At what age do you get menopause. Premature and Early Menopause: Causes, Symptoms, and Treatment Options

20.02.197506.10.2021 by alexxlab

When does premature menopause occur. What are the symptoms of early menopause. How is primary ovarian insufficiency diagnosed. What treatment options are available for women experiencing premature menopause.

Содержание

Understanding Premature and Early Menopause

Premature menopause and early menopause are conditions that affect women at younger ages than expected. But what exactly are these conditions, and how do they differ from natural menopause?

Premature menopause occurs when a woman experiences menopause before the age of 40. Early menopause, on the other hand, happens between ages 40-45. Both conditions can result in infertility and are associated with various health risks due to the early loss of estrogen.

Primary ovarian insufficiency (POI), previously known as premature ovarian failure, is a related condition where the ovaries stop functioning normally before age 40. Unlike premature menopause, women with POI may still have intermittent ovulation and periods.

Key Facts About Premature and Early Menopause

Premature menopause affects approximately 1% of women under 40
Early menopause occurs in about 5% of women under 45
Both conditions can have known medical causes or occur spontaneously
Women with these conditions face increased health risks due to early estrogen loss

Causes of Premature and Early Menopause

Various factors can contribute to the onset of premature or early menopause. Understanding these causes is crucial for proper diagnosis and management.

Medical and Surgical Causes

Surgical removal of ovaries (oophorectomy)
Hysterectomy (removal of the uterus)
Chemotherapy or radiation treatment
Autoimmune disorders
Chromosomal abnormalities
Certain infections (e.g., mumps, tuberculosis)

Lifestyle and Genetic Factors

Smoking
Family history of early menopause
Certain genetic mutations

Are certain women more predisposed to premature menopause? Genetics play a significant role, with family history being a strong indicator. Women whose mothers or sisters experienced early menopause are more likely to go through it themselves. Additionally, lifestyle factors like smoking can accelerate the onset of menopause.

Recognizing the Symptoms of Premature and Early Menopause

Identifying the signs of premature or early menopause is crucial for timely diagnosis and treatment. While symptoms can vary among individuals, there are several common indicators to watch for.

Common Symptoms

Irregular menstrual cycles
Hot flashes and night sweats
Vaginal dryness and discomfort during intercourse
Mood changes (irritability, anxiety, mild depression)
Sleep disturbances
Decreased libido
Urinary tract issues

Can symptoms of premature menopause differ from those of natural menopause? While the symptoms are generally similar, women experiencing premature menopause may have more severe symptoms due to the sudden drop in estrogen levels. Additionally, the psychological impact of early menopause can be more profound, as it may affect family planning and self-image.

Diagnosis of Premature and Early Menopause

Diagnosing premature or early menopause involves a combination of clinical evaluation, hormone tests, and sometimes genetic testing. Healthcare providers typically follow a step-by-step approach to ensure accurate diagnosis.

Diagnostic Process

Medical history review and physical examination
Hormone level tests (FSH, estradiol, AMH)
Pregnancy test to rule out pregnancy
Thyroid function tests to exclude thyroid disorders
Genetic testing in cases of suspected chromosomal abnormalities

How is primary ovarian insufficiency (POI) differentiated from premature menopause? POI is diagnosed when a woman under 40 has irregular or stopped periods and two FSH blood tests show high levels. Unlike premature menopause, women with POI may still have intermittent ovarian function and can occasionally ovulate.

Health Risks Associated with Premature and Early Menopause

Early loss of estrogen due to premature or early menopause can lead to various health complications. Understanding these risks is crucial for developing appropriate preventive strategies and treatment plans.

Potential Health Risks

Increased risk of osteoporosis and fractures
Higher risk of cardiovascular disease
Cognitive decline and increased risk of dementia
Mood disorders, including depression and anxiety
Sexual dysfunction and fertility issues
Increased risk of certain cancers

Do women with premature menopause have a shorter life expectancy? Studies have shown that women who experience premature menopause may have a slightly increased risk of premature mortality, primarily due to cardiovascular diseases. However, with proper management and lifestyle modifications, many of these risks can be mitigated.

Treatment Options for Premature and Early Menopause

Managing premature and early menopause involves addressing symptoms, preventing long-term health risks, and potentially preserving fertility. Treatment approaches are typically tailored to individual needs and health status.

Hormone Replacement Therapy (HRT)

HRT is often recommended for women with premature or early menopause to replace the hormones that the body is no longer producing. This treatment can help alleviate symptoms and reduce long-term health risks associated with estrogen deficiency.

Estrogen therapy (with or without progestogen)
Bioidentical hormone therapy
Transdermal patches or gels
Oral medications

Is HRT safe for women with premature menopause? For most women experiencing premature or early menopause, the benefits of HRT outweigh the risks when used until the average age of natural menopause. However, individual risk factors should be considered, and treatment should be regularly reviewed.

Non-Hormonal Treatments

For women who cannot or choose not to use HRT, several non-hormonal options are available to manage symptoms and health risks:

Selective serotonin reuptake inhibitors (SSRIs) for hot flashes and mood symptoms
Gabapentin or clonidine for hot flashes
Vaginal lubricants and moisturizers for vaginal dryness
Bisphosphonates or other bone-preserving medications for osteoporosis prevention

Lifestyle Modifications

Adopting a healthy lifestyle can significantly impact symptom management and overall health:

Regular exercise, including weight-bearing and strength training exercises
Balanced diet rich in calcium and vitamin D
Stress reduction techniques (e.g., meditation, yoga)
Avoiding triggers for hot flashes (e.g., spicy foods, alcohol)
Quitting smoking

Fertility Preservation and Family Planning

For women diagnosed with premature menopause or at risk of early menopause who wish to have children, fertility preservation options may be considered.

Fertility Preservation Options

Egg freezing (oocyte cryopreservation)
Embryo freezing
Ovarian tissue freezing

Can women with premature menopause still get pregnant? While natural pregnancy is rare after premature menopause, it’s not impossible. Some women may have intermittent ovarian function. However, for most women with premature menopause who wish to conceive, assisted reproductive technologies using donor eggs or previously frozen eggs or embryos offer the best chances of success.

Living with Premature and Early Menopause

Coping with premature or early menopause can be challenging, both physically and emotionally. Understanding the impact and developing coping strategies is crucial for maintaining quality of life.

Emotional and Psychological Support

The emotional impact of premature menopause can be significant, affecting self-image, relationships, and mental health. Seeking support is essential:

Counseling or psychotherapy
Support groups for women with premature menopause
Open communication with partners and family members

Long-term Health Management

Women with premature or early menopause require ongoing health monitoring and management:

Regular bone density scans
Cardiovascular health assessments
Annual gynecological exams
Routine health screenings (e.g., mammograms, cholesterol tests)

How often should women with premature menopause have health check-ups? It’s generally recommended that women with premature menopause have more frequent health check-ups, typically annually or as advised by their healthcare provider. These check-ups should include comprehensive assessments of bone health, cardiovascular risk factors, and overall well-being.

Research and Future Directions

The field of premature and early menopause is continually evolving, with ongoing research aimed at improving diagnosis, treatment, and quality of life for affected women.

Current Research Areas

Genetic factors contributing to premature ovarian insufficiency
Novel hormone replacement therapies with improved safety profiles
Advancements in fertility preservation techniques
Long-term health outcomes of women with premature menopause

What promising treatments are on the horizon for premature menopause? Emerging research is exploring the potential of stem cell therapies to restore ovarian function and hormone production. Additionally, personalized medicine approaches using genetic profiling may help tailor treatments more effectively in the future.

Understanding premature and early menopause is crucial for affected women and healthcare providers alike. By recognizing the symptoms, understanding the causes, and being aware of treatment options, women can better navigate this challenging transition. With proper management and support, it’s possible to mitigate health risks and maintain a good quality of life despite experiencing menopause at an earlier age than expected.

Premature and Early Menopause: Causes, Diagnosis, and Treatment

Overview

What are premature menopause, early menopause and primary ovarian insufficiency?

Premature menopause and early menopause are conditions where a woman goes through menopause at an earlier age than is typically expected. Both conditions can result in women being unable to become pregnant. If there is no obvious medical or surgical cause for the premature menopause, this is called primary ovarian insufficiency (POI). Primary ovarian insufficiency is also referred to as premature ovarian insufficiency.

The name premature ovarian failure (POF) is no longer used because women who are told they have early menopause can have intermittent ovulation, menstrual bleeding or even pregnancy after being told they have ovarian “failure.”

What is menopause?

Menopause is a stage in a woman’s life when menstruation (periods) ends. Natural menopause typically happens when a woman is in her early 50s. This is a normal part of the aging process and means that a woman can no longer become pregnant. There are three stages to natural menopause:

Perimenopause: This is a transition phase where the ovaries start to make less hormones, causing fluctuating levels of estrogen and progesterone, as well as less testosterone. This stage stops when menopause begins. Menopausal symptoms tend to begin during this time and can often be the worst.
Menopause: In this stage, a woman’s period stops. The ovaries no longer release eggs and estrogen levels become very low. Once a woman has not had periods for 12 straight months, she has gone through menopause. However, it is important to ensure that the lack of periods is not due to another reason (like abnormal thyroid function or the use of birth control pills).
Postmenopause: This is the time after a woman has gone through menopause. The symptoms that happen during menopause, such as hot flashes, may start to fade away but could continue for a decade or longer in many women.

What age does a woman typically go through menopause?

Women typically go through natural menopause in their early 50s. The average age is between 51 to 52.

What is the difference between premature menopause and early menopause?

The difference between premature menopause and early menopause is when it happens. Premature menopause occurs before a woman is 40. Early menopause is when a woman undergoes menopause before age 45.

Many of the causes of premature menopause can also be causes of early menopause. The two types of menopause also share many of the same symptoms.

How common is premature menopause, early menopause and primary ovarian insufficiency?

Premature menopause happens to about 1% of women under age 40. Early menopause, occurring in women under age 45, is seen in about 5% of women.

Symptoms and Causes

What causes premature menopause?

Premature menopause can be caused by a medical condition or treatment or it may have no known cause (spontaneous). Possible factors that could cause premature menopause include:

Having a surgery that removes the ovaries.
Being a smoker.
Having surgery to remove the uterus (hysterectomy).
A side effect of chemotherapy or radiation.
Having a family history of menopause at an early age.
Having certain medical conditions, including:
Having certain infections, including:

What are the symptoms of premature menopause, early menopause and premature ovarian insufficiency?

