What is Menopause?
The menopause is a natural biological process marking the end of a woman’s reproductive years. The term “menopause” refers to the last menstrual period of a woman whose uterus has not been removed and who is not taking hormones. The transition process to this phase and the period immediately following it are called perimenopause. In the true sense, menopause is only retrospectively confirmed when 12 months have passed since the last menstrual bleeding. The postmenopause begins after this 12-month period.
The word “menopause,” similar to “puberty,” can refer both to the period of changing ovarian function and often to the time after the climacteric. Likewise, the term “climacteric” is also used to describe this transition process.
Women generally enter menopause at an average age of 45-55 years. However, about 1% of women may experience menopause before the age of 40 (early menopause), and even one in a thousand before the age of 30. The onset of menopause before the age of 40 is defined as premature ovarian insufficiency. Chronic diseases such as smoking and diabetes can cause menopause to start about two years earlier. Furthermore, a genetic predisposition can lead to similarities in the age of menopause between mothers and daughters.
What Are the Symptoms of Menopause?
During menopause, about 80% of women experience various symptoms. These symptoms can vary from person to person and differ in their intensity. The most common symptoms are:
- Hot Flashes and Sweating: These are sudden sensations of heat and sweating attacks that can intensify, especially at night. Fluctuations in estrogen levels are thought to cause this condition. They usually occur in the first five years of menopause but can last longer than ten years.
- Sleep Disorders: Difficulty falling asleep, waking up due to night sweats, or a general decrease in sleep quality are common. Sleep apnea and restless legs syndrome can also occur. Treating vasomotor symptoms can reduce sleep disorders, but this may not resolve all sleep problems, as other causes of sleep disturbance, such as anxiety and depression, can also be present during menopause.
- Dryness of Mucous Membranes: Vaginal dryness can cause pain during sexual intercourse. Dry eyes and mouth can also occur. This is observed in 50% of cases.
- Bone Loss: Begins in the perimenopause. The annual loss of bone mineral density is highest in the year before and two years after the last menstruation.
- Cardiovascular Diseases: After menopause, the risk of cardiovascular diseases increases. This is partly attributed to estrogen deficiency and partly to changes in cardiovascular risk factors, such as the lipid profile, during the perimenopause.
- Anxiety, Irritability, and Depression: Hormonal changes can affect emotional state and lead to anxiety, irritability, or depressive feelings.
- Dry Skin: The decrease in estrogen can lead to dry skin and loss of elasticity.
- Fatigue and Weakness: A common symptom, whose cause can be multifactorial.
- Headaches: Hormonal fluctuations can trigger headaches.
- Decreased Libido: A decrease in sexual desire can be observed.
These symptoms can begin a few years before menopause and last up to 13 years. Women who experience their first hot flashes during menstruation can have longer-lasting symptoms (an average of 11.8 years) than those whose symptoms begin only after menopause (an average of 3-4 years).
What Are the Phases of Menopause?
The World Health Organization (WHO) divides the menopausal process into three basic phases to better understand and classify the physiological changes women experience: premenopause, menopause, and postmenopause. These phases are characterized by changes in hormonal activities and the associated symptoms. The median duration of the transition to menopause is approximately 4 years.
- Premenopause (Pre-Menopausal Period): Premenopause covers the variable period in which the first signs of menopause appear and which lasts until menopause. In this phase, follicular activity in the ovaries begins to slow down. This slowdown leads to fluctuations and a gradual decrease in the production of the main female hormones, estrogen and progesterone. The most noticeable result is irregular menstruation. The duration, frequency, and intensity of menstrual bleeding can change. Premenopause varies from person to person and can last from a few months to several years. During this time, some typical symptoms of menopause (e.g., mild hot flashes, sleep disorders) can also begin to manifest.
- Menopause: Menopause refers to the time of the last menstrual bleeding. In clinical practice, however, a woman must not have had a period for 12 consecutive months to be truly classified as being in menopause. At the end of this 12-month period, the last menstrual bleeding is retrospectively defined as “menopause.” Menopause is a turning point where the reproductive functions of the ovaries permanently cease, and estrogen production significantly decreases.
- Postmenopause (Post-Menopausal Period): Postmenopause covers a long period that begins with menopause and extends into a woman’s later life. According to the WHO classification, this period generally refers to the 6 to 8 years after menopause. In postmenopause, the ovaries no longer produce significant estrogen, and the body tries to adapt to these low hormone levels. The acute symptoms of menopause (such as hot flashes) may subside over time, but long-term health risks due to estrogen deficiency (e.g., osteoporosis, cardiovascular diseases) can persist. Therefore, healthy lifestyle choices and regular health checks are of great importance in postmenopause.
How is Menopause Diagnosed?
The diagnosis of menopause is generally based on the patient’s medical history and clinical symptoms. Uzm. Dr. Burcu Meryem Atak Sançmış, a specialist in endocrinology, carefully evaluates many factors in this process, from changes in the menstrual cycle to hormonal symptoms. Although there is no specific “menopause test,” the diagnostic process can be supported by laboratory tests, such as hormone level determinations, if necessary. Our doctor adopts an individual approach for each patient and manages the process with a scientific and human balance.
