Understand the average age for menopause in women and why menopause awareness and education should start earlier in life. Learn about the challenges women face and the solutions available to manage the transition.

The Increasing Population of Menopausal and Postmenopausal Women

By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year. This highlights the growing importance of addressing the needs and concerns of women during this stage of life.

The Importance of Early Conversations about Menopause

Dr. Stephanie Faubion, a women’s health expert at Mayo Clinic and the medical director of the North American Menopause Society, emphasizes that women should start discussing menopause with their healthcare providers as early as 35 or 40 years old. This is because women may start experiencing symptoms related to the menopause transition up to 10 years before their last menstrual period.

Recognizing Early Menopause Symptoms

The early symptoms of menopause can be subtle and include variations in menstrual cycle length, hot flashes, night sweats, joint aches, vaginal dryness, and mood and sleep disturbances. Many women are unaware that these symptoms are related to the beginning of the menopause transition, leading to a “big surprise” when they start experiencing them.

Seeking the Right Healthcare Provider

Dr. Faubion recommends that women start the conversation about menopause with their local internist, family physician, nurse practitioner, or physician assistant. However, she notes that education about menopause is often lacking, so women may need to seek out a specialist certified in menopause management, such as an obstetrician or gynecologist.

The Value of Menopause Specialists

Menopause specialists have additional training and awareness about the latest therapies and treatments available to guide women before, during, and after their transition into menopause. This is particularly relevant when women want to understand hormone therapy and whether they are a candidate for it.

Utilizing New Technologies for Menopause Management

The Midday app, developed by Lisa Health using Mayo Clinic technology and artificial intelligence algorithms, can assess the severity of menopause symptoms and provide personalized education. This can help eliminate barriers to care and provide women with information about their health risks and potential treatment options, including hormone therapy.

The Importance of Proactive Menopause Management

Being proactive about menopause can help ensure a woman’s quality of life long before the transition occurs. The effects of menopause are far-reaching, with lost work productivity and increased healthcare utilization due to menopause estimated to be in the billions of dollars in the U.S. alone. Women do not have to suffer, as there are solutions available to manage the transition effectively.

Why is it Important to Start Menopause Conversations Early?

It is important to start menopause conversations early because women may start experiencing symptoms related to the menopause transition up to 10 years before their last menstrual period. By discussing menopause with their healthcare providers as early as 35 or 40 years old, women can better understand and prepare for the changes they may experience, as well as explore options for managing their symptoms proactively.

What are the Challenges Women Face in Recognizing Early Menopause Symptoms?

The early symptoms of menopause, such as variations in menstrual cycle length, hot flashes, night sweats, joint aches, vaginal dryness, and mood and sleep disturbances, can be subtle and easily overlooked. Many women are unaware that these symptoms are related to the beginning of the menopause transition, leading to a “big surprise” when they start experiencing them.

How Can Women Find the Right Healthcare Provider for Menopause Management?

Dr. Faubion recommends that women start the conversation about menopause with their local internist, family physician, nurse practitioner, or physician assistant. However, she notes that education about menopause is often lacking, so women may need to seek out a specialist certified in menopause management, such as an obstetrician or gynecologist. The North American Menopause Society website provides a “locate provider” tab to help women find experts certified in menopause management.

What are the Benefits of Seeing a Menopause Specialist?

Menopause specialists have additional training and awareness about the latest therapies and treatments available to guide women before, during, and after their transition into menopause. This is particularly relevant when women want to understand hormone therapy and whether they are a candidate for it. Menopause specialists can also provide valuable information about other management options, such as lifestyle changes, to assist women in navigating the menopausal transition.

How Can New Technologies Help Manage Menopause Symptoms?

The Midday app, developed by Lisa Health using Mayo Clinic technology and artificial intelligence algorithms, can assess the severity of menopause symptoms and provide personalized education. This can help eliminate barriers to care and provide women with information about their health risks and potential treatment options, including hormone therapy. By utilizing this kind of technology, women can better understand and manage their menopausal symptoms proactively.

Menopause awareness and education should start earlier in life

• By

  Cynthia Weiss

  October 25, 2022

For many women, having uncomfortable conversations with their mothers or a health care professional about menstruation was a rite of passage. Today, there is a lot of education available for girls, but what still is lacking is education around menopause.