Women may start having irregular menstrual cycles for a few years prior to the last menstrual period. If your cycles are irregular, you should speak with your doctor to look into possible causes. The symptoms of premature and early menopause include many of the typical menopause symptoms. These can include:

Hot flashes (sudden warmth that spreads over the body).
Night sweats and/or cold flashes.
Vaginal dryness; discomfort during sex.
Urinary urgency (a pressing need to urinate more frequently).
More urinary tract infections (or symptoms without an infection).
Difficulty sleeping (insomnia).
Emotional changes (irritability, mood swings, mild depression, worsening anxiety).
Dry skin, dry eyes or dry mouth.
Breast tenderness.
Racing heart.
Headaches.
Joint and muscle aches and pains.
Changes in libido (sex drive).
Difficulty concentrating, memory lapses (often temporary).
Weight gain.
Hair loss or thinning.

What are the risks of premature menopause and primary ovarian insufficiency?

Loss of estrogen at a younger age is associated with increased risks of various medical problems. These risks include:

Diagnosis and Tests

How is premature menopause, early menopause and primary ovarian insufficiency diagnosed?

If you begin to have symptoms of menopause before the age of 40, your healthcare provider will do several tests and ask questions to help diagnose premature or early menopause. These tests can include:

Asking about the regularity of your menstrual periods.
Discussing your family history of menopause at an early age.
Testing your hormone levels (estrogen and gonadotrophin).
Looking for other medical conditions that may be contributing to your symptoms.

Women who have not had a menstrual period for 12 straight months, and are not on any medication that could stop menstruation, may have gone through menopause.

Management and Treatment

How is premature menopause and primary ovarian insufficiency treated?

Management of the condition can vary depending on why menopause started earlier than normal. Given the health risks associated with early menopause, hormone replacement therapy (HRT) is routinely recommended to all women with premature menopause or primary ovarian insufficiency, unless there is a compelling reason it can’t be used. There is a lot of confusion about the safety of hormone therapies. Many of the risks of hormone therapy used after natural menopause are not thought to apply to women who have premature menopause. It is important to discuss the pros and cons of hormone therapy with your doctor. Some healthcare providers have additional certification in the management of menopause, and these providers will be a valuable resource when receiving conflicting information about the safety of hormone therapy.

Outlook / Prognosis

Can I still get pregnant after being diagnosed with premature menopause, early menopause or primary/premature ovarian insufficiency?

Unless the ovaries have been surgically removed, it can be difficult to diagnose a woman younger than age 45 with “menopause” as opposed to primary ovarian insufficiency (POI). Women with POI can have intermittent ovulation, which may or may not be accompanied by a menstrual bleed. Other women may be able to get pregnant through in vitro fertilization with egg donation. It is important to work with a fertility specialist to explore options.

Options available to you will vary depending on whether you have interest in having children in the future. In some cases, fertility may be restored and pregnancy could be possible. Assisted reproductive technology (ART), including in vitro fertilization (IVF) might be considered.

If you do not want to get pregnant while on hormone-replacement therapy, your doctor will talk to you about contraceptive options.

Talk to your healthcare provider about possible causes of premature or early menopause and your questions regarding fertility.

Introduction to Menopause | Johns Hopkins Medicine

What is menopause?

When a woman permanently stops having menstrual periods, she has reached the stage of life called menopause. Often called the change of life, this stage signals the end of a woman’s ability to have children. Many healthcare providers actually use the term menopause to refer to the period of time when a woman’s hormone levels start to change. Menopause is said to be complete when menstrual periods have ceased for one continuous year.

The transition phase before menopause is often referred to as perimenopause. During this transition time before menopause, the supply of mature eggs in a woman’s ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases. It is the big drop in estrogen levels that causes most of the symptoms of menopause.

When does menopause occur?

Although the average age of menopause is 51, menopause can actually happen any time from the 30s to the mid-50s or later. Women who smoke and are underweight tend to have an earlier menopause, while women who are overweight often have a later menopause. Generally, a woman tends to have menopause at about the same age as her mother did.

Menopause can also happen for reasons other than natural reasons. These include:

Premature menopause. Premature menopause may happen when there is ovarian failure before the age of 40. It may be associated with smoking, radiation exposure, chemotherapeutic drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.
Surgical menopause. Surgical menopause may follow the removal of one or both ovaries, or radiation of the pelvis, including the ovaries, in premenopausal women. This results in an abrupt menopause. These women often have more severe menopausal symptoms than if they were to have menopause naturally.

What are the symptoms of menopause?

These are the most common symptoms of menopause. However, each woman may experience symptoms differently. Some have few and less severe symptoms, while others have more frequent and stressful ones. The signs and symptoms of menopause may include:

Hot flashes

Hot flashes or flushes are, by far, the most common symptom of menopause. About 75% of all women have these sudden, brief, periodic increases in their body temperature. Usually hot flashes start before a woman’s last period. For 80% of women, hot flashes occur for 2 years or less. A small percentage of women experience hot flashes for more than 2 years. These flashes seem to be directly related to decreasing levels of estrogen. Hot flashes vary in frequency and intensity for each woman.

In addition to the increase in the temperature of the skin, a hot flash may cause an increase in a woman’s heart rate. This causes sudden perspiration as the body tries to reduce its temperature. This symptom may also be accompanied by heart palpitations and dizziness.

Hot flashes that happen at night are called night sweats. A woman may wake up drenched in sweat and have to change her night clothes and sheets.

Vaginal atrophy

Vaginal atrophy is the drying and thinning of the tissues of the vagina and urethra. This can lead to pain during sex, as well as vaginitis, cystitis, and urinary tract infections.

Relaxation of the pelvic muscles

Relaxation of the pelvic muscles can lead to urinary incontinence and also increase the risk of the uterus, bladder, urethra, or rectum protruding into the vagina.

Cardiac effects

Intermittent dizziness, an abnormal sensation, such as numbness, prickling, tingling, and/or heightened sensitivity, cardiac palpitations, and fast heart rhythm may occur as symptoms of menopause.

Hair growth

Changing hormones can cause some women to have an increase in facial hair or a thinning of the hair on the scalp.

Mental health

While it is commonly thought that mental health may be negatively affected by menopause, several studies have indicated that menopausal women suffer no more anxiety, depression, anger, nervousness, or feelings of stress than women of the same age who are still menstruating. Psychological and emotional symptoms of fatigue, irritability, insomnia, and nervousness may be related to both the lack of estrogen, the stress of aging, and a woman’s changing roles.

What can I do about hot flashes?

Hot flashes occur from a decrease in estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain’s thermostat, causing your body temperature to fluctuate. Hormone therapy has been shown to relieve some of the discomfort of hot flashes for many women. However, the decision to start using these hormones should be made only after you and your healthcare provider have evaluated your risk versus benefit ratio.

To learn more about women’s health, and specifically hormone therapy, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the Women’s Health Initiative (WHI) in 1991. The hormone trial had 2 studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. Both studies ended early when the research showed that hormone therapy did not help prevent heart disease and it increased risk for some medical problems. Follow-up studies found an increased risk of heart disease in women who took estrogen-plus-progestin therapy, especially those who started hormone therapy more than 10 years after menopause.

The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It states that hormone therapy should not be taken to prevent heart disease.

These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Although hormone therapy may be effective for the prevention of postmenopausal osteoporosis, it should only be considered for women at significant risk of osteoporosis who cannot take nonestrogen medicines. The FDA recommends that hormone therapy be used at the lowest doses for the shortest time needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their healthcare providers.

Practical suggestions for coping with hot flashes include:

Dress in layers, so that you can remove clothing when a hot flash starts.
Avoid foods and beverages that may cause hot flashes, like spicy foods, alcohol, coffee, tea, and other hot beverages.
Drink a glass of cold water or fruit juice when a hot flash starts.
Reduce your stress level. Stress may worsen hot flashes.
Keep a thermos of ice water or an ice pack next to your bed during the night.
Use cotton sheets, lingerie, and clothing that allow your skin to breathe.
Keep a diary or record of your symptoms to find what might trigger your hot flashes.

Treatment for menopause

Several therapies that help to manage menopause symptoms including:

Hormone therapy (HT)

Hormone therapy (HT) involves the taking a combination of the female hormones estrogen and progesterone during perimenopause and menopause. HT is most commonly prescribed in pill form. However, estrogen can also be given by using skin patches and vaginal creams.

The decision to start using these hormones should be made only after you and your healthcare provider discuss the risks and benefits.

Estrogen therapy (ET)

Estrogen therapy (ET) involves taking estrogen alone, which is no longer being made by the body. ET is often prescribed for women who have had a hysterectomy. Estrogen is prescribed as pills, skin patches, and vaginal creams.

The decision to start using this hormone should be made only after you and your healthcare provider discuss the risks and benefits.

Non-hormonal treatment

This type of treatment often involves the use of other types of medicines to relieve some of the symptoms associated with menopause.

Estrogen alternatives

Estrogen alternatives are the so-called “synthetic estrogens,” like ospemifene, improve symptoms of vaginal atrophy without affecting endometrial cancer risk.

Alternative therapies

Homeopathy and herbal treatments, often called bioidentical hormones, may offer some relief from some symptoms of menopause. However, there are concerns about potency, safety, purity, and effectiveness.

What Happens When You Hit Menopause Early

For Leslie Mac, it started with irregular menstrual periods. Mac, a digital strategist and organizer, didn’t think much of it, but once she started going months without menstruating, she decided to see her doctor. “Something must be wrong,” she remembered thinking.

She was not expecting to hear that, at 28, she had already entered perimenopause, the transition to menopause.

“I didn’t even know it was possible to start the process so early,” Mac explained. By 34, she received a diagnosis of menopause, which is officially diagnosed when a woman goes a year without a menstrual period.

Menopause is a normal part of a woman’s life and signals the end of the reproductive years. In the U.S., this typically occurs around age 51, but 5% of women have early menopause, which occurs between ages 40 and 45, and 1% experience premature menopause, which occurs before age 40.

While age of diagnosis may differ, premature and early menopause follow the same process as usual menopause. As women age, the levels of the hormones estrogen and progesterone in their body begin to decline. In premenopausal women, the ovaries produce these hormones in a regular cycle, and they’re important for both reproductive and overall health.

“You have estrogen receptors everywhere in your body,” explained Dr. Barb DePree, director of the Women’s Midlife Services at Holland Hospital, founder of MiddlesexMD and a member of HealthyWomen’s Women’s Health Advisory Council.