- Assessment of the Menstrual Cycle: The most important diagnostic criterion is that a woman has not had a menstrual period for 12 consecutive months. Especially if this occurs within the typical menopausal age range (45-55 years), a menopause diagnosis can usually be made. Our doctor will inquire about when the menstrual cycle became irregular, its frequency, duration, and intensity.
- Clinical Symptoms: The characteristic symptoms of menopause (hot flashes, night sweats, sleep problems, vaginal dryness, etc.) provide important supporting clues for the diagnosis. The presence and severity of these symptoms can help in making the diagnosis.
- Medical History: Our specialist doctor will evaluate the woman’s general health status, family history (especially the age of menopause), medications used, and past medical conditions (e.g., ovarian surgery, chemotherapy). This information can help understand whether menopause is a natural process or due to another cause.
- Physical Examination: A general physical examination is performed. A pelvic examination can be performed to assess vaginal dryness or other menopausal changes.
- Hormone Tests (if necessary): Outside the typical menopausal age (e.g., if early menopause is suspected before age 40) or if the diagnosis is unclear, some hormone tests may be ordered. These tests typically examine the following hormone levels:
- FSH (Follicle-Stimulating Hormone): In menopause, ovarian function decreases, so FSH levels typically rise. The brain tries to stimulate the ovaries to produce more hormones.
- Estradiol (A Type of Estrogen): In menopause, estradiol levels are low because the ovaries produce less estrogen.
- LH (Luteinizing Hormone): Like FSH, LH levels also generally rise in menopause.
Hormone test results alone are not always sufficient for a menopause diagnosis. Hormone levels can fluctuate during perimenopause. Therefore, test results should be evaluated in conjunction with clinical symptoms and menstrual history.
- Other Tests (if necessary): Additional blood tests may be ordered to rule out other medical conditions that could cause symptoms similar to menopause (e.g., thyroid problems).
In summary, the diagnosis of menopause is generally based on changes in a woman’s menstrual cycle and her clinical symptoms. Hormone tests play a supportive role, especially in cases of suspected early menopause or an unclear diagnosis.
Are There Treatment Methods for Menopause?
Although menopause is a natural process, there are various treatment and management approaches aimed at alleviating symptoms and improving quality of life:
- Hormone Replacement Therapy (HRT): This involves replacing declining hormone levels with medications containing estrogen and sometimes progesterone. It is particularly effective in relieving symptoms such as hot flashes, sleep disorders, and vaginal dryness. However, due to potential risks, it should be used under medical supervision and after an individual risk-benefit assessment.
- Non-Hormonal Treatments: For hot flashes, non-hormonal options are available, such as certain antidepressants, epilepsy medications, or blood pressure medications. For vaginal dryness, moisturizers and lubricants can be used.
- Use of Bioidentical Hormones: The use of bioidentical hormones refers to the use of hormones in drug form whose chemical structures are identical to those naturally produced in the human body. These medications, which can be preferred in Hormone Replacement Therapy, show a similar effect to the body’s own hormones. Although marketed as “natural,” their efficacy and safety must be proven by clinical studies, similar to conventional HRT medications. Their use must be under medical supervision.
- Lifestyle Changes: A healthy diet, regular exercise, stress management techniques, and sufficient sleep can alleviate the symptoms of menopause and improve overall health.
- Sleep Hygiene Counseling: This is a first-line treatment. Cognitive behavioral therapy is the most effective method for treating insomnia in perimenopausal and postmenopausal women. Literature data show that melatonin is beneficial for circadian rhythm disorders and reduces sleep onset latency but does not reduce night awakenings. First-line medications include GABA agonists (such as zolpidem), certain benzodiazepines, and dual orexin receptor antagonists.
- Prevention and Treatment of Osteoporosis: Since the risk of osteoporosis increases after menopause, adequate intake of calcium and vitamin D, weight-bearing exercises, and, if necessary, medication (bisphosphonates, etc.) are important.
Frequently Asked Questions
How should women undergoing Hormone Therapy be followed up, and what should be the duration of treatment?
Women undergoing hormone therapy should generally be evaluated for efficacy and side effects initially within the first 3 months and then every 6-12 months. Hormone therapy started before age 60 has been shown to be safe for at least 5 years.
What should be considered when receiving Hormone Replacement Therapy?
Patients should be informed about the breast cancer risk and advised to undergo age-appropriate breast cancer screenings. In cases of abnormal vaginal bleeding, the endometrium must be examined for hyperplasia and cancer. The risks of systemic combined hormone therapy include thromboembolic disease and breast cancer. The ovarian cancer risk can also increase depending on the duration of treatment. The recommendation of various menopause guidelines in this regard is an annual evaluation of patients regarding the continuation of treatment and aiming for the shortest possible treatment duration.
Why do hot flashes occur during menopause?
The main reason for hot flashes during menopause is that declining estrogen levels affect the function of the hypothalamus, the heat-regulating center in the brain.
Is there a specific age for menopause?
There is a specific age range for menopause. Women generally enter menopause between 45 and 55 years of age. The average age of menopause is 51-52 years. However, some women may experience menopause earlier (early menopause) or later than this range due to genetic factors, lifestyle, or medical conditions.
Is there a test for menopause?
What does early menopause mean?
What does the use of bioidentical medications mean?
How should nutrition be during menopause?
Is there a medication for menopause?
How do I know if I'm in menopause?
Can one get pregnant during menopause?
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