Mayo Clinic experts hope to change that.

Dr. Stephanie Faubion, a women’s health expert at Mayo Clinic and medical director of the North American Menopause Society, is focused on educating women about menopause and the value of having conversations long before that stage of life arrives.

By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year.

Early Discussions

“I would argue that women should be starting to have this conversation with their providers at the age of 35 or 40 — so, much earlier than one would expect, because women may start to have symptoms related to the menopause transition six to 10 years before their last menstrual period,” says Dr. Faubion.

She adds that for women in their late 30s or early 40s, this can be challenging to discern, since symptoms can vary and include subtle variations in their menstrual cycle length, as well as hot flashes, night sweats, joint aches, vaginal dryness, and mood and sleep disturbances. “This is not something they would even think might be related to the beginning of the menopause transition. It is a big surprise when they begin to experience symptoms that are the same as women who are already in menopause,” says Dr. Faubion.

“It’s important to have conversations proactively with their providers to say: ‘Help me understand what it might be like for me. What can I do about managing symptoms when they start? And what is out there in terms of technology that can be helpful in bridging that care gap that women may be experiencing?’”

It can be even more challenging for a woman to know who to connect with, as they might not have a designated menopause expert.

Where to start

Dr. Faubion suggests starting with your local internist, family physician, nurse practitioner, physician assistant or other members of your health care team. Certainly, it could be an obstetrician, gynecologist or other specialist.

The challenge is that education is lacking about menopause. As such, she recommends women visit the North American Menopause Society website at menopause.org and search its “locate provider” tab to find experts certified in menopause management. “You need to be your own patient advocate. And you need to understand that if you don’t feel it’s right and you’re not getting the answers that you need, you may need to look for another provider,” says Dr. Faubion.

She notes that patients often wonder about why it’s important to have a specialist certified in menopause management. “The value is that individual will have additional training and awareness about the latest therapies and treatments available to guide women before, during and after their transition into menopause,” she says.

Is HRT right for you

This is particularly relevant when women want to understand hormone therapy and if they are a candidate. Cultural disparities often have women believing they are not candidates for hormone therapy, which can increase the gap of care.

Hormone therapy is something many women hear about — and it may be valuable to some — but there are many options, including lifestyles changes, that can assist with the management of symptoms. Speaking to an expert and utilizing new technology can provide additional benefits to women as they navigate the transition, notes Dr. Faubion. The Midday app, launched by Lisa Health, a digital health company, uses Mayo Clinic technology and artificial intelligence algorithms to assess the severity of menopause symptoms and provide education.

“One of the biggest benefits of the Midday app by Lisa Health is that it eliminates some of the barriers to care that woman might experience. And it would give them the information specific to their health risks. As well, it can give them information about whether they might be a candidate for hormone therapy,” explains Dr. Faubion.

Being proactive about menopause can help ensure a woman’s quality of life long before the transition occurs, notes Dr. Faubion, adding that the effects of menopause are far-reaching. She says that lost work productivity and increased health care utilization due to menopause is estimated to be in the billions of dollars in the U.S. alone. 

The bottom line: “Women don’t have to suffer. There are solutions out there and doing nothing doesn’t have to be the answer,” says Dr. Faubion.

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Menopause basics | Office on Women’s Health

Menopause is when your period stops permanently. Menopause is a normal part of a woman’s life. It is sometimes called “the change of life.” Menopause does not happen all at once. As your body transitions to menopause over several years, you may have menopause symptoms and irregular periods. The average age for menopause in the United States is 52.

What is menopause?

Menopause is when your periods stop permanently and you can no longer get pregnant. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.

After menopause your ovaries make very low levels of the hormones estrogen and progesterone. These low hormone levels can raise your risk for certain health problems. 

What is perimenopause, or the transition to menopause?

Perimenopause (PER-ee-MEN-oh-pawz), or the menopausal transition, is the time leading up to your last period. Perimenopause means “around menopause.”

Perimenopause is a long transition to menopause, or the time when your periods stop permanently and you can no longer get pregnant. As your body transitions to menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly.  During this transition, your ovaries make different amounts of the hormones estrogen (ES-truh-jin) and progesterone (proh-JES-tuh-RONE) than usual.

