Menopause: Information & specialists for the menopause

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

Menopausal symptoms are disease-like symptoms that women suffer from when their hormone balance changes. Menopausal symptoms can have a major impact on a woman's attitude to life and general mood. The treatment and alleviation of menopausal symptoms has therefore become increasingly important for doctors and their patients in recent decades. Here you will find further information as well as selected specialists and centers for the menopause.

ICD codes for this diseases: N95

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Article overview

Menopausal symptoms: Definition

The climacteric, as the menopause is known in specialist jargon, usually occurs in mid-life. The menopause is divided into three stages:

  1. The period before the last menstrual period is the perimenopause. It announces itself with cycle disorders (shortening of the cycle, irregular bleeding intervals) and begins on average at 47.5 years of age.
  2. On average, women enter the menopause at around 52 years of age. This term refers to the last menstrual period in a woman's life.
  3. The phase after the menopause is the postmenopause.

The time before the menopause is also known as the premenopause. The ovaries are already producing fewer hormones during this phase, which can also lead to cycle irregularities.

The ratio between the female sex hormones oestrogen and progesterone (a gestagen) and the male sex hormone testosterone changes: initially, less progesterone is produced. In the pre- and perimenopause, there is therefore an oestrogen dominance in relation to progesterone, i.e. a relative excess of oestrogen.

Less oestrogen is produced with a time delay. This is reflected in an absolute oestrogen deficiency during the advanced peri- and postmenopause.

Eventually, the production of female hormones stops completely, resulting in the absence of the menstrual cycle and menstruation. The production of male hormones, on the other hand, only gradually decreases.

Ältere körperbewusste Frauen
During the menopause, the body and well-being change © oneinchpunch | AdobeStock

Nine out of ten menopausal women suffer from one or more symptoms during this hormonal change. These are perceived as disturbing, unfamiliar and restrictive. This can also lead to psychological symptoms.

The menopause is a period of hormonal change. It is perceived by those affected as a stressful time in which they experience a variety of problems with their own body.

The symptoms of menopausal symptoms are complex. It is related to the relative and absolute hormone concentrations during the different phases of the menopause.

First signs of menopausal symptoms

Those who enter the menopause are usually initially surprised by irregularities in their cycle. Periods are shorter or longer than usual and bleeding is often heavier.

The oestrogen dominance can also result in a feeling of tightness in the breasts and lower abdominal pain. Sometimes these observations are accompanied by increased dryness of the mucous membranes.

However, depending on the individual case, it can also happen that the onset of the menopause is not announced, but occurs suddenly and unexpectedly.

Physical symptoms - hot flushes and co

The term hot flushes is inextricably linked to the menopause. A large majority of menopausal women report regular hot flushes.

These are outbreaks of extreme heat sensations. They often spread from the head over the entire body and usually only last a few minutes. They are often associated with increased palpitations. Occasionally the sensation of heat is so strong that the body begins to produce sweat.

The hot flushes also put those affected under stress, for example when the symptoms occur in public.

After the menopause, the hot flushes gradually subside, although for some women they never stop completely. On average, however, hot flushes last for 5.2 years.

Ältere Frau mit Fächer bei Hitzewallung
Hot flushes are a typical symptom of the menopause © missty | AdobeStock

A disturbed sleep rhythm is also typical of the menopause. It is more difficult to fall asleep, night sleep is restless and the waking phases are long at night. The feeling of tiredness and lack of energy in the morning is correspondingly pronounced.

The lack of sleep and lack of restful sleep also contributes to

  • fatigue,
  • a decrease in performance and
  • feelings of exhaustion

are also counted among the symptoms of the menopause. Whether these symptoms are triggered by hormonal fluctuations or are the result of disturbed sleep patterns has not been conclusively clarified in medical circles. However, it is undisputed that the symptoms occur and cause discomfort.

Due to the lack of oestrogen, the mucous membranes are less well supplied with blood. This manifests itself in a dryness of the mucous membranes in the area of

  • the vagina
  • the urethra and
  • bladder.

The altered mucus composition can lead to more frequent urinary tract infections and vaginal infections with fungi and bacteria.

The dryness of the vaginal mucosa can also result in sexual intercourse being perceived as very painful. Water-based lubricants, which can be bought in any pharmacy, can help here.

In extreme cases, an increased urge to urinate can lead to temporary incontinence.

The hormone deficiency also increases the risk of

  • osteoporosis,
  • joint and bone problems and
  • cardiovascular diseases

increase. Weight gain is also not uncommon.

Psychological symptoms of menopausal symptoms

The menopause is an exhausting process that also affects the psychological constitution. The period before and after the menopause is often a period of psychological stress for those affected.

Due to the

  • often chronic feeling of exhaustion,
  • the various sensations of pain and
  • struggling with their own self-image

the menopause induces negative moods, which in many cases can lead to depression.

The nagging concerns and hormonal irregularities lead to

  • increased irritability,
  • mood swings and
  • nervousness

which in some cases make social contacts more difficult.