Estrogen affects multiple organ systems, including the cardiovascular, nervous and skeletal systems. During perimenopause, the ovaries begin producing less estrogen and progesterone. Eventually, the ovaries stop production completely.

Causes and symptoms

In about two-thirds of women who go through premature or early menopause, physicians can’t identify a cause, according to DePree. In some cases, like the surgical removal of ovaries, the cause is obvious. This procedure may be used to treat ovarian cancer and endometriosis and is used preventively in women with increased risk of breast or ovarian cancer. Other cancer treatments, namely chemotherapy and radiation, are toxic to the ovaries and may induce early menopause as well.

In women with certain autoimmune diseases, such as rheumatoid arthritis, the immune system can target the ovaries, shutting them down at a young age. In other cases, like Mac’s, a genetic predisposition makes someone more susceptible to early or premature menopause. Chromosomal abnormalities like Turner syndrome and Fragile X syndrome may also lead to premature menopause.

The first sign a woman is entering perimenopause is variation in her periods. “Typically, what we use to help identify women in perimenopause is a change in periods,” DePree said. “Associated with that, oftentimes, are cyclic night sweats.”

But the menopausal experience differs from woman to woman. Some don’t experience any symptoms at all. According to Dr. Wen Shen, in the division of gynecology at Johns Hopkins and director of the Menopause Consultation Clinic, most experience some moderate symptoms, commonly hot flashes and irregular bleeding. Other symptoms are night sweats, sleep issues, vaginal dryness, loss of libido, mood changes and weight gain.

In addition to menopausal symptoms, early and premature menopause put women at risk for later health complications. They’re more likely to develop cardiovascular disease, osteoporosis, mood disorders and early onset dementia.

Treatment

Hormone therapy with estrogen and progesterone or progestin (a synthetic version of progesterone) can be an effective way for women to manage symptoms and reduce health risks.

“Estrogen is an important protective hormone, and by missing out on a decade or more of that, they are at greater risk of chronic conditions,” DePree said.

Premature or early menopause leads to ovarian failure at least six years earlier than average, which means progesterone and estrogen levels drop off that much earlier. Taking hormone therapy until the average age of menopause means the body gets a few more years of exposure to higher hormone levels, which provides health benefits.

“That will help maintain their heart, bone and brain health so that they do not have an early heart attack, early onset dementia or osteoporosis,” Shen explained.

Long-term hormone therapy may raise the risk of developing breast cancer and it’s not recommended for women at an increased risk for blood clots; however, according to Shen, the benefits of being on hormone therapy until the average age of menopause outweigh the risks for young women.

Early and premature menopause don’t just have physical repercussions; there are
emotional ramifications as well. When Mac received her diagnosis, she felt a sense of loss. At first, it made her ask, “What does womanhood mean for me? What does it mean to have this piece of womanhood no longer in my life anymore — and at such a young age?” Talking through those feelings with her support system was important for Mac.

For women who want to have children, Shen often sees anger and grief. When she encounters patients who may be approaching early or premature menopause with concerns about fertility, she refers them to reproductive endocrine infertility specialists. Interventions like
in vitro fertilization may help some women become pregnant.

“Sometimes, there isn’t the option to do that, but at least have that conversation” Shen said.

The experience can also be isolating. “Six thousand American women become menopausal every day, and only
1% of those are under the age of 40.

“None of my friends were going through this,” said Mac. “I didn’t have a lot of people my own age to talk to.”

That changed when she tweeted about premature menopause and other women shared their experiences. “That felt really good to feel like I wasn’t so isolated,” Mac said.

“I think that the more women who know about this, the more knowledgeable we can be and not feel as broken.”

Resources:

The American College of Obstetricians and Gynecologists

The the North American Menopause Society

How it affects your body

Q: I’m 39 years old and was diagnosed with premature menopause. What does this mean and what should I do?

A: Menopause is considered to be premature if it occurs before the age of 40. You’re not alone, though — approximately one percent of women have premature ovarian failure; their ovaries run out of follicles before “their time” and consequently stop producing estrogen. Once there is no estrogen to stimulate the uterine lining, it doesn’t get built up, there is nothing to slough, and menstruation ceases. The diagnosis of “unable to work” ovaries is made through a blood test that shows low levels of estrogen, and high levels of follicle stimulating hormone (FSH) and lutenizing hormone (LH). The pituitary secretes the latter two hormones. Their levels become high when the brain and pituitary are “trying harder and harder” to get the ovaries to produce estrogen, alas, to no avail.

There are a number of reasons why premature menopause may occur:

Family history

Did your mom and/or older sisters become menopausal before the age of 40? If so, there could be a familial genetic disorder called fragile X, in which a certain portion of the X chromosome is abnormal. This can lead to various degrees of mental retardation, developmental delay, and behavioral changes especially in affected males who have only one X chromosome. (Remember women are XX and men are XY). The women in the family (you included) may simply have a pre-mutation; they can pass on this gene to their progeny, while they, themselves, develop socially, psychologically and intellectually in a normal fashion. But up to 20 percent of women with fragile X pre-mutations undergo premature menopause.

Autoimmune diseases

Lupus, diabetes, kidney failure, and rheumatoid arthritis can predispose a woman to the destruction of her ovarian follicles and affect her ability to produce estrogen. Your doctor should make sure you don’t have these underlying diseases.

Endometriosis

Cells that normally line the uterus can grow in other parts of the pelvis, including the ovaries. Endometriosis is usually accompanied by painful and abnormal menstrual cycles, so chances are you would probably have been diagnosed with this disorder before you entered premature menopause.

Body radiation and certain chemotherapies for cancer can cause “ovarian shut down”. And of course women who have had both their ovaries removed (bilateral oophorectomy) during their reproductive years will undergo immediate menopause.

There are also cases of mysterious premature menopause, where the ovaries simply stop working and we’re not sure why.

How premature menopause can affect your body

The lack of estrogen that accompanies premature menopause will most likely lead to menopausal symptoms that include hot flashes, night sweats, vaginal dryness, loss of libido, joint discomfort, change in skin, and sleep disturbances. These tend to be more severe than symptoms experienced by women who reach menopause at a later age. It’s not uncommon for women who develop these symptoms at a younger age to be dismissed with the diagnosis that “you’re too young to be menopausal”. They are told to wait and see… for years!

Aside from these obvious symptoms, premature menopause can, unfortunately, affect your future health, increasing your risk of developing cardiovascular disease (heart attack and stroke), osteoporosis and even Alzheimer’s.

We now know that absence of estrogen before the age of 50 increases cholesterol plaque formation in blood vessel walls. This leads to subsequent “clogging” which then can cause clots to form or, if the plaque becomes unstable and breaks away, cause the blockage of small vessels in the heart or brain. Estrogen also slows down the activity of osteoclasts, cells that break down bones. So a lack of estrogen allows these “bone gobblers” to go to it and create micro cavities that thin the bones and make them fragile.

Estrogen has a positive effect on the neurons in the brain; depriving the brain cells of this hormone in your forties can lead to future (and earlier than usual) damage that occurs with the onset of Alzheimer’s.

The vagina is also very estrogen-dependent. Without estrogen, lubrication disappears; the vaginal walls become thin, lose their elasticity, and sex hurts. A total lack of estrogen can also affect your sex drive (although testosterone is also important for libido and can continue to be produced by the menopausal ovary for a number of years).

Having painted such a grim picture I must give equal time (or at least mention) to the fact that premature menopause may decrease your risk of breast and ovarian cancer.

The North American Menopausal Society and most other societies that deal with hormone replacement have issued recommendations that, if there are no major contraindications (previous blood clots, known clotting disorders, a very high familial incidence of breast cancer and/or you’ve had breast cancer), the use of hormone replacement therapy (HRT) is helpful for women who’ve undergone premature menopause. Since you’re young, you’ll need a fairly high level of estrogen to mimic the level found in women of your age group. If you have a uterus you should also use some form of progestational agent to protect the uterine lining from pre-cancerous changes that can occur when estrogen is “unopposed.” You can use a cyclical progestational agent (so you’ll get your period every month or every three months, depending on how your doctor prescribes it) or if you wish to have a period-less existence, you can take both hormones continuously. There are more than 20 ways to give HRT, so discuss the types (pills, patches, creams) thoroughly with your doctor.

You can continue to use HRT until the age of “usual” menopause (51). If you decide to continue using hormones after this time, you will do so for the same reasons that menopausal women in their 50’s decide to begin and/or continue hormone therapy.

Dr. Reichman’s Bottom Line: Premature menopause is harmful to your health and it shouldn’t be ignored. Consider hormone replacement therapy and discuss the many types of available hormones with your doctor.

Dr. Judith Reichman, the “Today” show’s medical contributor on women’s health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, “Slow Your Clock Down: The Complete Guide to a Healthy, Younger You,” which is now available in paperback. It is published by William Morrow, a division of HarperCollins.

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.

Menopause and Perimenopause | CS Mott Children’s Hospital

Topic Overview

What is menopause? What is perimenopause?

Menopause is the point in a woman’s life when she has not had her period for 1 year.

For most women, menopause happens around age 50. But every woman’s body has its own time line. Some women stop having periods in their mid-40s. Others continue well into their 50s.

Perimenopause is the process of change that leads up to menopause. It can start as early as your late 30s or as late as your early 50s. How long perimenopause lasts varies, but it usually lasts from 2 to 8 years. You may have irregular periods or other symptoms during this time.

Menopause is a natural part of growing older. You don’t need treatment for it unless your symptoms bother you. But it’s a good idea to learn all you can about menopause. Knowing what to expect can help you stay as healthy as possible during this new phase of your life.

What causes menopause?

Normal changes in your reproductive and hormone systems cause menopause. As your egg supply ages, your body begins to ovulate less often. During this time, your hormone levels go up and down unevenly (fluctuate), causing changes in your periods and other symptoms. In time, estrogen and progesterone levels drop enough that the menstrual cycle stops.

Some medical treatments can cause your periods to stop before age 40. Having your ovaries removed, having radiation therapy, or having chemotherapy can trigger early menopause.

What are the symptoms?

Common symptoms include:

Irregular periods. Some women have light periods. Others have heavy bleeding. Your menstrual cycle may be longer or shorter, or you may skip periods.
Hot flashes.
Trouble sleeping (insomnia).
Headaches.
Vaginal dryness.

Some women have only a few mild symptoms. Others have severe symptoms that disrupt their sleep and daily lives.

