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Menopause

Dr. Panagiotis Polyzos MD PhD MSc

Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School

Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.

Contents

Menopause

Menopause

What is menopause?

Menopause is the point in time when a woman’s menstrual period stops. Menopause occurs because the ovaries stop producing the hormones estrogen and progesterone.

During the transition to menopause (perimenopause), your period may stop for a while and then start again. Therefore, the only way to know that you have officially reached menopause is if you have not had a period for one full year. (It is not considered menopause if your period stops for another reason, such as illness.) The average age of menopause is 51, but for some women it may happen as early as 40 or as late as 55.

Some women worry about menopause because it may cause unpleasant symptoms. However, there are many ways to treat these symptoms so you can remain active and strong.

Typically, menopause is a natural process. This means it happens on its own and does not require medical treatment unless your symptoms are bothersome. Sometimes, however, menopause is medically induced, meaning it is caused by certain procedures or medications. If so, you will need to work closely with your doctor to stay comfortable and support your overall health.

What is Perimenopause?

If you are still having periods, even if they are irregular, you can still become pregnant. Talk with your doctor about birth control. Keep in mind that most methods of birth control will not protect you from sexually transmitted infections (STIs), including HIV.

Perimenopause, the transition to menopause, is the time leading up to a woman’s final menstrual period. Periods may stop and then start again, so you are considered to be in perimenopause until one full year has passed since your last period. During perimenopause, a woman will experience changes in her estrogen and progesterone levels. These changes may lead to symptoms such as hot flashes. Some symptoms may last for months or even years after periods stop. There is no way to know in advance how long this transition will take. It could take anywhere from two to eight years.

Sometimes it is difficult to tell if you are in the menopausal transition. Symptoms, a physical exam, and your medical history can provide clues to your doctor. Your doctor may also check the levels of hormones in your blood. But because hormones change throughout your menstrual cycle, these tests alone cannot say for sure that you have reached menopause or that you are close to it. If there is no medical reason for the testing, doctors usually do not recommend it.

What is Premature Menopause?

When menopause occurs before the age of 40, it is considered premature. Premature menopause may be caused by certain medical treatments, or it may simply happen on its own.

Medical treatments that can cause premature menopause include:

  • Chemotherapy or pelvic radiation, which are cancer treatments. These therapies can damage the ovaries and cause your periods to stop. The chances of entering menopause depend on the type and amount of chemotherapy used. Also, the younger the woman, the lower the likelihood of menopause.
  • Surgical removal of the ovaries. The surgical removal of both ovaries, also called a bilateral oophorectomy, causes menopause immediately. A woman’s periods will stop after this surgery, and her hormone levels will drop quickly. She may experience strong menopause symptoms such as hot flashes and decreased sexual desire.
  • Surgery to remove the uterus. Some women who undergo a hysterectomy, which removes the uterus, can keep their ovaries. They will not enter menopause immediately because their ovaries will continue to produce hormones. However, since their uterus has been removed, they will no longer have periods and cannot become pregnant. They may experience hot flashes because the surgery may sometimes affect blood flow to the ovaries. Later on, they may go through natural menopause one or two years earlier than expected.
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Sometimes menopause happens early on its own. Some possible causes include:

  • Chromosomal abnormalities. Chromosomal problems can lead to premature menopause. For example, women with Turner syndrome are born without all or part of the X chromosome, which causes the ovaries to not function properly and the first signs of menopause to appear early.
  • Genetics. Women with a family history of premature menopause are more likely to experience premature menopause themselves.
  • Autoimmune diseases. The body’s immune system, which usually fights disease, may mistakenly attack the ovaries and prevent them from producing hormones. Thyroid disease and rheumatoid arthritis are two illnesses that may cause premature menopause.
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What are the causes of menopause?

Many women today go through menopause, seeing it as an opportunity to gain maturity and freedom.

The cause of menopause is the permanent cessation of ovarian function. The reduction of ovarian follicles results in decreased production of hormones.

The hormones (estrogen and progesterone) produced by the ovaries help regulate the function of the uterus, vagina, and breasts, and they also affect the function of other organs as well as a woman’s psychological state.

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What are the symptoms of menopause?

