Overview
Menopause is the end of a woman's reproductive period. It is diagnosed after 12 months of no menstruation. The average age of menopause in our country is 47-48.
Menopause is not a disease; it is a natural biological transition. However, the ovaries stopping estrogen production can create many symptoms and long-term health risks.
Stages
1. Perimenopause:
- 4-10 years before menopause
- May start in mid-40s
- Menstrual irregularities begin
- Hormonal fluctuations
2. Menopause:
- Officially diagnosed 12 months after the last period
- Average age 47-48
- Early menopause: under age 40
- Late menopause: over age 55
3. Postmenopause:
- Period after menopause
- Lasts for life
Symptoms
Menstrual changes:
- Irregular periods
- Cycles becoming longer or shorter
- Changes in menstrual flow
- Cessation of periods
Vasomotor symptoms:
- Hot flashes
- Night sweats
- Facial flushing
- Palpitations
Genitourinary syndrome:
- Vaginal dryness
- Painful intercourse
- Decreased sexual desire
- Frequent urinary tract infections
- Urinary incontinence
Psychological:
- Mood changes
- Irritability
- Anxiety
- Depression
- Difficulty concentrating
- Memory problems
- "Brain fog"
Sleep and general:
- Sleep disturbances
- Fatigue
- Joint and muscle pain
- Headache
- Weight gain (especially abdominal)
Skin and hair:
- Dry skin
- Hair thinning/loss
- Brittle nails
Causes
Natural menopause:
- Aging
- Decline in ovarian function
- Decrease in estrogen and progesterone
Early/surgical menopause:
- Removal of ovaries
- Chemotherapy, radiotherapy
- Some genetic conditions (Turner syndrome)
- Autoimmune diseases
- Some infections
Long-Term Health Risks
- Osteoporosis (estrogen protects bone density)
- Cardiovascular disease (risk increases after menopause)
- Risk of type 2 diabetes
- High blood pressure, high cholesterol
- Sexual dysfunction
- Cognitive changes
- Depression, anxiety
- Urinary incontinence
When to See a Doctor
- If menstrual irregularities have started
- Severe hot flashes, night sweats
- Sleep disturbances
- Vaginal dryness, painful intercourse
- Mental health issues
- General health follow-up (annual)
- Postmenopausal bleeding (emergency evaluation - may be cancer)
- Suspected menopause under age 40
Diagnosis and Treatment
Diagnosis:
- Clinical evaluation
- 12 months no periods
- FSH (elevated)
- Estradiol (low)
- Anti-Müllerian hormone (AMH)
- Thyroid tests (differential diagnosis)
- Bone density measurement (DEXA)
- Mammography, cholesterol, blood sugar screening
Treatment:
1. Hormone Replacement Therapy (HRT):
- Most effective treatment (for hot flashes, vaginal symptoms)
- Estrogen + progesterone (in those with a uterus)
- Estrogen only (in those who have had their uterus removed)
- Risk-benefit assessment:
- Benefits: symptom relief, osteoporosis protection
- Risks: breast cancer (long-term), clots, stroke (age and form dependent)
- Lowest effective dose, shortest duration
2. Non-hormonal options:
- SSRIs/SNRIs: Paroxetine, venlafaxine (for hot flashes)
- Gabapentin
- Clonidine
- Fezolinetant (new, NK3 receptor antagonist)
- Soy, black cohosh (limited evidence)
3. For vaginal symptoms:
- Local estrogen (cream, tablet, ring)
- Vaginal moisturizers
- Lubricants
- Pelvic floor exercises
4. Osteoporosis prevention/treatment:
- Calcium, vitamin D
- Exercise
- Bisphosphonates (if needed)
Prevention and Lifestyle
General health:
- Healthy, balanced nutrition
- Calcium- and vitamin D-rich diet
- Regular exercise (especially strength, aerobic)
- Maintain a healthy weight
- Quit smoking
- Limit alcohol
- Stress management
- Adequate sleep
Reducing hot flashes:
- Avoid trigger foods (spicy, hot)
- Limit caffeine, alcohol
- Layered clothing
- Cool environments
- Breathing exercises
- Yoga, meditation
Sexual health:
- Regular sexual activity (maintains vaginal health)
- Use lubricants
- Open communication with your partner
Regular check-ups:
- Annual gynecological examination
- Mammography (every 2 years between ages 40-50, yearly after 50)
- Smear test
- Bone density
- Blood sugar, cholesterol, blood pressure
- Thyroid function
Mental health:
- Maintain social connections
- Engage in hobbies
- Get professional support (if needed)
- Open communication with family and spouse
- Menopause support groups