Symptoms tend to last or get worse the first year or more after menopause. Over time, hormones even out at low levels, and many symptoms improve or go away.

Do you need tests to diagnose menopause?

You don’t need to be tested to see if you have started perimenopause or reached menopause. You and your doctor will most likely be able to tell based on irregular periods and other symptoms.

If you have heavy, irregular periods, your doctor may want to do tests to rule out a serious cause of the bleeding. Heavy bleeding may be a normal sign of perimenopause. But it can also be caused by infection, disease, or a pregnancy problem.

You may not need to see your doctor about menopause symptoms. But it is important to keep up your annual physical exams. Your risks for heart disease, cancer, and bone thinning (osteoporosis) increase after menopause. At your yearly visits, your doctor can check your overall health and recommend testing as needed.

Do you need treatment?

Menopause is a natural part of growing older. You don’t need treatment for it unless your symptoms bother you. But if your symptoms are upsetting or uncomfortable, you don’t have to suffer through them. There are treatments that can help.

The first step is to have a healthy lifestyle. This may help reduce symptoms and also lower your risk of heart disease and other long-term problems related to aging.

Make a special effort to eat well. Choose a heart-healthy diet that is low in saturated fat. It should include plenty of fish, fruits, vegetables, beans, and high-fiber grains and breads.
Eat a nutritious diet and be sure you are getting adequate amounts of calcium and vitamin D to help your bones stay strong. Low-fat or nonfat dairy products are a great source of calcium.
Get regular exercise. Exercise can help you manage your weight, keep your heart and bones strong, and lift your mood.
Limit caffeine, alcohol, and stress. These things may make symptoms worse. Limiting them may help you sleep better.
If you smoke, stop. Quitting smoking can reduce hot flashes and long-term health risks.

If you have severe symptoms, you may want to ask your doctor about prescription medicines. Choices include:

Birth control pills before menopause.
Hormone therapy (HT).
Antidepressants.
A medicine called clonidine (Catapres) that is usually used to treat high blood pressure.

All medicines for menopause symptoms have possible risks or side effects. A very small number of women develop serious health problems when taking hormone therapy. Be sure to talk to your doctor about your possible health risks before you start a treatment for menopause symptoms.

Remember, it is still possible to become pregnant until you reach menopause. To prevent an unplanned pregnancy, keep using birth control until you have not had a period for 1 full year.

Cause

Menopause is a natural part of aging. As you age, the number and quality of your eggs decline, hormone levels fluctuate, and your menstrual cycle becomes less predictable until it finally stops completely.

Causes of early menopause

Certain lifestyle choices and medical treatments can cause or are linked to an earlier menopause, including:

Symptoms

The first sign that you are nearing menopause is a change in your menstrual periods. They may become less frequent. And they may be lighter or heavier than you’re used to.

Menopause symptoms range from mild (or none) to severe. They include:

Hot flashes.
Sleep disturbances (insomnia).
Emotional changes, such as mood swings or irritability.
A change in sexual interest or response.
Problems with concentration and memory that are linked to sleep loss and fluctuating hormones (not a permanent sign of aging).
Headaches.
Rapid, irregular heartbeats (heart palpitations).

These symptoms usually go away after 1 or 2 years. But some women have them for several years longer.

Other conditions can cause similar symptoms. Examples include pregnancy; a significant change in weight; depression; anxiety; or uterine, thyroid, or pituitary problems.

Menopause caused by surgery, chemotherapy, or radiation therapy can cause more severe symptoms than usual. Preexisting conditions such as depression, anxiety, sleep problems, or irritability can also make symptoms worse.

Later symptoms

After you stop having menstrual periods, you may get other symptoms, including:

Drying and thinning of the skin, caused by lower collagen production.
Vaginal and urinary tract changes, such as:

What Happens

In your late 30s, your egg supply begins to decline in number and quality. As a result, your hormone production changes. You may notice a shortened menstrual cycle and some premenstrual syndrome (PMS) symptoms that you didn’t have before.

Gradually, your periods become irregular. This can start as early as your late 30s or as late as your early 50s. It continues for 2 to 8 years before menstrual cycles end.

During this time, your ovaries are sometimes producing too much estrogen and/or progesterone and at other times too little. Your progesterone is likely to fluctuate more than before. This can lead to heavy menstrual bleeding. (If you have heavy or unexpected vaginal bleeding, see your doctor to be sure it isn’t caused by a more serious condition.)

About 6 months to a year before your periods stop, your estrogen starts to drop. When it drops past a certain point, your menstrual cycles stop. After a year of no menstrual periods, you are said to have “reached menopause.”

During the next year or so, estrogen levels keep going down. This lowers your risk for certain types of cancers (estrogen is linked to some types of cancerous cell growth). But low estrogen also creates some health concerns, such as:

Bone loss. Low estrogen levels after menopause speed bone loss, increasing your risk of osteoporosis.
Skin changes. Low estrogen leads to low collagen, which is a building block of skin and connective tissue. It’s normal to have thinner, dryer, wrinkled skin after menopause. The vaginal lining and the lower urinary tract also thin and weaken. This condition can make sexual activity difficult. It can also increase the risk of vaginal and urinary tract infections.

Although the reasons aren’t well understood, a woman’s risk of heart disease increases after menopause. Because heart disease is the number one killer of women, consider your heart risk factors when making lifestyle and treatment decisions.

When to Call a Doctor

Call your doctor if you have:

Menstrual periods that are unusually heavy, irregular, or prolonged (1½ to 2 times longer than normal).
Bleeding between menstrual periods, when periods have been regular.
Renewed bleeding after having no periods for 6 months or more.
Unexplained bleeding while you are taking hormones.
Symptoms, such as insomnia, hot flashes, or mood swings, that aren’t responding to home treatment and are interfering with your sleep or daily life.
Vaginal pain or dryness that doesn’t improve with home treatment, or you have signs of a urinary tract infection, such as pain or burning during urination or cloudy urine.

Who to see

The following health professionals can help you manage menopause symptoms and evaluate menstrual period changes:

Exams and Tests

Your age, your history of menstrual periods, and your symptoms will tell your doctor whether you are near or at menopause. If possible, bring a calendar or journal of your periods and symptoms.

If you have severe symptoms, if your doctor suspects another medical condition, or if you have a medical condition that makes a diagnosis difficult, your doctor may do one or more of the following blood tests:

If you have had no menstrual periods for 1 year, this is a good time to have a full physical exam, with particular focus on your heart health and risk factors for osteoporosis.

Treatment Overview

Menopause is a natural part of aging. But symptoms can be difficult for some women.

If you have trouble sleeping, mood swings, hot flashes, cloudy thinking, heavy menstrual periods, or other symptoms, treatment can help you get through this time more comfortably.

Treatment for menopause symptoms may include:

Healthy lifestyle habits, including exercise, healthy eating, and quitting smoking. To learn more, see Home Treatment.
Hormones and other medicines, such as antidepressants. To learn more, see Medications.
Treatments such as black cohosh and soy. To learn more, see Other Treatment.

Home Treatment

A healthy lifestyle may help you manage menopause symptoms. It can also help lower your risk for heart disease, osteoporosis, and other long-term health problems.

If you smoke, stop smoking to reduce hot flashes and long-term health risks.
Exercise regularly to promote both physical and emotional health.
Limit alcohol intake, which may help to manage or reduce menopause symptoms and long-term health risks.
Make healthy eating a priority. Cut back on simple sugars and caffeine, which may make menopause symptoms worse. You’ll not only feel better but may also prevent long-term health problems.
Pay attention to how the emotional side of menopause is affecting you. Have a support network, and seek help as needed.
Make sure you get enough calcium and vitamin D. Eat foods that are rich in calcium. This can help lower your risk of osteoporosis. Ask your doctor if taking a supplement with calcium and vitamin D is right for you. The amount of calcium and vitamin D that you need to take depends on our age, your health, and how much calcium you get from the foods you eat.
Improve bladder control with regular Kegel exercises.

To manage hot flashes, try keeping your environment cool, dressing in layers, and managing stress.

To improve vaginal dryness, try using a vaginal lubricant.

Medications

Medicines can help you cope with bothersome menopause symptoms. Some medicines contain hormones, and some don’t.

Hormone therapy is sometimes used to treat menopause symptoms. But women who use it may have a higher risk of other health problems.

If your symptoms are the result of early menopause brought on by having your ovaries removed along with your uterus, you may consider estrogen therapy (ET).

Medicine choices

Hormone medicines

Birth control pills regulate menstrual bleeding and can relieve symptoms until menopause. They aren’t used after menopause.
Progestin pills and the levonorgestrel IUD release a form of progesterone into the uterus. This reduces heavy, irregular menstrual periods. Some women have side effects.
Low-dose vaginal estrogen (cream, tablet, or ring) reduces dryness and other tissue changes in and around the vagina.
Hormone therapy (HT) in pill, patch, vaginal ring, gel, spray, or cream form can be used to treat menopause symptoms.
Estrogen therapy (ET) is used to prevent symptoms that come with menopause.
Testosterone
with estrogen is sometimes used for menopausal symptoms that don’t improve with estrogen therapy.

Non-hormone medicines

Antidepressants
can lower the number and severity of hot flashes. They may also help with irritability, depression, and moodiness.
Clonidine, a high blood pressure medicine, can reduce the number and severity of hot flashes.
Gabapentin (Neurontin) is an antiseizure medicine. It can reduce the number and severity of hot flashes.
Ospemifene (Osphena) is used to reduce vaginal changes that can make sex painful.

Other Treatment

Many women have turned to alternative medicine for menopause symptom relief.

Mind and body relaxation using breathing exercises. It may reduce hot flashes and emotional symptoms.
Black cohosh (such as Remifemin) may prevent or relieve menopause symptoms. But the research on black cohosh has had mixed results.
Soy may improve menopause symptoms. But studies have shown mixed results.
Yoga (which often includes meditative breathing) and/or biofeedback gives you tools you can use to reduce stress. High stress is likely to make your symptoms worse.

Remember that dietary supplements aren’t regulated the way medicines are. It’s important to be careful when taking supplements. Tell your doctor what you are taking.

Treatments to avoid

Based on the latest research, some treatments aren’t recommended, either because they don’t work or because they can cause dangerous effects. These include:

Angelica.
DHEA (dehydroepiandrosterone).
Dong quai.
Evening primrose.
Kava.
Wild yam or natural progesterone creams.

