Menopause is a time in every woman’s life when there is a gradual loss of fertility due to the extinction of hormonal function of the ovaries. Although menopause is diagnosed when a woman has not had a period for 12 months, the first symptoms of menopause appear much earlier.

The most recognizable symptom of female menopause is the onset of the last menstrual period. However, before a woman stops menstruating, her body gradually prepares for the arrival of menopause by sending a series of annoying signals, such as chronic fatigue, sleep problems, hot flashes, heavy sweats, palpitations, and menstrual cycle disorders.

This period is perimenopause, also known as premenopause.

What is perimenopause?

Menopause is a process that takes place in several stages. There are 3 stages of menopause:

  1. perimenopause
  2. menopause proper
  3. postmenopause

The first stage of menopause is perimenopause. During this perimenopausal period of several years, women increasingly develop menstrual disorders.

In a woman in perimenopause, irregular menstrual periods can be mainly observed, as well as shortening or lengthening of menstrual cycles. Short cycles are those that are about 21 days long and sometimes even less, while longer menstrual cycles last more than 35 days.

These cycles are anovulatory – the Graaf’s follicle no longer matures in the ovary, because it is simply not there. More or less heavy periods follow – it depends on what the patient’s estrogen level is.

The moment when periods, and therefore cycles, become irregular is called luteal insufficiency. During this period, getting pregnant is no longer possible.

How to recognize the first symptoms of menopause?

The first symptoms of menopause appear as early as the perimenopausal period. Therefore, in addition to menstrual disorders, a perimenopausal woman may notice other troublesome symptoms in herself.

The earliest and most common symptoms associated with menopause are hot flashes and excessive sweating, which locate primarily on the face.

Other characteristic symptoms of menopause include: sleep disorders, especially insomnia, and mood volatility, known as emotional lability. During this period, women may also experience:

  • Weight gain despite no change in diet,
  • a general feeling of fatigue,
  • hair loss,
  • decrease in libido,
  • urinary incontinence.

Of course, every woman experiences the nagging symptoms of menopause on an individual basis. Some women go through menopause more mildly, while others experience these symptoms in significant intensity. Many women observe only some of the symptoms of menopause in themselves.

All of these symptoms are associated with a drop in estrogen and progesterone levels in a woman’s body.

How long does perimenopause last and when does menopause occur?

Perimenopause can occur even several years before the onset of the last bleeding. Most often, menopause occurs 2-3 years after perimenopause, statistically between the ages of 45 and 55.

However, this is an individual issue.

Long-term risks of menopause

It is important to remember that menopause is not just a temporary period associated with a drop in hormone levels, causing, among other things: hot flashes, brain fog or mood swings.

Menopause is also associated with a number of long-term risks, such as:

  • osteoporosis,
  • heart disease,
  • skin changes,
  • vaginal atrophy (vaginal dryness, pain during sexual intercourse, discharge, discomfort and possibility of urinary tract infections),
  • increase in LDL cholesterol.

These and other menopause-related problems can be remedied by implementing hormone replacement therapy (HTZ).

Benefits of taking hormone replacement therapy (HTZ)

During the menopausal period, it is recommended to start hormone replacement therapy as soon as possible for patients who do not have contraindications to it. Why?

With the help of hormone replacement therapy, we can significantly reduce the risk of developing hypertension. Estrogens delivered as part of the therapy slows down the stiffening of the arteries, as they help to produce additional nitric oxide in the blood vessels, which causes them to remain flexible and dilate.

With the prompt inclusion of hormone therapy for menopause, we are able to delay and even completely eliminate all neurodegenerative and dementia diseases.

Is hormone replacement therapy safe?

There is a perception among various patients that hormonal menopausal therapy can be dangerous. Many women express concern that HTZ may delay their menopause, or make menopause appear immediately after discontinuing hormone therapy.

Hormone therapy for menopause, is the newest menopause treatment available on the market. It is safe because it has the estrogen estradiol valerate, a substance similar to estrogen produced by the female body.

So this is a safe therapy.

Unfortunately, from the 1990s to the present day, there has been a stereotype that HTZ can be dangerous, which is due to the fact that estrogen for hormone replacement therapy used to be extracted in very high doses from the urine of pregnant mares. At the time, the therapy also contained the “old” gestagen, medroxyprogesterone, which caused thromboembolic complications in many people.

Of course, it should be borne in mind that with hormone replacement therapy such complications can still occur, but today it is not common. In addition, the risk of thromboembolic complications can be lowered by drinking enough fluids and being physically active.

Can hormone replacement therapy be implemented in every menopausal patient?

No, contraindications to implementing HTZ include:

  • active or past embolic-thrombotic disease,
  • estrogen-dependent tumors,
  • condition after myocardial infarction,
  • severe heart failure,
  • liver failure,
  • elevated liver enzymes,
  • jaundice,
  • stroke.

The role of antidepressants in the treatment of menopausal symptoms

Antidepressant therapy can be helpful for those menopausal patients who struggle with lowered mood, emotional lability or difficulty sleeping.

The goal of implementing antidepressant treatment is for a woman to feel the benefit of HTZ treatment, so it is beneficial to include an antidepressant at the beginning of therapy.

Antidepressants, most commonly escitalopram, are given for 6-9 months until the hormones given as part of HTZ normalize. Once hormone levels normalize and the patient feels well, the drug is discontinued.

On the other hand, such therapy is not advisable for every menopausal woman, and the judgment about implementing such treatment depends on the doctor and the well-being of the patient.

Diet modification during menopause

First of all, during menopause, a proper dietary style is key. This may involve modifying the diet we have had up to now. Why?

During menopause, a woman’s metabolism slows down by approximately 25%. Therefore, if the patient continues to eat the same amount of calories, she will unfortunately gain weight, and hormone replacement therapy alone will not stop this process.

Ladies going through menopause should therefore choose products that have a lower glycemic index and more fiber. This will make them feel like they have eaten more than they have actually consumed. In this way, they will provide themselves with the right amount of calories, i.e. reduced compared to how they used to eat, while maintaining the feeling of satiety.

Physical activity during menopause

One way to improve well-being during the menopausal period is physical activity. Women in this period are advised to do gymnastics, walking, yoga, swimming pool, actually any form of activity that the patient prefers.

To improve their well-being, menopausal women should also remember to exercise their minds – solve all kinds of crosswords, sudoku, puzzles.

During this difficult time, it is extremely important to constantly engage the nervous system to work.

Supplementation during menopause

A very important risk that menopause brings is osteroporosis. Therefore, it is important to supplement vitamin D, calcium and magnesium in the perimenopausal period itself.

Women at this time can additionally support themselves with a variety of remedies based on red clover or soybean extract, available in pharmacies without a prescription. However, these remedies are of such low concentrations that they will not provide significant relief from the symptoms and course of menopause, but only support the HTZ therapy implemented.

Ladies who continue to experience persistent menopausal symptoms, including a decrease in libido, despite taking HTZ, should see a doctor in charge of the therapy. It may be necessary to assist with testosterone gel, which is applied by lubricating the forearm with it. However, this is an off-label therapy (beyond the indications shown on the leaflet), but recommended for weakened libido and routinely used.

In our Lumedic Medical Center the treatment of perimenopause is in charge of dr. Anna Wójcikiewicz