Menopause, a simple but precise definition

The word comes from the Greek meno (cycle) and pause (stop): menopause literally means the stopping of the cycle. It occurs on average around age 51, but it's only confirmed once a woman hasn't had her period for a full year. No hormone test or specific sign is needed to diagnose it: that full year without periods is what confirms it. During that transition year, there's no way to know in advance if it's "the one": it can only be confirmed in hindsight.

Why estrogen deficiency explains (almost) everything

Estrogen is the quintessential female hormone, influencing much of a woman's health and wellbeing. At menopause, its production drops sharply. This deficiency is behind most of the symptoms experienced.

The 4 signs of menopause to know

Hot flashes (climacteric signs), affecting about three-quarters of women. Mood and sleep disturbances. Urogenital symptoms (vagina, vulva, bladder), which appear later, after months or years of deficiency. And joint pain, an increasingly recognized sign: morning stiffness, diffuse joint discomfort.

The silent risks: bones and blood vessels

Beyond the symptoms you feel, estrogen deficiency has an impact you don't necessarily notice: the risk of osteoporosis increases, and blood vessels age faster. That's why it's better to enter menopause already in good physical shape.

Who is Odile, and why her approach is different

Odile has practiced gynecology for over 40 years. She's also trained in psychosomatic gynecology and psychoanalysis, a dual expertise she puts to use for her patients: to her, a woman is not "a uterus with legs." She draws on a quote from psychoanalyst Monique Bydlowski: a practitioner's scientific knowledge is on the same level as a patient's knowledge of her own body and experience. Odile is also the author of several books on the subject, the latest of which, Ménopause, je traverse la tempête, summarizes current scientific data.

An approach that goes beyond the medical

The psyche has a strong effect on health. Odile illustrates this with a personal anecdote: an herbal tea meant to restart her milk supply worked purely through the placebo effect and trust in her doctor, before she realized the label read "milk-boosting tea" (literally, a tea to produce milk). She also notes that a woman's hormonal life is marked by recurring cycles: periods every month, then potentially pregnancy, childbirth, breastfeeding, then menopause, a continuity men don't experience in the same way.

The real advantages of menopause

The end of periods, a real relief for women who suffered from conditions like endometriosis, heavy bleeding, fibroids, or ovulation pain. The "midlife" (ages 45-65), a period conducive to taking stock and personal reorientation. The end of contraception concerns, a real liberation. And potentially better sex: more self-knowledge, less pressure related to procreation, provided any vaginal dryness issues are addressed.

The downsides not to be minimized (but to be put into perspective)

Hot flashes and the transition period (the first year without periods) can be uncomfortable, especially without support (hormonal or complementary medicine). Odile puts this in perspective: in her view, this transition is less destabilizing than puberty, where the body changes just as much without teenagers being as well supported as they are today.

Who to consult, and when

Menopause should be part of an annual gynecological check-up, which can be done by a gynecologist, a general practitioner, or a midwife (qualified for prevention and screening, but not to prescribe hormone therapy, once there's a pathology, it's outside her scope). There's a dedicated consultation for ages 45-55, with self-questionnaires available on Amelie to prepare for the appointment. Odile also acknowledges an important reality: access to gynecologists remains difficult in some parts of France, which makes the role of midwives and GPs in this follow-up all the more valuable. There's no urgency to consult at the first hot flash.

The myth of hormone testing (FSH)

Contrary to popular belief, there's no test that confirms menopause. FSH levels (a hormone that rises at menopause) have no reliable threshold for standard diagnosis, and can even create confusion (lab results often show a very broad "menopause" range, even for women who still have periods). This test is only useful in one specific case: a woman on continuous birth control pills or a hormonal IUD, who therefore has no periods to otherwise assess her situation.

The goal is to be meno-optimistic.

What's next?

Odile warns that menopause can sometimes arrive "early": that's the whole subject of the next episode, dedicated to perimenopause. She also mentions that the topic of weight, often wrongly attributed solely to menopause, will be covered in detail later in the series.