[Menopausal transition, physiopathology, clinical and treatment]

Menopausal transition is a period that begins four years before menopause as a result of follicular decline. The first hormonal change is a decrease in B inhibin levels, followed by a decrease in estradiol and an increase in FSH levels; abrupt plasmatic oscillations of these hormones can be observed. Climacteric symptomatology may appear before cycle disorders and provoke an impairment in quality of life. Bone loss equally precedes menopause. Some authors, but not all of them, accept that during perimenopause there is an increased risk of cardiovascular disease. We point out the need of beginning hormonal therapy when the first clinical signs of estrogenic deficiency arise, independent of menstrual cycle and hormonal levels. Women aged over 45 are suitable for the classical sequential therapy, adjusting it to the cycle while it still persists; younger patients may use transdermal estrogens for short periods of time. Whenever contraception is required or there is irregular bleeding we indicate low dose estrogenic contraceptives, if possible the 28 days of the cycle. It is necessary to correct potentially dangerous daily habits and treat concomitant diseases that may enhance cardiovascular risk. The patient's education is an indispensable goal for the success of the treatment.