Irregular periods happen during this time because you may not ovulate every month. Your periods may be longer or shorter than usual. You might skip a few months or have unusually long or short menstrual cycles. Your period may be heavier or lighter than before. Many women also have hot flashes and other menopause symptoms during this transition.

When does the transition to menopause usually start?

Perimenopause, the transition to menopause, usually starts in a woman’s mid- to late 40s.¹ On average, women are in perimenopause for four years before their periods stop.

How will I know if I am starting the transition to menopause?

Sometimes it can be hard for you and your doctor to tell whether you are in perimenopause, the transition to menopause:

• Symptoms: Tell your doctor or nurse about any menopause symptoms, such as hot flashes or trouble sleeping.
• Irregular periods: Track your periods. Irregular periods may be your first sign of menopause.
• Hormone levels: Your doctor may test the amount of hormones in your blood if your periods stopped at an early age (before 40). Doctors don’t usually recommend this test unless there is a medical reason to do so. This is because, for most women, hormone levels go up and down in an unpredictable way during the transition to menopause. So it is difficult to tell for sure whether you have gone through menopause or are getting close to it based on this blood test.

How will menopause affect me?

Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
• Your periods might be heavier or lighter than before.
• You might have hot flashes and problems sleeping.
• You might experience mood swings or be irritable.
• You might experience vaginal dryness. Sex may be uncomfortable or painful.
• You may have less interest in sex. It may take longer for you to get aroused.

Other possible changes are not as noticeable. For example, you might begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke.

Talk to your doctor about possible treatment for your menopause symptoms if they bother you.

How long does the transition to menopause last?

Perimenopause, the transition to menopause, can last between two and eight years before your periods stop permanently. For most women, this transition to menopause lasts about four years. You will know you have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.

Should I continue using birth control during the transition to menopause?

Yes. You can still get pregnant during perimenopause, the transition to menopause, even if you miss your period for a month or a few months. During perimenopause you may still ovulate, or release an egg, on some months.

But it is impossible to know for sure when you will ovulate. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your birth control needs. Learn more about different birth control methods. 

You can’t get pregnant after menopause, but anyone who has sex can get sexually transmitted infections (STIs, or STDs) (PDF, 187 KB). If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or dental dam correctly every time you have vaginal, oral, or anal sex. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sex, exposing you to STIs.

When does menopause usually happen?

Menopause happens when you have gone 12 months in a row without a period. The average age of menopause in the United States is 52. The range for women is usually between 45 and 58.² One way to tell when you might go through menopause is the age your mother went through it.³

Menopause may happen earlier if you:

• Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.⁴
• Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who don’t smoke.⁵

Certain health problems can also cause you to start menopause earlier.

Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries. Learn more about early menopause on our Early or premature menopause page. 

What happens after menopause?

After menopause you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can mean that you have a serious health problem.  

You may experience any of the following after menopause:

• Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.
• Menopause symptoms instead of period problems. After menopause, most women get relief from period problems or menopause symptoms. However, you may still experience symptoms such as hot flashes because of changing estrogen levels. One recent study found that hot flashes can continue for up to 14 years after menopause.^6,7
• Vaginal dryness. Vaginal dryness may be more common post-menopause. Learn more about treatments for vaginal dryness.

Did we answer your question about menopause?

For more information about menopause, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:

• Aging changes in the female reproductive system — Information from the National Library of Medicine
• Health & Aging: Menopause — Information from the National Institute on Aging (NIA)
• Menopause — Information from the Eunice Kennedy Shriver National Institute of Child Health and Human Development
• Menopause Flashes — Web magazine from the North American Menopause Society
• Perimenopause: Changes, Treatment, Staying Healthy — Information from the Association of Reproductive Health Professionals
• Perimenopause: Rocky road to menopause — Article from the Harvard Medical School

