When the cardio-gynecology teams of the Parisian hospitals of Hôtel-Dieu and Port-Royal asked us to relay their request for a long-term menopause prevention consultation to all women, from the age of 45, we gave them everything. immediately opened our pages. For what ? Because the recommendation of these expert doctors makes sense: today, despite existing systems, too many women suffer alone, amid general incomprehension. In this context, the parliamentary mission launched by the Minister of Health and Access to Care on the occasion of World Menopause Day, October 18, demonstrates (finally!) the government’s interest in subject. “Identifying concrete solutions to better inform, monitor and support women affected by menopause” seems commendable. But Isn’t the long menopause prevention consultation already a concrete solution?exactly ?
France has 14 million postmenopausal women, or 100% of those over 55, at higher risk of developing bone fragility, depression, cardiovascular disease – the leading cause of female mortality. It’s time for their health to become a priority.
Alert the government to the need for support for women entering the menopausethis is the purpose of the column that we are publishing. Written by Drs Sandrine Kretz, gynecologist-endocrinologist at Hôtel-Dieu (Paris) and Sandrine Pérol, medical gynecologist at Port-Royal (Paris), it is supported by the services of Professor Geneviève Plu-Bureau (medical gynecology at Port -Royal) and Professor Jacques Blacher (cardiology at Hôtel-Dieu), as well as by the members of the study group on menopause and aging (Gemvi) chaired by Professor Florence Trémollières (Gynecologist – endocrinologist at Toulouse University Hospital).
A long consultation for better information and management of menopause
Menopause is an inevitable event in a woman’s life.. It occurs on average at the age of 51. In France, more than a third of the female population is postmenopausal, and each year 500,000 new women are affected.
This transition, often still taboo in our society, requires specific information and support.
If menopause is only a physiological, normal, obligatory stage in the life of all women, it is accompanied in the short term, for more than 80% of them, by a so-called climacteric syndrome, the flagship symptom are the classics hot flashes. Thus, for the majority of women, their personal, social, professional and intimate lives can be greatly altered.
Many women lack information on the symptoms that may occur during this period, finding themselves very helpless in the face of these disorders. However, simple explanations and informed information on this syndrome could easily reassure them that they understand this period.
Its support must be greater than it is in 2024. In particular, the use of a hormonal treatment for menopausethe most effective treatment for managing hot flashes, should probably be more widely offered to very symptomatic women, by carefully evaluating its benefit-risk balance. Our Anglo-Saxon neighbors are thus one of the countries where care has been very clearly optimized for several years, thanks to significant media and female mobilization.
Long-term consequences must also be anticipated in a collective prevention effort.
Indeed, this transition is also accompanied by medium and long-term risks which can be anticipated by improving women’s information and their support:
- loss of bone density and risk of fractures,
- the increased incidence of cardiovascular diseases and its emerging specifically female risk factors for which research must be systematic (vascular complications of pregnancy, gestational diabetes, pregnancy-related hypertension, migraines with aura, etc.),
- the genitourinary syndrome menopause,
- carcinological events and in particular breast cancer…
If, for the latter pathology, screening is organized, there is, for example, no specific organized screening for cardiovascular diseases, which nevertheless represent the leading cause of mortality among postmenopausal women. Women, potentially protected by their hormones before menopause, will quickly “catch up” with men’s risks. Indeed, with the increase in life expectancy since the middle of the previous century, they now spend more than a third of their lives in a situation of estrogen deficiency, a consequence of the cessation of ovarian function at menopause. .
This deficiency is also the essential determinant of the risk of osteoporosis. It can easily be detected at the start of menopause thanks to thebone densitometry examination which makes it possible to quantify bone stock, an essential determinant of future fracture risk. This examination is still subject to certain clinical conditions in order to be reimbursed, which has only contributed to underestimating its interest in the eyes of many practitioners. However, it is at the start of menopause that its predictive value for the risk of osteoporosis is best. To do without this tool is to underestimate the morbidity, the excess mortality associated with this pathology and even more so a health cost which is only increasing with the aging of populations.
So, knowing how to screen for all cardiovascular risk factors such as the risk of osteoporosis means being able to implement preventive measures and limit their consequences.
In addition to possible medical measures, it is essential to remember the importance of a better lifestyle, simple gestures to improve well-being, health and sometimes even save lives (fight against a sedentary lifestyle, tobacco and alcohol, maintaining a balanced diet, etc.).
Prevention Assessments have just been implemented at different ages of life for men and women, which is to be welcomed. However, this cannot in any way replace a systematic medical consultation, specific for women during the period of life around menopause.
It is in this context that a long “menopause” consultation, like that already established for contraception, should be put in place for all women, in order to inform, detect, prevent, take care of and to reduce the consequences of menopause.
This measure, by its generalization to the entire territory, would allow optimized care for all menopausal women in our country, including (and especially) the most precarious, and thus reduce the inequalities between men and women in access. to care.
