What is menopause? What are the symptoms of menopause?

What is menopause? What are the symptoms of menopause?

Menopause is a period of life just like infancy, adolescence and sexual maturity. During the menopause period, the amount of follicles in the ovaries decreases and accordingly, estrogen production decreases. Over time, estrogen production stops and the ovaries shrink. As a result, the menstrual cycle is interrupted and the ability to reproduce is lost. The word menopause is derived from the Greek words mens (ay) and pause (to stand). The World Health Organization defines menopause as a permanent cessation of the menstrual cycle as a result of the ovaries losing their activity. The age of menopause is 45-55 years worldwide.

The menopause period is divided into three periods according to the classification of the World Health Organization:

  • Premenopause : It covers the period from the first symptoms to menopause. Follicle activity slows down in the ovaries. Pieces become irregular. This process can take several months or years. 
  • Menopause : The last menstrual bleeding is seen. 
  • Postmenopause : It covers 6-8 years from menopause to old age. In order for a woman to have postmenopause, she must not have a period for 12 months. 

Menopause is also classified according to the form of occurrence:

  • Natural menopause
  • Premature menopause: Menopause that occurs before the age of 45 is called premature menopause. Uncertain causes may occur due to reasons such as autoimmune diseases, radiotherapy, chemotherapy, infections, environmental causes, abortions and miscarriages, frequent pregnancy, obesity, and hypothyroidism. 
  • Surgical menopause: Some operations can lead to premature menopause. If a woman’s ovaries are surgically removed, menstruation stops and menopause develops. Radiation treatments can lead to menopause. Ovarian function losses seen during cancer chemotherapy are reversible.

What are the factors affecting menopause?

  • Genetic factors: It is observed that women in a family generally go through menopause at similar ages.
  • Genital factors: It has been observed that women who have irregular menstruation enter menopause earlier than those who have regular menstruation. Other than that, fertility status, first menstrual age, use of birth control pills, breastfeeding for more than two years may affect the age of menopause. 
  • Psychological factors: Psychological traumas accelerate the development of menopause. It has been observed that war, migration, earthquake and prolonged prison life triggered early menopause.
  • Physical and environmental factors: Menopause age is earlier for women living in cold climates and extreme conditions. 
  • Smoking: Women who smoke heavily enter menopause 1-2 years earlier than non-smokers.
  • General health status: Severe metabolic diseases, genetic disorders, infectious diseases, chemotherapy and radiotherapy can affect the age of menopause. 
  • Social factors: Menopause may be early in rural and traditional societies. 

What are the premenopausal period disorders?

  • Menstrual irregularities
  • Decrease in ovulation
  • Hot flashes
  • Excessive sweating
  • Depressed mood
  • Inability to sleep
  • Nervousness, nervousness
  • Increased appetite
  • Difficulty concentrating
  • Percentage blushing
  • Increased heart rate
  • Headache, dizziness;
  • Hot flushes
  • Low self-esteem
  • Forgetfulness
  • Carelessness
  • Tiredness
  • Decreased sexual desire

What are the symptoms seen after menopause?

  • Symptoms seen in premenopause continue.
  • After a long-term estrogen deficiency, atrophy, or shrinkage, is observed in the genital organs. Shrinkage occurs in the uterus, vagina and vulva and urethra. Consequently, frequent urination, constipation, itching in the vulva, painful sexual intercourse, uterine prolapse, urinary incontinence, bladder sagging, rectal sagging may occur. 
  • There are estrogen receptors in the skin, hair follicles and sweat glands. After menopause, related changes occur. The skin becomes thinner, the amount of collagen decreases. The amount of hair and hair is reduced. The skin dries, loses its elasticity and wound healing is delayed. Thick hairs may appear on the chin, lips and chest. The amount of hair in the armpit and genital area decreases. 
  • During menopause, there may be dry mouth, bad taste in the mouth and gum diseases. Constipation and hemorrhoids are common. Reflux and gallstones are also common. 
  • The risk of developing heart disease in women increases with menopause. While estrogen is a hormone that reduces the risk of coronary heart diseases, the risk of coronary heart diseases increases with the decrease of estrogen with menopause. Cholesterol increases with menopause. High blood pressure may occur. Vascular stiffness is seen. 
  • Another major problem seen with menopause is osteoporosis. Osteoporosis invites fractures as a result of decreased bone mineral density. Menopausal women lose 3-4% of their bone mass each year. 
  • Fattening: After menopause, metabolic rate slows down and weight gain is seen in women.
  • Sexual reluctance arises.

How is menopause diagnosed?

Early diagnosis of menopause is important. Because most of the losses in menopause occur in the first year. Early diagnosis provides early treatment. Menopause can be diagnosed if FSH and LH hormones are increased in the blood taken on the third day of menstruation from a woman with infrequent menstruation, hot flashes and psychological disorders. If the FSH level is above 40 pg / ml in a woman with irregular menstruation, the diagnosis of menopause is definitely made. If the FSH level is between 25-40 pg / ml, it is thought that there is premenopause, and women in this period may get pregnant rarely. However, pregnancy and other diseases that cause irregular bleeding should be investigated and ultrasound should be performed in every woman with irregular bleeding. 

Sex life in menopause

Sex life does not end with menopause. Due to lack of estrogen, sexual organs shrink. Accordingly, pain may be felt during sexual intercourse. Oils are used to reduce pain. 

How should nutrition be in menopause?

  • Due to estrogen deficiency, metabolic rate slows down and rapid weight gain begins. 
  • 1500 mg of calcium should be taken daily to prevent osteoporosis. 
  • Vitamin E can prevent hot flashes and fatigue.
  • Vitamin D should be kept at a normal level. 
  • Salt intake should be restricted.
  • It is important to exercise regularly during menopause. 

Things to do in menopause

It is necessary to wear light and layers against hot flashes that are common during menopause. Thus, the clothes can be reduced in case of hot flashes. It is beneficial to reduce spices and caffeine and avoid smoking and alcohol. Soothing oils are used against painful sexual intercourse due to lack of estrogen. Regular sexual intercourse is necessary to prevent atrophy. It is important to pay attention to daily calcium intake and exercise regularly to prevent osteoporosis. If your physician deems appropriate, he can apply hormone replacement therapy.

What is hormone replacement therapy?

Hormone replacement therapy (HRT) is an estrogen replacement therapy. The patient is regularly given medications containing estrogen and progesterone. The aim of hormone therapy is to reduce the incidence of osteoporosis and cardiovascular diseases, which increase with menopause. Hormone therapy is also beneficial for symptoms such as hot flashes, sweating, palpitations and fatigue, which are common in some women. Hormone replacement therapy prevents bone loss due to menopause and increases bone mass. This reduces the risk of fractures. It reduces the risk of cardiovascular diseases. Treatment also has a positive effect on sexual life. Dry mouth, bad taste in the mouth and decrease in tooth decays. 

Who cannot receive hormone therapy?

  • Known and suspected uterine and breast cancer
  • Patients with undiagnosed abnormal bleeding
  • Have liver disease
  • Patients at risk of clotting
  • Obesity, varicose veins, hypertension, excessive smoking
  • Those who have had a heart attack
  • Hormone replacement therapy is not used in patients with cerebral vascular occlusion or stroke.
  • It should be used with caution in the presence of hypertension, diabetes, gallstones, hyperlipidemia, migraine and uterine fibroids. 

HRT can be used both by injection and orally. There are also those in the form of vaginal cream. Regular breast and uterine examination and bone measurement should be performed in patients receiving this treatment.