Sources

1. Grady, D. (2006). Management of Menopausal Symptoms. New England Journal of Medicine; 355: 2338–2347.
2. Shifren, J.L., Gass, M.L.S., for the NAMS Recommendations for Clinical Care of Midlife Women Working Group. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women. Menopause; 21(10): 1038–1062.
3. Mishra, G.D., Cooper, R., Tom, S.E., Kuh, D. (2009). Early life circumstances and their impact on menarche and menopause. Womens Health; 5: 175–190.
4. Avis, N.E., McKinlay, S.M. (1991). A longitudinal analysis of women’s attitudes toward the menopause: Results from the Massachusetts Women’s Health Study. Maturitas; 13: 65–79.
5. women.smokefree.gov. (n.d.). 11 Harmful Effects of Smoking on Women’s Health 
6. Avis, N.E., Crawford, S.L., Greendale, G., Bromberger, J.T., Everson-Rose, S.A., Gold, E.B., et al. (2015). Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Internal Medicine; 175(4): 531–539.
7. Tepper, P.G., Brooks, M.M., Randolph, J.F., Crawford, S.L., Khoudary, E., Gold, E.B., et al. (2016). Characterizing the trajectories of vasomotor symptoms across the menopausal transition. Menopause; 23(10): 1067–1074.

All material contained on these pages are free of copyright restrictions and maybe copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated.

Page last updated:
January 6, 2023

Early menopause. How to recognize and what to do

. We analyze painful issues and look for a solution together with a specialist

Updated March 29, 2023, 16:17

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Menopause is an inevitable event in the life of every woman. On average, it begins in the age range from 45 to 55 years, but there are times when a woman learns from her own experience what an early menopause is, having just celebrated her thirtieth birthday. How do you know if menopause is coming early? And what strategy of behavior in this case to follow? RBC Life found out what are the causes of early menopause, whether it can be delayed and what measures to take so that it does not lead to a decrease in the quality of life.

Physiological Menopause: What You Need to Know

The average age at which most women go through menopause is 51 years. However, this does not change the fact that the transition period with associated symptoms can begin much earlier. After all, the age at which the first signs of menopause appear varies significantly from woman to woman. Menopause most often occurs between the ages of 45 and 55. However, some experience this much earlier: before they reach the age of forty, and sometimes even at the tender age of 20-25 years.

Menopause has several stages and is preceded by a long process.

If we consider in more detail the meaning of the concept of “menopause”, it is worth referring to the Greek origin of this word, which in translation into Russian means “monthly cessation”. Menopause itself is just one point on a timeline that spans the premenopausal and postmenopausal periods.

With confidence to say that menopause has come, it is possible only when menstruation is absent for exactly 12 months.

As defined by the World Health Organization (WHO), the following terms are distinguished:

• menopause is the last spontaneous menstruation, the so-called starting point, which can be discussed if menstruation is absent for more than a year;
• pre-menopause — the period from the onset of “failures” of the menstrual cycle to the onset of menopause;
• perimenopause – period of menstrual irregularities preceding the cessation of the cycle and lasting one more year after the last menstruation;
• post-menopause – period after menopause.

When can menopause be considered early

If a woman under 40 years of age has not had a period for at least four months and her hormonal levels have changed significantly, this can be regarded as a sign of premature menopause. In this case, ovulation no longer occurs and the level of estrogen hormones begins to decline rapidly. At the same time, the levels of other hormones, such as FSH (a hormone that stimulates the growth of follicles) and LH (luteinizing hormone that stimulates the production of progesterone), are determined above normal.

Early menopause is also called “primary ovarian failure” or “premature ovarian failure” (POF). These terms indicate the stoppage of ovarian function, the absence of growing follicles and therefore the absence of ovulation, making pregnancy impossible.

A doctor can confirm early menopause with a blood test.

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What are the causes of early menopause?

1. Natural early menopause

At birth, every woman has an individual ovarian reserve of 1 million to 2 million eggs. This number decreases throughout life, and by the time of menopause, about 1 thousand eggs remain. If there are not enough of them, the menstrual cycle stops. Early menopause can occur due to the depletion of egg reserves at a young age.

2. Chromosomal abnormalities

In some chromosomal abnormalities, such as Turner syndrome or Fragile X Syndrome, the egg reserve may also be reduced from birth.

