletata la sua funzione di procreatrice.

Certo non è semplice gestire un cambiamento così radicale, non ci si abitua facilmente ad i nuovi fastidiosi sintomi, non si impara da un giorno all’altro a conoscere questa nuovo lato di se stesse, ma tutto ciò fa parte delle gioie e dei dolori dell’essere donna. Concludiamo l’argomento sorridendo, con un’immagine che fa un po’ di sana ironia.

Vignetta ironica sui sintomi menopausali
Vignetta ironica sui sintomi menopausali
Vicepresidente | Nata a Napoli il 25 Giugno 1992. Ho frequentato l'università degli studi della Campania "Luigi Vanvitelli" laureandomi in Medicina e Chirurgia nel 2017. Attualmente sono una specializzanda in Ostetricia e Ginecologia presso l'Università degli studi di Torino. Mi occupo di coordinare la Redazione de "La Medicina In Uno Scatto", di cui sono anche Vicepresidente.

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