What is menopause? What are the symptoms of menopause?

What is menopause? What are the symptoms of menopause?

Menopause is a period of life, just like infancy, puberty, and sexual maturity. During menopause, the amount of follicles in the ovaries (ovaries) decreases and accordingly, estrogen production decreases. Over time, estrogen production ceases and the ovaries shrink. Accordingly, the menstrual cycle is interrupted and reproductive ability is lost. The word menopause derives from the Greek words mens (month) and pause (stop). The World Health Organization defines menopause as the permanent cessation of the menstrual cycle as a result of the ovaries losing their activity. The age of menopause is 45-55 years worldwide. Studies show that the average age of menopause in Turkey is 46-48. 

The menopause period is divided into three periods according to the classification of the World Health Organization:

  • Premenopause : It covers the period from the first symptoms to menopause. Follicle activity in the ovaries slows down. Periods become irregular. This process can take several months or years. 
  • Menopause : It is the last menstrual bleeding. 
  • Postmenopause : It covers the period of 6-8 years from menopause to old age. For a woman to be postmenopausal, she must not have had a period for 12 months. 

Menopause is also classified according to the way it occurs:

  • natural menopause
  • Premature menopause: Menopause that occurs before the age of 45 is called premature menopause. It may occur due to conditions such as unknown causes, autoimmune diseases, radiotherapy, chemotherapy, infections, environmental reasons, abortions and miscarriages, frequent pregnancy, obesity, hypothyroidism. 
  • Surgical menopause: Some operations may cause premature menopause. If the ovaries of a menstruating woman are surgically removed, menstruation ceases and menopause develops. Radiation treatments can lead to menopause. Ovarian function losses seen during cancer chemotherapy are reversible.

What are the factors affecting menopause?

  • Genetic factors: It is observed that women in a family usually enter menopause at similar ages.
  • Genital factors: It has been observed that women with irregular menstruation enter menopause earlier than those with regular menstruation. Apart from this, conditions such as fertility status, first menstrual period, using birth control pills, and breastfeeding for more than two years may affect the age of menopause. 
  • Psychological factors: Psychological traumas accelerate the development of menopause. It has been observed that war, migration, earthquake and long prison life trigger early menopause.
  • Physical and environmental factors: Menopause age is earlier in women living in cold climates and extremely severe conditions. 
  • Smoking: Heavy smokers enter menopause 1-2 years earlier than non-smokers.
  • General health status: Severe metabolic diseases, genetic disorders, infectious diseases, chemotherapy and radiotherapy may affect the age of menopause. 
  • Social factors: Menopause age may be early in rural and traditional societies. 

What are premenopausal disorders?

  • menstrual irregularities
  • Decreased ovulation
  • hot flashes
  • excessive sweating
  • depressed mood
  • Uyyamama
  • nervousness, irritability
  • increased appetite
  • difficulty concentrating
  • Facial flushing
  • increase in heart rate
  • headache, dizziness
  • hot flashes
  • low self-confidence
  • Forgetfulness
  • Carelessness
  • Tiredness
  • Decreased sexual desire

What are the symptoms after menopause?

  • The symptoms seen in premenopause continue.
  • After a long-term lack of estrogen, atrophy, that is, shrinkage, is seen in the genital organs. The uterus, vagina and vulva and urethra shrink. As a result, frequent urination, constipation, itching in the vulva, painful sexual intercourse, uterine prolapse, urinary incontinence, sagging urinary bladder, sagging rectum may occur. 
  • There are estrogen receptors in the skin, hair follicles, and sweat glands. After menopause, related changes occur. The skin becomes thinner, the amount of collagen decreases. The amount of hair and hair is reduced. The skin dries out, loses its elasticity and wound healing is delayed. Thick hair may appear on the chin, lips and chest. The amount of hair in the armpit and genital area is reduced. 
  • During menopause, dry mouth, bad taste in the mouth and gum disease may occur. Constipation and hemorrhoids are common. Reflux 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 diseases, the risk of coronary heart diseases increases with the decrease in estrogen with menopause. Cholesterol increases with menopause. High blood pressure may occur. Atherosclerosis is seen. 
  • Another important problem seen with menopause is osteoporosis. Osteoporosis invites fractures as a result of decreased bone mineral density. Menopausal women lose 3-4% of their bone mass each year. 
  • Obesity: In postmenopausal women, the metabolic rate slows down and weight gain is observed.
  • Sexual reluctance appears.

How is menopause diagnosed?

Early diagnosis of menopause is important. Because most of the losses in menopause occur in the first year. Early diagnosis provides early treatment. Menopause can be diagnosed if FSH and LH hormones are increased in the blood taken on the third day of menstruation from a woman who has infrequent menstruation, hot flashes and psychological disorders. If the FSH level is above 40 pg/ml in a woman with irregular menstruation, the diagnosis of menopause is definitely made. If the FSH level is between 25-40 pg/ml, it is considered to be premenopausal and women in this period may become pregnant, albeit rarely. However, pregnancy and other diseases that cause irregular bleeding should be investigated and ultrasound should be performed in every woman with irregular bleeding. 

Sex life in menopause

Sex life does not end with menopause. Due to the lack of estrogen, there is shrinkage in the genitals. As a result, pain may be felt during sexual intercourse. Oils are used to reduce pain. 

How should nutrition be in menopause?

  • Due to estrogen deficiency, the metabolic rate slows down and rapid weight gain begins. 
  • To prevent osteoporosis, 1500 mg of calcium should be taken daily. 
  • Vitamin E can prevent hot flashes and fatigue.
  • Vitamin D should be kept at normal levels. 
  • Salt intake should be restricted.
  • Regular exercise is important during menopause. 

What to do in menopause

It is necessary to wear light and layered clothing against hot flashes, which are common during menopause. Thus, the clothing can be reduced in case of hot flashes. It is beneficial to reduce spices and caffeine, and to avoid smoking and alcohol. Relaxing oils are used against painful sexual intercourse due to estrogen deficiency. Regular sexual intercourse is necessary to prevent atrophy. It is important to pay attention to daily calcium intake and to exercise regularly to prevent osteoporosis. If your doctor deems it appropriate, hormone replacement therapy can be applied.

What is hormone replacement therapy?

Hormone replacement therapy (HRT) is estrogen supplementation therapy. The patient is given medications containing estrogen and progesterone regularly. The aim of hormone therapy is to reduce the incidence of osteoporosis and cardiovascular diseases, which increase with menopause. Hormone therapy also helps with symptoms such as hot flashes, sweating, palpitations and fatigue, which are common in some women. Hormone replacement therapy prevents bone loss due to menopause and increases bone mass. This reduces the risk of fracture. It reduces the risk of cardiovascular diseases. The treatment also has a positive effect on sexual life. There is a decrease in dry mouth, bad taste in the mouth and tooth decay. 

Who should not be treated with hormone therapy?

  • Known and suspected uterine and breast cancer
  • Patients with undiagnosed abnormal 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 applied to patients who have had cerebral vascular occlusion or stroke.
  • It should be used with caution in the presence of hypertension, diabetes, gallstones, hyperlipidemia, migraine and uterine fibroids. 

HRT can be used both by injection and orally. There are also those in the form of vaginal creams. Breast and uterus examination and bone measurement should be done regularly in patients receiving this treatment.