3. Genetic features

The cause may also be genetic, and therefore premature menopause may be hereditary. For example, if the mother had an early menopause, then the chances of a similar development of events increase in the daughter. Abnormalities in the structure of the X chromosome can cause the ovaries to stop producing estrogen earlier.

4. Endometriosis

Endometriosis (or an overgrowth of the lining of the uterus) can also be a cause of early menopause.

5. Ovary removal

This surgery causes immediate and consequently early menopause.

6. Thyroid dysfunctions

Sometimes early menopause is associated with autoimmune thyroid disease.

“There are a number of factors that can provoke and hasten the onset of early menopause. First, it’s genetics. If we talk about other risk factors, then menopause can be brought closer by smoking (including past experience), low body weight, excessive exercise and the absence of a sexual partner.

Tatyana Petrovna Zefirova Menopause expert

What are the symptoms of approaching menopause?

The symptom complex can be very wide. It is wrong to focus only on the cessation of menstruation. Many of the events associated with menopause occur even before the end of the cycle. As a result, most often women do not associate this with the approaching menopause at all.

The following symptoms should alert you.

• Dry mucous membranes – and not only dryness of the vaginal mucosa and associated pain during intimacy. This is also dry mouth, dry eyes.
• Cracking and pain in the joints, especially if there were no such symptoms before, but then suddenly they appeared. All this is due to a decrease in the synthesis of the hormone estrogen, which is involved in the synthesis of collagen, which is so important for the health of the musculoskeletal system.
• Nighttime urge to urinate.
• Urinary incontinence. At first, it often happens in everyday situations: a few drops leak during laughter, sneezing, coughing or jumping – that is, with any increase in intra-abdominal pressure.
• Gain in weight and volume of the body. When nutrition did not change significantly, but after 38–40 years, there was a tendency to gain weight.
• An increase in blood pressure that has never bothered me before.
• Decreased sex drive (libido), especially with weight gain.
• Decreased motivation, ease of climbing and the appearance of unusual laziness.

In addition to the above symptoms, there are a few more common symptoms that make it clear that menopause is fast approaching.

1. Loop failure

Irregular menstruation, which may vary in duration and be more or less profuse than usual. During premenopause, bleeding is normal. However, during perimenopause, women are more likely to have irregular discharges, either lighter or heavier, earlier or later than usual. During this period, women may also experience brownish discharge.

2. Hot flashes and night sweats

About 80% of women suffer from hot flashes and night sweats. Hot flushes are irritating hot flashes that rise from the chest to the face. They are often accompanied by redness, increased heart rate, and excessive sweating. Chills may follow after a severe attack of heat. Hot flashes can occur up to 30 times a day and last for several minutes.

Why is this happening? A certain part of the brain regulates temperature, and the hormone estrogen has a big influence on this. When the level of estrogen in the blood decreases, the work of the thermoregulatory center of the brain is disturbed. As a result, this internal “thermostat” receives an erroneous signal from time to time that the body is “too hot”.

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This means that the body temperature should rise only slightly, for example due to a cup of coffee, stress or emotional events – while the body reacts as if its temperature is too high. The blood vessels in the skin then dilate to bring more blood to the skin. For this reason, you start to sweat: in fact, in this way the body tries to get rid of excess heat.

3. Mood swings

Mood swings are caused by hormonal imbalances. The body begins to produce less and less “hormones of happiness”, such as serotonin and endorphin. This can make a woman restless, irritable, gloomy, provoke depression.

Even if you are under 40, but you observe all these signals and notice something not quite typical from the side of health, this is a reason to visit an endocrinologist and a gynecologist.

How to get rid of the discomfort of early menopause?

This diagnosis can be difficult to accept and psychologically and emotionally difficult to bear. Therefore, it is very important to be able to talk about it – and increase the level of literacy about how to prolong the quality of life if early menopause does occur. After all, there are still many years of life ahead, and it would be a crime to spend these years dissatisfied with oneself, with a feeling of inner trouble and poor health.

In the case of menopause, we are not talking about a cure, because it is not a disease, but a natural process. However, the symptoms associated with it can cause discomfort and take away the zest for life. To reduce their negative impact on the quality of life, you should first contact a specialist. Your doctor will be able to check if you have indeed entered menopause by taking a blood test.