What to do about menopausal symptoms?

The first point of contact for menopausal problems is your gynecologist. They are very familiar with the particularities of the female hormone balance.

Hormone replacement therapy (HRT) has advantages and disadvantages

One way of alleviating the symptoms of the menopause is hormone replacement therapy, also known as HRT, but this therapy interferes with the hormone balance. It should therefore not be used without medical necessity and consideration of the advantages and disadvantages.

The current guidelines of the most important German and Swiss gynecological societies recommend that healthy women with a uterus undergo HRT for the treatment of menopausal symptoms over a period of three to five years if medically necessary. The treatment can also last longer, but the dosage should always be as low as possible.

According to the guidelines mentioned, hormone replacement therapy has positive effects on

  • Hot flushes,
  • vaginal dryness,
  • sleep disorders,
  • depressive moods,
  • reduced performance and memory as well as
  • bone and joint problems.

The authors also believe that HRT reduces the risk of some diseases, including

Hormonersatztherapie in den Wechseljahren
Hormone replacement therapy can significantly reduce the symptoms of the menopause © RFBSIP | AdobeStock

The increased risk of breast cancer and vascular occlusion is considered to be low. However, it is also emphasized that it should be checked annually whether hormone therapy is still necessary at all. Women over the age of 60 should not receive HRT.

The US Preventive Services Task Force (USPSTF) takes a slightly different view. It also recommends HRT for the short-term treatment of menopausal symptoms and describes it as safe in this application.

In its current recommendations, however, it rejects the administration of hormone preparations after the menopause for the prevention of disease. The disadvantages - such as an increased risk of, among other things

  • invasive breast cancer (particularly malignant form of breast cancer),
  • venous vascular occlusion (thromboembolism)

would outweigh the benefits.

Hormone replacement therapy should therefore always be used with caution and with restraint. The gynecologist will decide together with the patient

  • whether hormone replacement therapy is medically indicated and
  • whether the benefits outweigh the potential risks.

Implementation of hormone replacement therapy

Hormone replacement therapy is not subject to a fixed regimen, but must be tailored to the hormonal characteristics of each woman. For this reason, when planning HRT, affected women should provide their gynaecologist with all relevant information

on the course of the cycle and

any special features

any special features. This is the only way to find the right level of treatment. For example, symptoms are treated differently in women who have had breast cancer or a hysterectomy.

As part of HRT, the body's own hormones are usually administered as part of a combination therapy. The hormones oestrogen and gestagens are combined.

In this way, the symptoms of the menopause can be effectively contained. Those affected feel less or even none of the hormonal processes in their own body.

Hormone preparations are available in many different forms. They are available as

  • tablets,
  • creams,
  • suppositories,
  • patches or
  • injections

administered. The German-Swiss associations recommend the use of creams.

Herbal remedies for menopausal symptoms

Herbal remedies such as monk's pepper or black cohosh are available as an alternative to HRT medication. Valerian helps against sleep disorders.

However, the benefits of herbal preparations have not been scientifically proven.

Hot flushes can also be treated with special serotonin reuptake inhibitors. Here too, as with herbal medicines, the long-term risks are as yet unknown.

Depending on the symptoms, other preparations may be considered for the acute treatment of symptoms.

Mönchspfeffer als Heilkraut
Medicinal herbs such as monk's pepper are said to have a soothing effect on menopausal symptoms © fgsmiles | AdobeStock

Change of lifestyle

Lifestyle changes, such as

  • more exercise,
  • conscious nutrition and
  • abstaining from smoking

reduces the risk of developing hormone deficiency-related diseases such as

Light clothing, a cold washcloth or a cool pack on the neck or forehead can make hot flushes more bearable. Women who suffer from sleep disorders should avoid caffeinated drinks in the afternoon and have dinner a little earlier.

With the right therapeutic approach, it is possible to reduce menopausal symptoms to a very bearable level.

References

  • aerzteblatt.de (2017) Kein sicheres „Timing“: US-Leitlinie lehnt Hormone zur Krankheitsprävention nach der Menopause weiter ab. Ärzteblatt vom 13. Dezember 2017
  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, Berufsverband der Frauenärzte, Deutsche Menopause Gesellschaft et al. (2015) Anwendungsempfehlungen zur Hormonsubstitution in Klimakterium und Postmenopause. Aktualisierte gemeinsame Empfehlungen. Frauenarzt 56(8): 657-660
  • Krebsinformationsdienst (2016) Hormone und Krebsrisiko. Für gesunde Frauen: Was tun gegen Beschwerden in den Wechseljahren? Deutsches Krebsforschungszentrum. https://www.krebsinformationsdienst.de/vorbeugung/risiken/hormonersatztherapie1/
  • NICE guideline (2015) Menopause: diagnosis and management. NICE, nice.org.uk/guidance/ng23
  • US Preventive Services Task Force (2017) Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal WomenUS Preventive Services Task Force Recommendation Statement. JAMA 318(22):2224-2233. doi:10.1001/jama.2017.18261
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