References

Other Works Consulted
American Association of Clinical Endocrinologists Menopause Guidelines Revision Task Force (2006). American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice, 12(3): 315–337.
Daley A, et al. (2011). Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews (9).
Grady D, et al. (2016). Menopause. In L Goldman, A Shafer, eds., Goldman-Cecil Medicine, 24th ed., vol. 2 , pp. 1623–1629. Philadelphia: Saunders.
Levis S, et al. (2011). Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms. Archives of Internal Medicine, 171(15): 1363–1369.
Shifren JL, Schiff I (2007). Menopause. In JS Berek, ed., Berek and Novak’s Gynecology, 14th ed., pp. 1323–1340. Philadelphia: Lippincott Williams and Wilkins.
U.S. Preventive Services Task Force (2017). Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: U.S. Preventive Services Task Force recommendation statement. JAMA, 318(22): 2224–2233. DOI: 10.1001/jama.2017.18261. Accessed December 27, 2017.

Credits

Current as of:
July 17, 2020

Author: Healthwise Staff
Medical Review:
Anne C. Poinier MD – Internal Medicine
Kathleen Romito MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Martin J. Gabica MD – Family Medicine
Carla J. Herman MD, MPH – Geriatric Medicine

Current as of: July 17, 2020

Author:
Healthwise Staff

Medical Review:Anne C. Poinier MD – Internal Medicine & Kathleen Romito MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine & Martin J. Gabica MD – Family Medicine & Carla J. Herman MD, MPH – Geriatric Medicine

Hot flashes, night sweats may linger well into a woman’s sixties

By Madeline Kennedy, Reuters Health

(Reuters Health) – A significant proportion of women aged 60 to 65 were still having menopausal hot flashes and night sweats in a new Australian study, suggesting that bothersome symptoms last longer than is usually assumed and are mostly going untreated .

The use of hormone replacement therapy to relieve menopause symptoms has dropped dramatically in all age groups, the study authors note, but current guidelines advise against it for any women over 60, leaving this group with few options.

“Most of the recommendations regarding management of postmenopausal women apply to women less than 60 years old,” said Susan Davis, the study’s senior author. “So we specifically wanted to determine the prevalence of symptoms in women aged 60 to 65 years.”

Davis is a professor of women’s health and director of the Women’s Health Research Program at Monash University in Melbourne.

Hot flashes and night sweats, also known as vasomotor symptoms, occur when the ovaries reduce their production of estrogen at menopause. While not all women experience these symptoms, for those who do, it can significantly affect quality of life.

“Some women simply cannot complete a day’s activities without considerable stress,” said Wulf Utian, an emeritus professor at Case Western Reserve University in Cleveland, Ohio, who was not involved in the study.

Although women typically go through menopause between the ages of 45 and 55, and vasomotor symptoms can start at any point during that transition, conventional wisdom holds that they only last a few years.

But one recent study found that for half of all women with bothersome hot flashes or night sweats, these symptoms typically last seven full years.

Davis and her colleagues analyzed data from a questionnaire-based study of women across Australia and focused on 2,020 participants between the ages of 40 and 65.

The researchers found that 42 percent of women 60 to 65 years old reported having hot flashes and night sweats, while 74 percent of women under 55 reported experiencing these symptoms.

For 6.5 percent of women between 60 and 65, the vasomotor symptoms were moderate to severe. The same was true for 28.5 percent of postmenopausal women under 55 and 15 percent of all women 55 to 60 years old.

Smoking and being overweight increased the likelihood of symptoms, while having an education beyond high school was linked to a lowered risk, Davis and her colleagues report in the journal Menopause.

Less than 12 percent of the postmenopausal women in any age group used hormonal therapy of any kind. Women aged 60 to 65 years were the greatest users of vaginal estrogen, a topical version of the treatment, with nearly 8 percent using this therapy.

Davis said in an email that hormone therapy is the most effective treatment for menopausal symptoms. She added that low dose antidepressant therapy can also give some relief.

Symptoms like hot flashes and night sweats may also be caused by other conditions, Utian noted. “Especially in older women other causes include hypertension (most frequent), diabetes, anxiety,” he told Reuters Health in an email.

The researchers write that current clinical guidelines recommend that hormone therapy should be limited to three to five years of use and should not be used by women over 60. They note that their results show there is some discrepancy between the recommendations and what doctors are prescribing. But they point out that overall hormone use was “strikingly low. ”

Such low rates of medication may show that postmenopausal symptoms are not receiving sufficient attention, the study team writes. Utian agreed that the symptoms of this age group are undertreated.

Davis recommended that anyone who experiences severe symptoms “should seek out treatment from a reliable source.”

“This is a real symptom, not to be ignored, for which numerous options are available that will provide significant relief,” Utian said. “Don’t try and just live with it, see your health provider.”

SOURCE: bit.ly/1BT8bUH Menopause, online February 20, 2015.

Starting periods at a young age is linked to early menopause

By Alice Klein

Girl talk: puberty hits younger and younger

Martin Barraud/Compassionate Eye Foundation/Getty

Women are more likely to go through menopause early if they started menstruating before their 12th birthday.

This is the conclusion of the largest study of its kind, involving 50,000 postmenopausal women in the UK, Australia, Japan and Scandinavia.

On average, a first period arrived around age 13 and the last when the women were 50. But 14 per cent had their first period before they were 12, and 10 per cent had their last period before they turned 45.

To investigate whether there was a link between early menstruation and early menopause, Gita Mishra at the University of Queensland, Australia, and her colleagues performed a statistical analysis, adjusting for possible confounding variables like weight and smoking.

They found that women who began menstruating before the age of 12 were 31 per cent more likely to have an early menopause – between the ages of 40 and 44.

Of the women who had their first period when they were 13, only 1.8 per cent had premature menopause (before the age of 40), and 7.2 per cent reached menopause early. But in women who had their first period when they were 11 or younger, 3.1 per cent had premature menopause, and 8.8 per cent went through it early.

Infertility link

Factors in early life may underpin this relationship, says Mishra. “We know, for instance, that stress during childhood tends to produce earlier menstruation, but it could also influence the age of menopause down the track,” she says.

Not having children was also related to earlier menopause age. Women without children who had their first period before 12 were five times more likely to reach menopause prematurely than women with two or more children, who started menstruating at 12 or older.

Often, these women had difficulty falling pregnant, Mishra says. This suggests there is a link between early menstruation, infertility and premature menopause. If a woman goes through menopause in her 30s, her fertility could start to decline in her 20s, Mishra says.

Now that girls are getting their periods younger and younger, we could see increases in fertility problems and premature menopause rates in the coming decades, Mishra says.

However, it is important not to be alarmist, says William Ledger at the University of New South Wales. “Yes, the study found a higher risk, but the effect size was small. Most of the women who had early menstruation still did not have early menopause,” he says.

Life choices

Nevertheless, women should know they might have a premature menopause if they began menstruating at a young age, Ledger says. “This might change their life plan – they may start trying to have children earlier,” he says.

“The big thing is to stop smoking, because it increases the risk of premature menopause further,” says Mishra.

Women also need to be prepared for the chronic conditions that may accompany menopause, such as osteoporosis and heart disease, says Mishra. This may involve eating a healthier diet or upping their physical activity, she says. “Menopause is a marker of biological age for women and has a variety of health implications, so you need to look after yourself.”

Journal reference: Human Reproduction, DOI: 10.1093/humrep/dew350

Menopause (climacteric syndrome) / Diseases / Clinic EXPERT

Today there is an established opinion that for every woman menopause is an inevitable physiological state that you just need to survive. But medical technologies do not stand still, and the issues of correcting menopausal problems are increasingly of interest to many patients.

Menopause should be understood as natural changes in the female body that occur as a result of age-related extinction of reproductive function and are accompanied by changes in hormonal levels.

The onset time and duration of the climacteric period are purely individual and directly depend on the characteristics of each specific organism.As a rule, the onset of cycle disorders occurs at the age of 45 to 47 years, and the average duration is 8-10 years.

Classification of menopause

Menopause is a long process, in clinical gynecology it is divided as follows:

premenopause – the period from the manifestation of the first menopause to the end of a whole year without bleeding
Menopause – the last menstrual bleeding (absence is diagnosed after 12 months menstruation)
perimenopause – the period connecting premenopause and the 1st year after the end of menstruation
postmenopause – begins one year after menopause and ends at 65–70 years.

The clinical course of the climacteric period

Menopause is characterized by a gradual cessation of the functional activity of the ovaries. In the first three years of postmenopause, the maturation of single follicles is still possible, but later this process stops. As a result, estrogen deficiency develops, it is called hypergonadotropic hypogonadism. Deficiency of hormones leads to disruption of the visceral brain, pituitary gland and hypothalamus, as well as suppression of the secretion of neurohormones.

During the premenopausal period, the menstrual cycle undergoes significant changes – menstrual bleeding ranges from regular ovulatory or anovulatory bleeding to prolonged amenorrhea or menorrhagia.

Hormonal disorders (lack of estrogen) at this time can manifest themselves through premenstrual-like sensations:

chest swelling
feeling of heaviness in the lower abdomen and lumbar region
hot flashes.

This physiological condition is called climacteric syndrome, which manifests itself as violations of the regulation of vascular tone by the autonomic nervous system, neuropsychic problems, microcirculation and metabolic and trophic processes.

Emotional-vegetative:

decreased sexual desire
excessive irritability
depressive states
drowsiness
weakness
memory problems.

Vasomotor disorders:

chills
hot flashes
excessive sweating
headache
arterial hypertension
tachycardia.

Disorders from the urogenital system:

urinary incontinence
itching, dryness and burning sensation in the vagina
painful urination
sensations of discomfort or soreness in the area of the external genitals and small pelvis
pollakiuria (frequent urination).

Skin condition:

brittle nails
decrease in skin elasticity
wrinkles
hair loss (alopecia).

Disorders of metabolic reactions:

pathology of the cardiovascular system
Decreased bone density
Alzheimer’s disease.

Diagnostics of menopause and possible complications

Diagnostic measures are based on the data of the patient’s life history and complaints.In most cases, the chronic course of concomitant pathologies complicates the diagnosis, makes the woman’s condition heavier and provokes the establishment of atypical forms. Therefore, in the presence of such diseases, the diagnosis of menopause involves the participation of related doctors: an endocrinologist, a neuropathologist and a cardiologist.

To obtain complete information, the following laboratory tests are prescribed:

biochemical blood test
urinalysis
hormonal panel (determination of the level of estrogen, FSH and LH)
thyroid panel (TTG, AkTG)
cytological examination.