“If there are no unpleasant symptoms, such as hot flashes, sleep disturbance or decreased performance, then it is enough to undergo an annual medical examination. It does not require any special analysis. If a woman older than 40 is at risk of premature menopause, her doctor may be able to suggest the right medications to reduce her symptoms and support her health. For women themselves, the main thing is to pay attention to risk factors and their prevention, as well as to monitor the appearance of characteristic symptoms, in the presence of which you should immediately contact a specialist.”

Tatyana Petrovna Zefirova Menopause expert

What strategy to follow to keep the beauty and vitality when the menopause came ahead of time?

1. Healthy lifestyle

A very important point for all its obviousness. Enough physical activity, quitting smoking, moderate consumption of alcohol, salt and unhealthy fats will be of great help in maintaining youth, activity and strong self-esteem.

2. Vitamin D intake

Decreased estrogen production is associated with a higher risk of osteoporosis. Therefore, women with early menopause are advised to maintain adequate levels of vitamin D, in particular by taking supplements such as Calcium-D3-Nycomed.

3. Hormone replacement therapy

When you are in menopause, your doctor may prescribe medications to relieve your discomfort. As a rule, these are hormonal drugs that mimic the production of estrogen. This is called “hormone replacement therapy” (HRT).

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Medicines containing hormones are available only on prescription, as they can only be used after consultation with a specialist. In addition, women who are or have been treated with hormonal or chemotherapy are advised not to use hormones to relieve menopausal symptoms. This is because hormones can interact with the therapy being taken, which can reduce the effectiveness of the treatment.

However, there are also safe alternatives to relieve menopausal symptoms through a non-hormonal mechanism of action, such as natural dietary supplements.

4. Non-hormonal natural supplementation

Mabelle is a natural herbal complex to support the health of women during menopause. It is a non-hormonal product based on a combination of flax flavolignans and red clover isoflavones, whose mechanism of action is well understood. These herbal extracts are, in fact, natural phytoestrogens that have a beneficial effect on a woman’s hormonal background and help make the menopause easier and calmer. Together, they help maintain hormonal balance. As a result, the Mabelle complex will help preserve and increase female beauty and vitality, despite all the difficulties of the menopause period.

It is precisely because of the absence of hormonal effects that Mabelle can be safely combined with various medications, as well as not to be afraid of gaining excess weight.

Duration of admission – one month. If necessary, the course can be repeated. The Mabelle complex is suitable for long-term use. But remember: safety is paramount – be sure to consult with a specialist first.

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symptoms, diagnostics and treatment at the Scientific and Clinical Center of Russian Railways, with a branch of the Central Clinical Hospital No.

1

What is menopause? Translated from Greek – a rung of a ladder. Indeed, menopause is just the beginning of another stage in a woman’s life, when a third of her life is still ahead. The entire transitional period before menopause, when cycle disorders begin (from delays to shortening of the cycle), the first menopausal complaints occur, and several years after menopause, when there is a serious restructuring of the body, is called menopause. And I want to live this stage of life in a quality, healthy way, without being distracted by sores and feeling unwell. Is climax a staircase up or down? The solution to this issue is in your hands.

What is menopause?

This is the last menstruation of a woman’s life. Menopause is set retrospectively one year after the last menstruation.

The average age of menopause is 51 years: by this age, the supply of eggs in the ovaries is completely depleted, and the synthesis of female sex hormones, estrogen, stops. Normally, the phenomena of the beginning of the transition period begin after 45 years, this is considered timely. If menopause occurs at 40-45 years old, they talk about early menopause. If at 37-40 years old – this is premature menopause. If the function of the ovaries is turned off before the age of 37, they speak of premature ovarian failure.

Age of menopause is genetically programmed. If the mother and female relatives had an early menopause, their daughter will almost certainly share their fate. It is impossible to stop or slow down the internal biological clock. To date, no means have been found that can prevent inherited insufficient ovarian activity. Gynecological operations, severe and prolonged stress, infectious diseases during puberty can bring the onset of menopause closer. Menopause can begin earlier with severe illness, exhaustion. The onset of menopause is caused by the removal of the ovaries or their dysfunction due to radiation or chemotherapy. It is believed that menopause occurs 1-3 years faster in women who smoke a lot. The number of pregnancies and childbirth does not affect the age at which menopause occurs.

