Menopause

Menopause is a period of life just like infancy, adolescence, and sexual maturity. During the menopause, the number of follicles in the ovaries decreases and accordingly estrogen production is reduced. Over time, estrogen production gradually ceases and the ovaries become smaller. Accordingly, the menstrual cycle is interrupted, and fertility is lost. The word menopause comes from the Greek words men (moon) and pause (halt). The World Health Organization defines menopause as the permanent cessation of the menstrual cycle resulting from loss of ovarian activity. The age at which menopause occurs is between the age of 45 and 55 years worldwide. Studies indicate that the typical age of menopause is 46-48 years in Turkey.

According to the classification of the World Health Organization, the menopause period is divided into three periods:

Premenopause: Covers the period from the first symptoms to the onset of menopause. Follicle activity slows down in the ovaries. The menstrual cycles (periods) become irregular. This process can take several months or years.

Menopause: Menopause is the last occurrence of menstrual bleeding.

Postmenopause: Covers 6-8 years from menopause to old age. Once a woman has gone 12 months without a period, she’s considered to be in menopause.

Menopause is also classified according to its occurrence:

Natural menopause

Premature (early)  menopause: Menopause that occurs before the age of 45 is called early menopause. It can occur due to conditions with unknown causes, autoimmune diseases, radiotherapy, chemotherapy, infections, environmental causes, abortion and miscarriages, frequent pregnancies, excessive obesity and hypothyroidism.

Surgical menopause: Some surgical operations can lead to premature menopause. If the ovaries of a menstruating woman are surgically removed, menstruation ceases and menopause occurs. Radiation treatment can lead to menopause. Loss of ovarian function seen during cancer chemotherapies are often reversible.

Factors Affecting Onset of Menopause

Genetic factors: It has been observed that women tend to have similar age at menopause to other women in their family.

Genital factors: It has been observed that women who had irregular menstruation tend to enter menopause earlier than those who had regular menstruation. In addition, conditions such as fertility, age at first menstruation,birth control pill use and breastfeeding for more than two years can affect the age of menopause.

Psychological factors: Psychological traumas accelerate the onset of menopause. It was observed that war, migration, earthquake and prolonged prison life triggered early menopause.

Physical and environmental factors: Menopause occurs earlier in women living in cold climates and under extreme conditions.

Smoking: Women who are heavy smokers experience menopause 1-2 years earlier than those who do not.

General health status: Severe metabolic diseases, genetic disorders, infectious diseases, chemotherapy and radiotherapy can affect the age of onset of menopause.

Social factors: In rural and traditional societies, the age of menopause can be early.

What are the Premenopausal Complaints?

  • Menstrual irregularities
  • Decrease in ovulation
  • Hot flushes
  • Excessive sweating    Increased heart rate
  • Depressed mood
  • Inability to sleep
  • Tension, irritability
  • Increased appetite
  • Concentration difficulties
  • Flushing of the face
  • Increased heart rate
  • Headache, dizziness
  • Hot flushes
  • Lack of self-confidence
  • Forgetfulness
  • Carelessness
  • Tiredness
  • Decreased sexual desire

Symptoms Seen After Menopause

Premenopausal symptoms persist.

After prolonged estrogen depletion, atrophy (shrinkage) occurs in the genital organs. There is shrinkage in the uterus, vagina and vulva and urethra. Accordingly, there may be frequent urination, constipation, itching in the vulva, painful sexual intercourse, uterine prolapse, urinary incontinence, sagging in the bladder, sagging in the anus.

Estrogen receptors are also found in the skin, hair follicles and sweat glands. Changes related to this occur after menopause. The skin becomes thinner, the amount of collagen decreases. The amount of hair decreases. The skin dries, loses its elasticity and wound healing is delayed. Thick hair may appear on the chin, lips, and chest. The amount of hair decreases in the armpit and genital area.

There may be dry mouth, bad taste in the mouth and gum diseases during the menopause. Constipation and hemorrhoids are common. Reflux (heartburn) and gallstones are also common.

The risk of developing heart disease in women increases with menopause. While estrogen is a hormone that reduces the risk of coronary heart disease, the risk of coronary heart disease increases with the decrease of estrogen with menopause. Cholesterol level increases with menopause. High blood pressure may occur. Vascular stiffness is observed.

Another major problem seen with menopause is osteoporosis. Osteoporosis facilitates bone fractures as a result of reduced bone mineral density. Women with menopause lose 3-4% of their bone mass every year.

Gaining weight: In women after menopause, the metabolic rate slows down and weight gain can be seen.

Sexual reluctance begins.

How Is Menopause Diagnosed?

It is important to diagnose menopause early. Because a significant part of the deficiencies in menopause occurs during the first year. Early diagnosis enables early treatment. If FSH and LH hormones are increased in the blood taken on the third day of the menstrual period from a woman with infrequent menstruation, hot flashes, and psychological disorders, the diagnosis of menopause can be made. If the FSH level is above 40 pg/ml in a woman with irregular menstruation, menopause can be definitively diagnosed. If the FSH level is between 25-40 pg/ml, it can be related with premenopause, and though rare, women in this period may get pregnant. However, pregnancy and other diseases that cause irregular bleeding should be investigated and ultrasound should be performed in every woman with irregular bleeding.

Eating Right During Menopause

Metabolic rate slows down due to estrogen deficiency and weight gain occurs.

1500 mg of calcium should be taken daily to prevent osteoporosis.

Vitamin E can prevent hot flashes and fatigue.

Vitamin D should be kept at a normal level.

Salt intake should be restricted.

It is important to exercise regularly during menopause.

What To Do In Menopause

It is necessary to dress lightly and in layers during the menopause period, for relief of hot flashes that are frequently seen especially in the first 2 years. Thus, if hot flashes occur, few layers of clothes can be taken off. It is beneficial to reduce spices and caffeine and to stay away from cigarettes and alcohol. Comforting oils are used against painful sexual intercourse due to low estrogen levels. Regular sexual intercourse is necessary to prevent atrophy. It is important to pay attention to daily calcium intake and exercise regularly to prevent osteoporosis. If your doctor finds it appropriate, hormone replacement therapy can be given. Bone density measurement (densitometry) should be performed at regular intervals.

What is Hormone Replacement Therapy?

Hormone replacement therapy (HRT) is an estrogen supplement therapy. The patient is regularly given medications containing estrogen and progesterone. The main purpose of hormone therapy is to eliminate complaints such as hot flashes and sweating due to menopause. However, the frequency of osteoporosis and cardiovascular diseases, which increase with menopause, can also be reduced.  Treatment also has a positive effect on sexual life. Dry mouth and bad taste in the mouth improve, and tooth decay diminishes.

Who Shouldn’t Take Hormone Therapy?

Those with known and suspected uterine and breast cancer

Patients with undiagnosed abnormal vaginal bleeding

Those with liver disease

Patients at risk of clotting

Obesity, varicose veins, hypertension, excessive smoking

Those who have had a heart attack

Hormone replacement therapy is not given to those who have brain vascular occlusion or stroke.

It should be used with caution in the presence of hypertension, diabetes, gallstones, hyperlipidemia, migraine and uterine myomas (fibroids).

HRT can be used both in the form of injections and orally. Vaginal cream form is also available.


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