We need to talk more about menopause – at least that is the assessment of the German Menopause Society, an organization that seeks to remove the taboos surrounding the topic and put it on the agenda of health policymakers.
In 2021, according to Global Health Organization26% of the world’s female population is aged 50 or over. This means that about 1.3 billion women are going through menopause or have already gone through it. But, after all, what happens at this stage of a woman’s life?
When does menopause start?
To answer this question, first of all, it is necessary to clarify the terminology, says gynecologist Anneliese Schoenkhagen. Based in Hamburg, she specializes in gynecological endocrinology: hormones – the main factors behind menopause – are her area of expertise.
Menopause is defined as the last menstrual period. According to the German Menopause Society, this happens on average between the ages of 51 and 52 years. In rare cases, its lifespan can reach about 40 years.
It represents the point at which monthly ovulation stops, leading to infertility. But the decline in a woman’s fertility actually begins during perimenopause, which can occur many years before menopause.
Perimenopause also refers to the 12 months after your last menstrual period. Only after this period of one year do we start talking about post-menopause. The term menopause includes almost all of these stages together, so the time at which it occurs can only be determined retrospectively.
What are the symptoms of menopause?
For about two-thirds of women, menopause is an unpleasant transition: a third complain of severe symptoms.
It all starts in perimenopause, mainly due to the fluctuating activity of the ovaries. Estrogen hormones, especially estradiol, are produced in ovarian follicles that mature in the ovaries. During perimenopause, periods become irregular, either longer or without bleeding.
This causes hormonal fluctuations, which in turn lead to symptoms such as breast tenderness, fluid retention, mood swings, and sleep disturbances. “Many women in this stage, which can sometimes start at age 40, don’t even know that their symptoms may be related to hormonal changes at the beginning of menopause,” Schoenkhagen explains.
During menopause, patients with previous psychiatric illnesses such as depression or anxiety disorders may also relapse. “Statistically, menopause is a high-risk state for psychiatric illness, due to hormonal instability, which makes the brain more vulnerable.” Migraine is one of the diseases that can worsen at this stage.
One of the main symptoms after menopause are hot flashes and sweating. The skin and mucous membranes become increasingly dry. “This particularly affects the vagina and bladder. There may be pain during sex or recurrent urinary tract infections,” says Schoenkhagen. Many also complain of joint pain. All this is a reflection of a constantly low level of estradiol – as the follicles are depleted, there is no longer any production of this hormone.
How to treat menopause?
Hormone replacement therapy (HRT) can relieve many symptoms. In it, estradiol is prescribed in the form of tablets or given through the skin using gels, sprays or patches. “If the uterus is still present, corpus luteal hormone therapy is also applied to protect the uterine lining.”
According to the gynecologist, vaginal dryness responds well to topical treatment with suppositories, pills, or creams that contain estrogen. This method can also reduce the risk of recurring urinary tract infections.
For a long time, hormone therapy did not have a good reputation. In fact, it may slightly increase the risk of blood clots and breast cancer. Therefore, women who have previously suffered from precancerous lesions or breast cancer are not advised to undergo HRT. On the other hand, hormone therapy also has some positive health effects, and for Schwenkhagen and other experts the benefits outweigh the risks.
Nowadays, it is known, for example, that hormone replacement therapy started soon after the last bleeding can have a protective effect on the cardiovascular system, Schweinhagen points out, and even reduce the risk of developing diabetes. This additional protective effect also extends to bones, where estrogen deficiency tends to negatively affect bone density, increasing the risk of osteoporosis.
Does menopause have benefits?
But, aside from the different circumstances over the years: is there anything positive about menopause? After all, hormonal symptoms often coincide with transitions between different stages of life – for example, children who are growing up and leaving home. This often puts years-long relationships to the test. “At work, many people oscillate between… boring And the BurntIn other words: between boredom and complete exhaustion.
For Schweinhagen, menopause can be seen as a turning point that women can use to take a look at themselves and redefine themselves. A turning point that requires a new examination of one’s body and health. Yes, but what about complaints? Fortunately, the gynecologist ensures that they respond well to the treatments.
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