Also, the onset of menopause means a pronounced decrease in the ability to conceive. But since spontaneous bursts of ovarian hormonal activity are still possible, pregnancy is still possible. Therefore, contraception can be canceled only two years after the last menstruation. Unexpected pregnancies in women 45-50 years old are not uncommon. A hormonal blood test can most likely tell about a woman’s ability to conceive. The main indicator that the doctor evaluates is the level of anti-Müllerian hormone, which reflects the supply of eggs.

Estrogen receptors are found not only in the reproductive organs (uterus, ovaries, cervix, vaginal mucosa), but also in the heart and blood vessels, bones, nervous system, skin, bladder and urethra, and many others. That is why the symptoms of menopause, that is, the symptoms of estrogen deficiency, are not limited to hot flashes and sweating, mood swings and sleep disturbance. And only with these complaints the patients address.

Climacteric symptoms :

For some reason it is believed that these are just unbearably annoying vegetative and emotional complaints (hot flashes, sweating, tearfulness, mood swings, sleep disturbances). Attacks of sudden sweating are associated with dysregulation of vascular tone and body temperature due to changes in the hormonal balance in a woman. They often occur at night (night sweats) and can lead to sleep disturbances. In the daytime, a number of factors can provoke the development of hot flashes and sweating: drinking coffee and, in general, drinking hot foods and drinks, drinking alcohol, situations of mental stress, and much more.

Since there is not enough estrogen during menopause, the most effective protection against hot flashes and sweating during menopause is to restore hormonal balance in the body through menopausal hormone therapy (MHT). You need to give the body what it lacks. You can, of course, use both herbal preparations and dietary supplements, but only the effectiveness of MHT reaches 90-95%, alternative means – no more than 40-50%, and herbal preparations – 20-30%, less than placebo. But is menopause only scary with hot flashes?

Deficiency of estrogen in the central nervous system causes depression, so characteristic of this age. Also, depression is aggravated by a change in social role – children have grown up and do not require constant care, etc. Characteristically, memory loss, difficulty concentrating and concentrating. After menopause, the risk of Alzheimer’s disease increases dramatically.

A decrease in the amount of estrogens during menopause gives rise to the development of atherosclerosis, since the female hormone estrogen prevents the deposition of cholesterol on the walls of blood vessels. According to statistics, myocardial infarction in women under 40 is 10 times less common than in men, and at 60 these figures are already the same. Estrogens have an anti-atherosclerotic effect, protect against cardiovascular pathology

Bone density and bone strength begin to decline, postmenopausal osteoporosis develops, fractures occur with minimal trauma (see Postmenopausal Osteoporosis – link).

Estrogen deficiency causes a decrease in the trophism of the vaginal mucosa: dryness in the vagina, itching and burning due to an imbalance in the vaginal flora, the impossibility of sexual intercourse due to severe soreness and vulnerability of the mucous membranes.

Atrophy of the urethra and decreased tone of the pelvic muscles is the cause of urinary disorders (urinary incontinence with stress or urgency), frequent cystitis occurs (see section Urinary incontinence in women – link).

Appearance is also a problem. Due to the lack of estrogen, the skin becomes thinner and dryer. As a result, the face “acquires” new wrinkles, an unhealthy color. The skin loses elasticity, acquiring the appearance of a shriveled apple, the chest sags, hair thins, psychological balance is disturbed, despondency and depression are increasingly coming. The body loses silkiness, elasticity. In general, the metabolism slows down, so women after menopause begin to gain weight dramatically. Of course, they do not follow a diet, they do not move much – although not one of them admits this, first of all to herself. The important thing is that the redistribution of fat begins, it begins to accumulate not on the buttocks, as in youth, but on the stomach. The so-called abdominal obesity is formed. In addition to a cosmetic defect, this type of obesity is a serious health risk (see section Obesity. For abdominal fat is the most active endocrine organ in our body! Not only sex hormones are synthesized in it, which is why unwanted hair grows on the face, along the white line of the abdomen, on the thighs and other hormone-dependent areas, uterine bleeding occurs due to uncontrolled growth of the mucosa, the risk of mammary gland pathology increases.A huge amount of pro-inflammatory factors, cytokines, growth factors, etc. are also produced there, which increases the risk of cardiovascular diseases and serves as the basis for a serious violation metabolism up to diabetes.What the body forgave at 20 years old – irregular, unbalanced diet, sleepless nights, lack of physical activity, frivolous attitude to preventive examinations – becomes categorically unacceptable after forty years!0003

