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A woman spends a third of her expected lifespan, almost half of her active life, without the cyclical function of the ovaries before and after her fertile age. Menopause (transition period) is expected around the age of 49-51. It is a natural, hormonal change, which is indicated by regular menstruation that is not followed by another within 12 months. The transition period is characterized by the gradual cessation of ovulation, the decreasing production of female hormones, and the resulting deficiency symptoms of follicular hormone (estrogen). Hormonal changes can begin individually, sometimes years before the last period, and/or can last for years afterwards. About a quarter of women do not feel any symptoms at all, while another quarter suffer from severe symptoms for years that severely affect their lifestyle, quality of life, work capacity, and sexual life. The majority of symptoms are mild and/or last for a shorter period.

Diagnosis, Examination, and Treatment of Menopause

Among the symptoms attributed to menopause (menopausal syndrome), hot flashes, night sweats, and vaginal dryness can be directly linked to the decrease in ovarian function and estrogen deficiency. However, heart palpitations, sleep disorders, mood swings, irritability, decreased mental abilities, osteoporosis, and small joint pains, decreased libido and sexual disorders, and urinary retention difficulties can also appear as symptoms of natural aging or diseases. During menopause, estrogen deficiency is not complete, there are measurable serum estrogen levels individually. This hormone can also be produced after the removal of the ovaries.

Menopause can occur

- unnaturally:

• after surgical removal of the ovaries
• following chemotherapy, radiation treatment

- earlier than usual:

• after uterus removal (with preserved ovaries)
• in the case of heavy smokers

- it can be temporary:

• due to starvation, intense physical, possibly psychological stress
• during prolonged stay in high mountains
• in autoimmune diseases

In addition, early exhaustion of the ovaries due to unknown reasons can also cause early menopause.

Menopausal Symptom Complex

As a result of changes in ovarian hormone levels, menstruations first come closer by a few days, then farther apart. The nature and quantity of bleeding change, then menopause occurs. At this time, the level of estrogen in the bloodstream decreases dramatically and the symptoms are the strongest:

• hot flashes with sweating become more frequent
• sensation of heart palpitations
• night sweats

Other individually varying symptoms appear:

• sleep disorders
• daytime fatigue
• increased anxiety
• mood swings
• vaginal dryness
• pain during sexual activity, colored discharge, minor bleeding
• frequent urge to urinate
• small joint pain
• bone loss (1% each year after menopause)

The symptoms appear in an extremely varied form, or they may not appear at all. Their duration, even if with decreasing intensity, can be up to 8-10 years in a significant proportion of women. Menopause, as part of the physiological changes of the female body, should not be considered a separate disease, even in the presence of severe symptoms!

Examinations in Menopause

For the diagnosis of menopause, a complete clarification of the history, physical and laboratory examinations, and imaging procedures may be necessary. Menopause should be distinguished from gynecological and other specialist diseases, such as high blood pressure, thyroid, carbohydrate metabolism and cardiovascular diseases, conditions predisposing to coagulation disorders, and the parallel occurrence of these should be clarified.

What do we recommend to women in transition?

First and foremost, to strive to follow a healthy lifestyle:

• quit smoking;
• moderate their alcohol consumption;
• watch their weight;
• eat healthily;
• exercise regularly;
• participate in screenings;
• get the recommended vaccinations for their age group.

Hormonal Treatment

Depending on the severity of the symptoms, hormonal treatment may be necessary to alleviate or eliminate them. Another reason for the treatment may be that the symptoms of estrogen deficiency can be associated with various diseases related to aging and genetic predisposition worsening or increasing in frequency (e.g., osteoporosis, cardiovascular diseases, diabetes, obesity, colorectal tumors, mental and sexual diseases, etc.). You can read more about the possibilities of hormonal treatment here.

The Positive Effects of Menopause

Unfortunately, there are not many positive effects of menopause, but among them, the cessation of menstrual bleeding and premenstrual symptoms can be highlighted. The absence of bleeding is experienced by women in an emotionally ambivalent way, however, it is a fact that in certain pathological conditions associated with blood loss, such as pelvic endometriosis, non-cancerous bleeding, the resulting anemia, pelvic inflammations, uterine fibroids, menstrual migraine, menopause can bring about a positive change.

If you would like to know more about treatment options, make an appointment and meet our gynecologist, Dr. Károly Sándor Tóth!