Instrumental diagnostics in menopause is aimed at identifying or excluding organic pathologies, therefore, electrocardiography and ultrasound of the pelvic organs are mandatory.

Treatment of menopause with hormone replacement therapy

In clinical gynecology, the therapy of climacteric manifestations is aimed at maintaining hormonal balance. For this purpose, HRT (hormone replacement therapy) is prescribed. This method of treatment allows you to compensate for the lack of your own sex hormones by taking artificial steroid substitutes (monotherapy with estrogens with a deficiency of these hormones or taking progestins to prevent hyperestrogenic conditions).

Please note that HRT is selected on a strictly individual basis after passing all the necessary diagnostic tests.

Prevention of menopause syndrome

Attentive attitude to your own health, smoking cessation and excessive alcohol consumption lead to a later onset of menopause and reduce the intensity of symptoms.

A fairly effective preventive measure is the use of HRT in premenopause. The drugs of this group prevent the development of severe forms of menopause and contribute to a milder course of this physiological period.

For more information about preventive measures to prevent menopause, contact your gynecologist. A specialist of the EXPERT Clinic will select the most suitable method at a face-to-face appointment that allows you to prolong women’s health and beauty.

Recommendations for patients

In our country, a conservative opinion prevails regarding the problem of menopause, which implies not interfering with the aging process. At the same time, foreign clinics use progressive medical approaches to treat menopause.Their essence lies in the artificial replenishment of estrogen-gestagenic deficiency by taking synthetic steroids.

If you have a desire to prolong sexual health and experience the old colors of life in full, we will gladly give you this opportunity.

In the multidisciplinary EXPERT Clinic, a medical consultation is engaged in the process of managing patients with climacteric problems, with the participation of gynecologists of the highest category, endocrinologists, cardiologists and neuropathologists.Do not waste precious time, sign up for a consultation.

Menopause at 40: Why So Fast? | Healthy life | Health

What is important to know about menopause? What can trigger early menopause? How to cope with hot flashes and feeling unwell?

The questions are answered by obstetrician-gynecologist of the highest category, Doctor of Medical Sciences, Leading Researcher of the Department of Gynecological Endocrinology of the Scientific Center of Obstetrics, Gynecology and Perinatology named afterAcademician Kulakov “Svetlana Yureneva.

“AiF”: – “Early menopause” – what is meant by this term? What is the age category of women?

Svetlana Yureneva: – First, I must say what is the normal age of menopause. Menopause, on average, comes to women at the age of 50, but normal limits are 45-55 years. If this function is turned off earlier, that is, at 40-45 years old, this situation is called early menopause.And if ovarian function is turned off before the age of 40, it is premature ovarian failure. In any case, this is bad for a woman.

In addition to the fact that she loses the ability to bear children, many processes associated with natural aging seem to shift in time. As a result, in the future, such a woman has a higher risk of heart disease, blood vessels, osteoporosis, fractures, and impaired cognitive function. Central nervous system diseases such as Alzheimer’s disease and parkinsonism are more common.

Photo by: globallookpress.com

“AiF”: – And what can provoke an early onset of menopause?

S.Yu .: – The reasons may be different. Most often this is a genetic predisposition. Therefore, when a patient comes to us with such complaints, we always clarify what happened to her mother. As a rule, if the mother’s ovarian function is turned off early, the daughter’s ovarian function may turn off several years earlier. This is one reason. The second reason is autoimmune disorders, that is, when the response of the ovaries is disrupted, antibodies to the ovaries are produced.But at the same time, antibodies can also be produced to other tissues, in particular the adrenal glands, the thyroid gland, therefore, such patients often have not only autoimmune disorders of the ovaries, but also autoimmune thyroiditis, autoimmune problems with the adrenal glands.

In addition, for some patients, we cannot say for sure what reason led to such a condition, there are a lot of factors. There is a theory that stressful situations can also contribute to an earlier shutdown of ovarian function.Of course, there are a number of damaging factors, such as nicotine. Women who smoke have been shown to have menopause a year earlier.

“AiF”: – So you can add this to the list of diseases on a pack of cigarettes?

S.Yu .: – Yes, and therefore it is not by chance that the skin of women who smoke looks different, and wrinkles appear earlier, and infertility is more common in them, and the function of the ovaries is turned off earlier.This is a big problem. Also, I do not know how much we can apply this to humans, but I think we can, it has been shown in animal husbandry that the use of genetically modified foods in food can affect fertility. This is another reason that can contribute to an earlier shutdown. You also need to remember about surgical intervention in women on the uterus and uterine appendages. When ovarian surgery is performed, the removal of some ovarian tissue can reduce ovarian reserve, and in such women menopause occurs earlier.

There is another problem. We know that today surgeons are quite active in operating on such problems that are really subject to surgical treatment: large uterine fibroids, endometriosis. These are situations that significantly disrupt the quality of life, disrupt the functions of neighboring organs, lead to increased loss of hemoglobin, anemia. After removal of the uterus in some women, the ovaries may also shut down earlier. This is due to impaired blood circulation in the ovaries, because we know that the function of any organ is closely interrelated with the characteristics of the blood supply, and if ischemia occurs, this can also lead to an earlier shutdown of the function.

Photo by: globallookpress.com

“AiF”: – Modern women are very attentive to their health. What was the situation with this before? The menopause in women was calmer, or did they simply not pay attention to the accompanying problems?

S.Yu .: – Historically it so happened that really, this was not always paid attention. In addition, it must be remembered that today’s life and the intensity of stress on a woman is much greater. Today a woman performs a number of functions: she, as a rule, works, keeps her family on herself, raising children, and it is precisely at the age of pre- and menopause that the peak of her professional career falls.Therefore, on the one hand, colossal loads, on the other hand, the biological clock already suggests that hormonal changes are occurring and a woman is not always resistant to stress, and stress, among other things, can provoke the onset of hot flashes.

In addition, it was shown that many women used to spend this period of life in the fresh air, outside the harmful urban influences – without noise and polluted air. Green color generally has a positive effect on the function of the central nervous system.Rural women are less likely to experience hot flashes.

There is also a certain genetic predisposition. For example, in women of Japanese descent, hot flashes are a very rare occurrence, maybe this is due to genetics, or maybe due to dietary habits, because soy products, seafood are often used, the Japanese use little meat.

“AiF”: – What advice can you give to women entering the time of menopause?

S.Yu.: – All women can be given very good recommendations, because there is evidence that speaks about how, by influencing lifestyle, you can reduce the impact of menopause.

The first is weight control. This is a very powerful factor in avoiding hot flashes, because gaining body weight, increasing the amount of fat changes thermal conductivity, changes heat transfer. Obese women are more prone to hot flashes than women with normal body mass index.

Another point is nutrition. A moderate, low-calorie diet promotes a longer reproductive period, greater activity and longevity. A healthy diet can improve a woman’s well-being, in addition to allowing her to control her weight and is a real prevention of heart and vascular disease, which is the main cause of death in women.

Sleep is a very important aspect of healthy aging. With a decrease in the quality and quantity of sleep, we increase the risk of climacteric disorders, the development of depression and cardiovascular diseases.This is a separate topic of conversation, but women should remember that if during this transitional period of their life their sleep is disturbed, this will definitely require attention and correction. Sleep disturbance can be corrected and thereby prevent the development of many of the unwanted complications of menopause that may arise.

Another very important aspect is an active lifestyle. Previously, women walked, now women have moved into cars, spend a lot of time at the computer, sit a lot and walk a little.Recently I was in one of the European countries and was pleasantly amazed that almost all men and women have a pedometer hanging around their necks. Ten thousand steps a day is our norm. If we walk 10 thousand steps a day – this is the norm, this is a real preservation of health and prevention of many problems.

If a woman already has some symptoms, what can I add, which helps very well with auto-training, various methods of relaxation, yoga. They help to breathe correctly and correctly adjust all the rhythms of the body, not only breathing, but also the pulse and blood pressure, help us build our biorhythms.

The choice of fabrics in which a woman dresses is also important. During this period of time, it is better to give preference to natural fabrics that conduct heat well, do not retain it. These are cotton, linen, silk, wool.

If a woman is tormented by hot flashes, she constantly opens the windows, she is always hot, then it is necessary to create a comfortable temperature for herself, at which the probability of a hot flush is much less.

During this challenging period of time, I would recommend that all women avoid hot foods, hot drinks, spicy foods, as this provokes a hot flush.

Zoya Bakhtina on women’s health

07/09/2019

Zoya Bakhtina on women’s health

Anna Svetlova: “I want anything, except the desire to go on a date …”

Anna Svetlova: The Internet is simply replete with moralizing “experienced” about how important it is to preserve your femininity and sexuality. “Instagram-princess” demonstrates how important it is to take care of yourself and remain attractive at any age and at any time of the day or night.Beautiful mothers tell how to raise their child, remaining a supermistress in the kitchen and a queen in the arms of a beloved man … Having adopted my 40, I increasingly listen to my desires: what I want, in what form, at what time, what makes me happy, and what No? And here he is the first call: I want anything but the desire to go on a date. How long have I stopped flirting and courting? When did I manage to change my passionate nature? .. I brought up the topic of “cooling in the heart” with my girlfriends, friends, those who are in their early 40s, and those who are “baba berry again”.And lo and behold, it turns out that I am not the only one who has lost my desire to love. Almost every girl (regardless of the stamp in the passport) faces a loss of interest in the intimate sphere. Children, household chores, stress at work, the next news release – all this can not only spoil the mood, but also deprive the desire to have sex. But is it only this? I seriously wondered why at the peak of their activity – at the age of 35-40 – many women face such a delicate problem. By the type of my character, I cannot stay with my eyes wide shut for a long time, and therefore attracted one of the best specialists in women’s health to the discussion of this topic.I was lucky to get for an appointment with the endocrinologist Zoya Bakhtina. Unreasonable anxiety, apathy, tearfulness, irritability, loss of interest in the intimate sphere – these complaints began our acquaintance and joint work to improve the quality of my life.

Reference: Zoya Enverovna Bakhtina. She was born in Kazakhstan. In 1998 she graduated from the Arkhangelsk State Medical Academy with an excellent diploma, completed an internship in endocrinology and graduate school. Here in Arkhangelsk I fell in love and stayed to live.Raises two daughters with her husband. From 2005 to the present, he has been in charge of the Arkhangelsk City Endocrinological Center on the basis of the City Clinical Hospital No. 1 named after E.Ye. Volosevich.