Diagnosis and treatment:

All of the above is a consequence of the shutdown of ovarian function, the cessation of estrogen synthesis. Therefore, it is absolutely logical to prescribe hormone replacement therapy with preparations of natural sex hormones in low doses. The treatment is to replace your own hormones with identical ones that your ovaries produce. In fact, these drugs “deceive” the body. He receives the hormones he lacks in just the amount so as not to be “outraged”, but in much less than what was produced by the ovaries. Therefore, the process of restructuring does not slow down, but goes smoothly and almost painlessly.

Unfortunately, hormone therapy causes absolutely unreasonable fear and horror in our compatriots. The history of hormone therapy began in 1940. As you can see, the world did not choke on fat and bearded women, and cancers did not cause the extinction of the beautiful half of humanity.

To date, the safety of taking MHT for 5-7 years has been absolutely proven when MHT is first administered to a woman under 60 years of age who has not gone through menopause for more than 10 years. During this period, all age-related processes still continue, only they are not noticeable to a woman, do not violate her quality of life. And thanks to the protective preventive effect, the health of a woman improves in comparison with her peers who do not take MHT. And they look better – slender, without wrinkles, and feel younger – sleep well, enjoy life, are not chronic patients of a huge number of doctors.

If menopause is early and premature, then for the prevention of diseases of old age, MHT is prescribed immediately and at least up to 50 years. In this case, the benefits far outweigh the risks. Otherwise, if menopause occurs, for example, at the age of 38, by the age of 50 a woman may face sores of patients over 70 …

But we must remember that this is not an elixir of youth, not a panacea. MHT has indications and contraindications, it is not prescribed for everyone.

In addition, MHT is prescribed only by a doctor after a mandatory preliminary examination, taking into account indications and contraindications. Self-activity in the appointment of the drug MHT is fraught with serious consequences.

So, it is absolutely proven that MHT is unsurpassed in the relief of hot flashes and other vegetative complaints, is an effective prevention of osteoporosis, urinary incontinence problems and sexual disorders, Alzheimer’s disease and dementia, obesity and diabetes mellitus, cardiovascular diseases, helps to reduce the severity of arterial hypertension and the number of drugs to normalize blood pressure.

Before prescribing MHT, it is necessary to undergo an examination to clarify the indications and exclude contraindications:

• Pelvic ultrasound with vaginal probe
• Ultrasound of the thyroid gland and abdominal organs according to indications
• Mammography
• Pap smears from the cervix
• Blood chemistry plus lipid profile as indicated
• Hemostasiogram or coagulogram according to indications
• Densitometry according to indications
• Hormonal profile (FSH, estradiol, prolactin, TSH, free T4, AT-TPO, testosterone) according to indications
• Blood pressure measurement
• Physician consultation according to indications

It is obligatory to take into account concomitant and past diseases, data from extracts from previous hospitalizations.

While taking MHT, the patient should visit a gynecologist-endocrinologist at least once a year for a consultation and undergo an annual examination to clarify the state of health and re-assess the risks.

Many people think that after menopause there is no need to visit a gynecologist. It is not right. It is women of the 5th-6th decades who have an increased risk of such diseases as osteoporosis, atherosclerosis, various tumor diseases, which at first are asymptomatic and are detected only during a special examination. So, hormone replacement therapy before and after the onset of menopause minimizes such risks. And this means that a woman does not turn into a regular patient of the local clinic, but for many years she retains physical strength, mental alertness, and natural beauty.

You can stop MHT and turn to alternative methods. Phytopreparations relieve such unpleasant symptoms of menopause as hot flashes, sleep disturbance, headaches, frequent mood swings, excessive sweating, but are not able to protect against age-related changes in the cardiovascular system, bones, lower urinary tract, skin and nervous system.