Menopause affects each woman differently. Some women have no symptoms, while others experience changes in various aspects of their lives. It is not always possible to determine whether these changes are related to aging, menopause, or both.

Some changes that may begin in the years surrounding menopause include:

  • Irregular periods. Your period may come more often or less often, last more days or fewer, and be lighter or heavier. Do not assume that if your period is delayed for as long as a cycle or two, it means the start of menopause transition. Check with your doctor to see if you are pregnant or if there is another medical reason for the delay. Also, if you have not had a period for one year and begin spotting, see your doctor. This spotting could be caused by cancer or another health complication.
  • Hot flashes. This is a sudden feeling of heat in the upper part or the whole body. Your face and neck may turn red. Red patches may appear on your chest, back, and arms. Sweating and chills may follow.
  • Sleep problems. You may find it difficult to sleep through the night. You may have night sweats, which are hot flashes that cause you to sweat while sleeping. You may also feel extra tired during the day.
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  • Vaginal and urinary problems. These problems may begin or worsen in the years around menopause. The walls of your vagina may become drier and thinner due to low estrogen levels. Estrogen also helps protect the health of your bladder and urethra. With less estrogen, sex may become less comfortable. You may also experience more vaginal infections or urinary tract infections. Some women have difficulty holding their urine long enough to reach the bathroom (called urge incontinence). Urine may also leak with sneezing, coughing, or laughing (called stress urinary incontinence).
  • Mood changes. If you previously experienced mood swings due to your menstrual periods or postpartum depression, you may have more mood-related issues around menopause. Mood changes during this time could also come from stress, family concerns, or fatigue. Moodiness is not the same as depression.
  • Changes in sexual feelings. Some women feel less sexually responsive, while others feel more comfortable with their sexuality after menopause. Some women may be less interested in sex because it may be physically less comfortable. Learn what you can do to manage any concerns related to sex.
  • Osteoporosis. This is a condition in which your bones become thinner and weaker. It can lead to loss of height and bone fractures.
  • Other changes. You may become more forgetful or have difficulty concentrating. Your waist may become larger, you may lose muscle and gain fat. Your joints and muscles may become stiffer and more painful. Experts cannot say for certain whether some of these changes are due to the low estrogen levels of menopause or simply due to aging.

Menopause: what is the appropriate treatment to treat?;

Estrogen deficiency can cause a woman to develop osteoporosis or heart disease. The treatment given is hormone replacement. By administering oral tablets, transdermal systems, and ointments for vaginal administration.

Menopause, health and nutrition

Changes in your body in the years around menopause increase your chances of developing certain health problems. Low estrogen levels and age-related changes increase a woman’s risk for heart disease, stroke, and osteoporosis.

There are several important steps you can take to protect your health in the years around menopause:

  • Eat well. Keep a few key points in mind:
  • Older adults need many nutrients, but at the same time fewer calories for energy. Make sure you maintain a balanced diet.
  • Women over 50 need 2.4 micrograms of vitamin B12 and 1.5 milligrams of vitamin B6 every day. Ask your doctor if you need a vitamin supplement.
  • After menopause, a woman’s calcium needs increase in order to maintain bone health. Women over 51 should get 1,200 milligrams of calcium every day. Vitamin D is also important for bone health. Women aged 51 to 70 should get 600 IU of vitamin D daily. Women aged 71 and older need 800 IU of vitamin D daily.
  • Postmenopausal women who still have vaginal bleeding because they are on hormone therapy may need additional iron.
  • Be active. Exercise can help your bones, heart, mood, and more. Ask your doctor about activities that are right for you. Try to do:
  • At least 2 hours and 30 minutes of moderate aerobic physical activity per week or 1 hour and 15 minutes of vigorous aerobic activity, or a combination of both
  • Muscle-strengthening exercises two days each week
  • Quit smoking, which harms your health in many ways, including damaging your bones. Avoid secondhand smoke and get help with quitting if you need it.
  • Pay attention to your gynecological health. You will need a gynecological exam after menopause. Most women need a Pap test every three years. Depending on your health history, you may need a Pap test more often, so check with your doctor. Also, remember to ask how often you should have a mammogram.