Zoya Bakhtina: The topic that you have chosen is very relevant and interesting, and talking about it at the doctor’s appointment, whether it is a gynecologist or an endocrinologist, is somehow not accepted – often women are shy, or there is no way to talk about it time. Let’s try to open this topic. Today, in an era of increasing life expectancy and the associated later retirement, a modern woman after 40 needs to remain active.A woman at the peak of her career, loaded with family issues (children, grandchildren, aging and sick parents, a new family). Naturally, she does not want to lose her social status. It is psycho-emotional symptoms that prevent most women from living and working normally. Optimal health and wellness during this period is determined by normal levels of hormones , including sex hormones. Hormones are chemicals that mediate between various organs and tissues in our body. Sex hormones are responsible not only for reproductive function, but also for everything that makes a woman a woman and a man a man.

Anna: Can we say that at the age of 40, almost all women notice hormonal changes?

Zoya: Let’s see what happens at 35-45 years old. At this age, women usually feel healthy, but hormonal changes are already beginning to occur in the body, which can later lead to various diseases. 45-50 years: “menopausal transition” when health problems appear. Hot flashes and sweating, even with a constant cycle, are a sign of impending menopause.Also, a sign of a decrease in the amount of sex hormones can be delicate problems, including a decrease in sexual interest. Thoughts more and more often appear in my head: “Forget about sex, I already do not have enough energy” or “I sleep for 8-9 hours, and when I wake up, I feel that I need another 2-3 hours of sleep.” Sexologists believe that there should be at least five sexual fantasies a day (any pleasant thought about a partner). I would like to give an example of Japanese women: they can be called centenarians in the sexual sphere. The age of menopause in a Japanese woman is after 55 years, and sexual activity continues until 70 years! This is partly due to the traditional use in the diet of vegetables and legumes containing phytoestrogens (note).

Anna: Let’s be honest … Rarely does anyone take these changes seriously. Moreover, if they still cannot be avoided.

Zoya: This is true, but we must be prepared for the fact that in the absence of treatment, metabolic disorders and cardiovascular diseases develop at the age of 50-60, obesity, arterial hypertension, type 2 diabetes mellitus, strokes, heart attacks, as well as unpleasant symptoms – forgetfulness, absent-mindedness, it is difficult to remember new information, osteoporosis, joint and muscle pains, dental problems, dry eye syndrome develop.

Anna: Well, yes, at 40-50 years old women often turn to a cosmetologist or plastic surgeon to solve the problem of youth. And you tell me about vitamin D, vitamin E, sex hormones! ..

Zoya: Turning to a beautician (wrinkles, dry skin, excessive pigmentation), women and the specialists she turns to, these symptoms have nothing to do with her hormonal background. And in vain! You receive therapy that is often poorly effective or has a short-term effect.

Anna: So we approach beauty through health?

Zoya: Yes. Hormone therapy is an opportunity to preserve the health and beauty of women after 45. It has now been established that the most effective way to solve the problems associated with age-related decrease in the level of sex hormones, and to prevent late complications is menopausal hormone therapy (MHT). But we must understand that the decision on therapy with sex hormones is very individual and depends on the severity of menopausal symptoms, as well as on the presence of risk factors.

Anna: This is a terrible word “hormones” … But what about the “mustache”, “gaining excess weight” and many other fears?

Zoya: These are outdated myths. Here’s the real story: Menopausal hormone therapy, started before age 60, reduces overall mortality by 30-39%. Do not delay treatment. Therapy should be prescribed from the appearance of the first signs of a deficiency of sex hormones, it is in this case that it allows not only to significantly delay the development of age-related diseases, but also to improve the quality of life, including the sexual sphere.Women receiving hormone therapy maintain weight stability, while 60% of women without treatment experience weight gain. Basically, there is a redistribution of adipose tissue due to an increase in fat deposits in the abdomen. Therefore, one of the fears that hormones, they say, will lead to weight gain, is a myth – rather, the opposite is true. With timely treatment, my patients showed a decrease in weight after 6 months by 4 kg, after a year – by 6 kg.

Anna: Did I understand correctly that with age, the level of sex hormones decreases and this affects a decrease in libido (sex drive)?

Zoya: That’s right.However, the age-related decline in sex hormone levels occurs somewhat earlier before the problem becomes apparent. The main hormone responsible for sex drive is testosterone – in both men and women. Currently, it is not customary to divide sex hormones into male (androgens) and female (estrogens). Both are produced in both men and women. And they cause the same effects, but estrogens prevail in women, and the production occurs cyclically, in men – androgens.

Anna: Let’s be more specific: what hormones do we need to closely monitor and what are they responsible for?

Zoya: Estrogens – beauty hormones , moisturizing. Estrogen deficiency will manifest itself as dry, dehydrated skin and mucous membranes, wrinkles, age spots, hot flashes, mood swings, headaches, muscle stiffness … Testosterone is a hormone of energy, ambition and sexual desire. T estosterone determines character, success, leadership qualities, positive thinking .He is responsible for muscle mass and strength, hematopoiesis, immunity, bone density. This is just in time for our topic of loss of desire: if sexual desire has decreased, “drive”, self-confidence have disappeared, excess weight does not lend itself to diets, the inner side of the shoulders has become flabby, habitual physical activity seems too heavy – then testosterone levels have decreased. But there is another sex hormone – progesterone. It is a precursor of androgens and estrogens: in women, it is produced cyclically, unlike in men, and increases significantly during pregnancy.

Anna: Sorted out with hormones. Let’s talk about other causes of decreased sex drive?

Zoya: This is, first of all, stress. We work a lot, sleep little, and are overloaded with information. And people, as you know, do not reproduce under stress, and not only people. Further among the main reasons is obesity, oxidative stress that we experience when smoking, alcohol abuse, and environmental pollution. New dangerous factors of the present time – xenoestrogens .These molecules are not biochemically estrogen, but they act like estrogen. Natural estrogen binds to the receptor, sending the correct signal to the cell. Xenoestrogen, by binding to the receptor, sends the wrong signal to the cell, causing harmful effects. Sources include cheap plastics, the best known source of estrogen mimicking compounds. Almost all of our food comes in plastic, is processed with plastic equipment, and is often heated in plastic containers.Water, juices, coffee, and even tea are often served in plastic bottles. Our toothbrushes are plastic. Inorganic food is a rich source of xenoestrogens, due to insecticides and herbicides – since food is produced by industrial methods, whether it be plant products or meat, fish, poultry. Many lotions, cosmetics, creams – contain parabens, phthalates, which are used to flavor scented lotions, shampoos, soaps: they are also xenoestrogens. They cannot be identified in the blood. But we must know that they can cause not only a decrease in libido, but also terrible diseases such as infertility, obesity and cancer.

Anna: So, when the first signs of decreased libido appear, what should you pay attention to in the first place?

Zoe: If you want to increase your sex drive, then you need to increase your energy levels. P First of all, it is necessary to eliminate hypoxia, deficiency of vitamin D and sex hormones (especially after 45 years). Change your diet to more sex-friendly foods like leafy greens, lean protein, and complex carbohydrates.In your search for lost desire, foods such as spinach, turkey, whole rice and fish can help you. I would like to quote from journalist Vladimir Yakovlev: “What is the difference between life after 50 from all previous life? It is believed that the main result of the increase in life expectancy is that older people now live longer. But this is not the case. The main, huge, strategic consequence of the leap in life expectancy that is changing before our eyes is not that old age now lasts longer, but that it begins much later.What do we know today about the “50+” period? It lasts almost 30 years – from 50 to about 75. The physical and intellectual capabilities of a person during this period, with the right approach, do not decrease and remain, at least, no worse, and in some cases even better than in youth. Potentially, this is the best, highest quality period in human life, since it combines health, strength and life experience. According to all the statistics of recent years, the happiest time in life, its peak now comes at about 65 years old.Those who are 55-65 years old today are the first in the history of mankind to live this period. Previously, it simply did not exist, since people grew old much earlier. In the next few decades, people aged 50-75 will become the most massive age group on the planet … ”

Anna Svetlova: Zoya Enverevna, what are your wishes for the Big Girls?

Zoya Bakhtina: Yes, today you can hide your age. As usual, “after 50 years my best friend is a cosmetologist.” But remember: in order to preserve inner and outer beauty, health, intelligence, our desire and love, other strategies and specialist support are needed.

Source: Magazine, June / 2019, https://vk.com/@magazine29-ya-poteryala-zhelanie

Climax is not only the absence of menstruation

Many women around the age of 45 experience a decline in their quality of life. They experience unpleasant sensations of hot flashes (“as if you suddenly find yourself in a bath”), increased sweating, and increased heart rate. Sleep disturbances, pressure instability, headaches appear or become more frequent, urination is disturbed, the quality of sexual life worsens (due to symptoms such as dryness, lack of satisfaction).The woman is accompanied by pain in the spine, which is “given” to the arms and legs. The mood “skips”, up to depression, weight increases. And of course, the menstrual cycle is disrupted – menstruation becomes rare or frequent, scarce or abundant, painful. All this together is called menopause.

Not all women know about this. And they begin to treat everything. But there is only one sure way – to the gynecologist . Because all of the above symptoms are rooted in gynecology. In the treatment of gynecological disorders, general symptoms also disappear. . Menopause is a transitional and very difficult period in a woman’s life. For some, it occurs at 40 or even earlier (this is an early menopause, menstruation can still be restored), for others only at 55.

A gynecologist diagnoses menopause on the basis of examination, interview, ultrasound diagnostics, additional hormonal blood tests. It also determines the general state of health. The doctor prescribes a comprehensive and highly individualized treatment. Selects a hormonal preparation, or phytoestrogens (herbal remedy) . Prescribes a local effect on the genitourinary tract, altered skin, mucous membranes. If there are problems with weight, then correction of metabolic disorders is carried out in parallel – the lipid spectrum, insulin-sugar metabolism, endocrine disorders are normalized (here the gynecologist works in conjunction with an endocrinologist). Therefore, normalizes the weight to .

When choosing a therapy, a gynecologist proceeds not only from medical indications, but also from the needs of the patient.Gradually, the woman’s quality of life is improving. Modern medicine is able to stop the process of “wilting” of a woman and prolong her youth.

Have questions? Write to the doctor.

90,000 What is menopause and how to deal with it

Almost every woman has heard the “terrible word” menopause, but not everyone knows that menopause (menopause) is a natural phase in a woman’s life, during which the hormonal balance in the body changes.The ovaries produce less and less sex hormones as a result of the natural aging process and associated hormonal changes. Thus, menopause is a physiological restructuring process, not a disease. An estimated 25 million women worldwide enter this phase each year. However, the severity of symptoms and complaints due to menopause varies significantly between them.

When the age of menopause approaches, the reproductive function fades, the production of sex hormones (estrogen and progesterone) decreases, and menstruation stops.The last menstrual period in a woman’s life is called menopause.

Menopause usually occurs between the ages of 50 and 52. However, this stage can occur at 45 or even 35 years old.

For most women, menopause does not come suddenly, there are symptoms that indicate it is approaching:

change in the nature of menstruation (they become scarce or, conversely, abundant)
irregular menstruation (interruptions of up to several months are possible)
the appearance of “climacteric symptoms”

The transition period in a woman’s life is the period of the most pronounced hormonal changes and covers several years before menopause and the first 1.5-2 years after its onset.Not all women are the same, every woman experiences this period of life in her own way.

The symptoms of menopause are manifold. Hot flashes, night sweats, dizziness, and sleep disturbances are usually transient but may persist for several years until the body adapts to low hormone levels.

Emotional disorders, such as irritability, self-doubt, and / or low mood, can also be a direct or indirect result of hormonal shifts characteristic of menopause.

A little later, dryness in the vagina, soreness during intercourse, and urination disorders join. These symptoms do not disappear on their own, but only intensify over time.

The most serious long-term consequence of low estrogen levels is bone loss (osteoporosis) and resulting bone fractures.

In young women, estrogens protect the body against the development of atherosclerosis and coronary heart disease.With the onset of menopause, when the level of hormones decreases, the effect of this protective mechanism weakens, which contributes to the development of arterial hypertension, atherosclerosis, and also increases the risk of heart attacks and stroke.

For many women, after 45 years of age, the hair turns gray, begins to lose elasticity and shine. Hair may begin to grow on other parts of the body (thighs, face). The skin becomes less elastic, wrinkles begin to appear. The main reason for all these changes is the low level of female hormones – estrogen and progesterone.The figure also often changes. Many women, as they approach the age of menopause, report unexplained weight gain and an increase in fat tissue, especially in the abdomen, despite all the attempts to lose weight. At the heart of these changes is a deficiency of female sex hormones.

But menopause is not a death sentence! The quality of life of a woman during menopause largely depends on herself.

Today every woman has a choice. Of course, you can endure all the manifestations of menopause without taking any measures and saying to yourself: aging is a natural process.But in our time there is a real opportunity to help every woman in this matter.

As a general rule, all women during this period are advised to monitor their weight, try to exercise regularly, quit smoking and avoid excessive drinking. However, a healthy lifestyle is not everything. A holistic approach to menopause can also include appropriately tailored medication.

It has now been established that the most effective way to solve the problems associated with menopause, and to prevent its late complications, is hormone replacement therapy (HRT).

The effect of HRT appears within 3-4 months of regular use.

With a short course (several months), HRT is most useful for relieving symptoms and preventing hot flashes, night sweats, vaginal dryness, sleep disturbances, emotional disorders, skin aging, and decreased libido. With prolonged use (several years) – for osteoporosis.

New research suggests that HRT may delay the onset of Alzheimer’s disease and reduce the risk of colon cancer.

However, many women also note the side effects of HRT.

The side effects of estrogen (nausea, seizures, headaches) usually diminish within 1 to 2 months.

Side effects of progesterone (swelling, breast tenderness, irritability, mood swings, anxiety, etc.) can last 4-5 months. They are similar to the manifestations of premenstrual syndrome. In women who have previously suffered from it, these side effects occur more often with HRT.

There is a wide range of different HRT medications available. Some women themselves, without consulting a gynecologist, start taking hormonal drugs, which is fundamentally wrong, and can cause irreparable harm to health. We recommend that you consult with a specialist before starting hormone replacement therapy, and visit a gynecologist 3-4 times a year during the entire therapy. If the side effects persist and interfere with a normal life, you do not need to wait for the next visit to the doctor, you need to immediately consult with a gynecologist to adjust the dosage or replace one drug with another.

Do not self-medicate, call 901-941 and we will help you.

90,000 what is it • Main symptoms and signs

We are talking about menopause – a natural, although sometimes not very pleasant stage in the life of any woman.

Many people think that menopause is old age, the end of life, and they are afraid of this. Although the processes of hormonal changes in the body occur throughout a woman’s life.Specifically, this stage is associated with a decrease in estrogen levels and the extinction of reproductive function. This does not mean the onset of old age, and, in particular, does not exclude an active sexual life.

Women often think that menopause coincides with the moment of the last menstrual period. This is not entirely true: doctors define menopause as the extinction of ovarian function, in other words, the cessation of egg production. At the same time, in the early stages of menopause (in the so-called premenopausal period), menstruation may persist for some time (although the cycle usually becomes longer).Doctors consider menopause to be “complete” if the last critical days were a year ago.

Age at menopause

The normal age for menopause, that is, the state when a woman can no longer conceive and bear children, is quite individual. The average value is 49-50 years, but 45 and 55 years are also the norm. It is rather difficult to answer the exact question: at what age does menopause occur. It does not start suddenly, because it takes time for the body to rebuild.Usually, the changes that cause certain inconveniences to women occur precisely at the beginning of the menopause.

Symptoms and signs of menopause

The onset of menopause can be determined by a number of signs. You don’t have to experience all of them: menopause starts differently for every woman.

The regularity of menstruation changes. The menstrual cycle of women gets confused, bleeding can start earlier and take longer, or, on the contrary, pass too quickly.Critical days can also become more painful.
The amount of discharge may change. In order not to change the usual way of life and to avoid discomfort with too heavy periods, it is worth choosing pads with increased absorbency. For example, the Always Platinum Ultra is just 3mm thick and offers excellent protection and softness.
“Hot flashes” appear: sensations of heat and palpitations, which appear abruptly and also quickly disappear. Some women also report insomnia, dizziness, or shortness of breath.

All this is the “first swallow”, the beginning of hormonal changes, by which you can usually understand what is happening to you. These changes are not pleasant, so it is worth visiting a doctor and finding out how to get through this period with the greatest comfort.

How to get rid of hot flashes during menopause

What are hot flashes during menopause? Sudden attacks of fever are the result of changes in hormone levels and malfunctioning of the hypothalamus. This part of the brain is responsible for a number of important body functions, one of which is thermoregulation.Hot flashes are often accompanied by increased sweating, redness of the skin, rapid breathing, and tachycardia. According to statistics, more than 75% of women are familiar with these unpleasant external symptoms. “Attacks” of the hormonal system are almost impossible to predict, and they last from half a minute to half an hour.

Hot flashes do not always occur regularly and with different frequencies: once every few months or dozens of times a day. This is due to what happens in a woman’s body. The concentration of sex hormones (estrogen and progesterone) in the blood decreases, and the synthesis of follicle-stimulating hormone, on the contrary, increases.The endometrium is no longer renewed, which leads to the cessation of menstruation. In addition to physiological changes, mood swings and a tendency to depression are often observed.

How long do hot flashes last during menopause? This is very individual. Someone will not notice the tides at all, and someone will suffer with them for a year or two. The consolation is that modern medicine is able to offer different options for salvation from such discomfort. What to do? First of all, consult your doctor.

In some cases, menopausal hormone therapy is prescribed.It significantly reduces both the external manifestations of this difficult condition and harmonizes internal processes, saving a woman from the development of osteoporosis, thyroid pathologies, neoplasms in the mammary glands, uterus and ovaries.

In addition, symptoms of menopause are often successfully treated with symptomatic medications such as antidepressants, vitamin D and calcium supplements. It is important to remember that although menopause is not a disease, all medications should only be done by a doctor.

Some women fight the heatwaves with folk remedies. It is believed that hot flashes can be eliminated by taking decoctions of herbs (dill, flax, clover, sage, hops, licorice, alfalfa). According to some reports, these plants contain substances that act similarly to human hormones. Despite the fact that herbs are sold without a prescription, self-medication should not be practiced. Ask your doctor if he recommends drinking this or that decoction.

To make it easier to survive the next wave of heat, it is worth ventilating the apartment more often and avoiding excessively warm clothes.Unlike medicines and herbs, fresh air can and should be taken more often without a prescription!

How to delay menopause

Although modern women no longer equate menopause and old age, many would like to postpone menopause. After all, estrogen in the body is becoming less and less, and not only the work of the reproductive system, but also the beauty and health of a woman, directly depends on it. This hormone regulates the renewal of the mucous membrane of the urethra and urinary bladder, is involved in the growth of bone tissue, promoting the absorption of calcium and the formation of bone cells.The estrogen-sensitive organs include the skin, as well as hair, nails, and sebaceous glands. Estrogen reduces the risk of developing atherosclerosis and other cardiovascular pathologies. Therefore, many people want to delay the onset of menopause.

Compensation of estrogen deficiency helps to delay the onset of menopause (as we already wrote, only a doctor can prescribe hormone replacement therapy). Along with this, adequate nutrition, giving up bad habits, as well as sufficient physical activity and lifestyle play an important role in maintaining good shape.

Diet and nutrition during menopause

The menu of a woman who does not want to give up for years should include vegetables, seafood, fish, complex (so-called “slow”) carbohydrates. There are many of them, for example, in unprocessed cereals and cereals.

Do not drink a lot of caffeinated drinks (this is not only coffee, but also tea and energy drinks). The reason is that caffeine removes magnesium and calcium from the body – elements that are especially lacking during menopause.

Avoid too salty foods and foods – excess sodium contributes to edema and the development of hypertension.But at the same time, do not allow a shortage of fluids: make it a habit to carry a bottle of drinking water with you and drink whenever you want.

Treatment and prevention of menopause at home

Fortunately, menopause is not a disease. But, unfortunately, for the same reason, it cannot be cured or avoided. You can only work on yourself: eat right, move a lot, keep cheerfulness and interest in life.

Here’s a simple checklist to get you through menopause without any problems:

Do not forget about physical activity (moderate exercise at least 30 minutes a day is desirable).Yoga, Pilates, or just a brisk walk will do.
Eat correctly and variedly (we wrote above what you should pay attention to).
Watch your weight: during menopause, it becomes easier to gain extra pounds due to hormonal changes in the body.
Do not smoke: this is not only harmful to overall health, but also accelerates the onset of menopause.
Get enough sleep (at least 8 hours a day).