Menopause: definition, symptoms, treatment

Overview

From mid-forties it starts

The menopause (climacteric) of the woman is a 10 to 15 years lasting phase, which marks the transition from full sexual maturity to old age (Senium). They usually start around the 45th to 55th year of life and sometimes extend into the 70th year of life. Menopause is not a disease in the strict sense as it is part of a woman's normal aging process. Nevertheless, they can cause discomfort that may require treatment.

These symptoms are due to the hormonal changes that go through during menopause. In particular, it comes to a steadily decreasing estrogen levels, which initially provides mainly for cycle irregularities and later falls so far that the rule is completely absent. The last rule is called retrospective menopause and represents an important milestone of the climacteric.

Hot flashes and bad mood

However, the lack of estrogens can cause many more symptoms. Typical are hot flashes and sweats as well as circulatory problems such as dizziness or tachycardia. But even irritability to depressive moods can be the result of hormonal changes during menopause.

Not all women suffer equally from menopausal symptoms. While one-third of people do not show any symptoms, one-third of them experience minor ailments that do not require treatment, while the last third cause symptoms so severe that medical treatment is required.

Therapeutic hormone preparations are used for very severe discomfort. These primarily contain estrogens and / or progestins such as progesterone and serve to catch the body's natural hormone waste, so that a better adaptation to the altered hormone levels can occur. However, hormone replacement therapy (HET) is not free of risks and side effects and should only be used after individual consideration for a maximum of three to five years.

As an alternative to HET, herbal medicines and a lifestyle change can help alleviate the symptoms of mild to moderate menopausal symptoms and help to better manage the climactic problems and anxieties.

definition

Process over 10 to 15 years

The menopause (climacteric) is not a disease in the true sense, but a phase of hormone change, which occurs in the life of every woman at any time. The term climacteric covers the entire period from the end of full sexual maturity to the onset of senile age (Senium) and usually begins a few years before the last menstrual period, also called menopause, occurs.

Overall, the menopause thus covers a period of 10 to 15 years, which take place approximately in the period between the 45th and the 70th year of life. The climacteric runs in different phases, all of which are temporally related to menopause and partially overlap or merge.

Menopause and what happens around them

Menopause occurs on average at the age of 50 to 51 years and is the last menstruation produced by the body. However, the variation around the average age of 50 years is individually very different and sometimes shows large deviations. For example, some women enter the menopause at the age of 45, others only after their 55th birthday.

The premenopause describes the phase before the last menstrual period. It lasts an average of two to seven years and is already characterized by early hormonal changes. For example, the level of estrogen in the blood slowly decreases, which leads to irregular period bleeding, while the jump takes place increasingly rare.

Perimenopause is the period of two years before and about two years after menopause. During this time, the ovaries completely stop functioning, ovulation is becoming rarer, and eventually it stops altogether. With the absence of ovulation, the menstrual cycle becomes more and more irregular, until the period finally stops altogether. The female sex hormones progesterone and estrogen are falling off, while male hormones, which are produced in small quantities in the female body, remain at their previous levels.

Postmenopause is the last phase of menopause.It begins about two years after the last menstrual period and continues until the entry into the Senium at about 65 to 70 years. During this time, the production of progestogens and estrogens comes to a standstill, the hormonal change of the body from sexual maturity to age is over and the body adapted to the new situation. Menopausal complaints are no longer expected in this phase.

causes

Menopause is a natural hormonal change that occurs around the age of 45 in the female body. The cause of this change is a diminishing function of the ovaries, in which gradually less and less eggs mature, until finally a last ovulation, followed by a last menstruation (menopause) comes.

Fate of the eggs

The paired ovaries of the woman already contain many millions of follicles (immature oocytes) after birth, which reduce to puberty to about 200,000 pieces. From puberty, several follicles begin to mature each month, but only one reaches the stage of the mature ovum, which leaves the ovaries with ovulation and is transported via the fallopian tubes to the uterus.

If it comes to the fertilization of this egg by a sperm cell, a pregnancy can arise. In all other cases, the cracked egg cell dies, and it comes to menstruation - the cycle begins again.

All others who have not finished the ripening process within one cycle will perish. Thus, the number of follicles is reduced month by month until, with an average of 45 - 50 years, no follicles are left.

Hormonal interaction

Mature and mature follicles are responsible for the production of the female sex hormone estrogen. As the number of follicles in the ovaries continues to decrease, estrogen production continues to decline.

The body is initially unaffected by this hormonal state and therefore sends more signals to the brain to produce follicle-stimulating hormone (FSH). FSH, together with other hormones (known as gonadotropins) from puberty, is responsible for regulating regular maturation of follicles and thus for the hormone levels of estrogens and progesterone. A fall in estrogen, therefore, leads to a reactive increase in FSH, which tries to bring the hormone balance back into balance.

During the menopause, a hormonal change takes place, which leads to a significant drop in the sex hormones estrogen and progesterone and also leads to an increase in gonadotropins, especially FSH. This hormonal imbalance can temporarily lead to the typical menopausal symptoms.

Function of female sex hormones

The female sex hormones estrogen and progesterone are increasingly formed from puberty and have a variety of functions in the female body. Their interaction is sometimes very complex.

The most important tasks of the sex hormones are:

  • Training and growth of the female breast during puberty
  • Development of pubic hair
  • Training of the female voice
  • Establishment of a regular menstrual cycle as well as growth of uterine lining and uterine musculature
  • cyclic changes in the cervix such as the opening of the cervix just prior to entry and the regulation of consistency and amount of cervical mucus
  • Preparation and maintenance of pregnancy
  • Increasing bone stability by increasing the number of bone-forming cells

All in all, estrogen and progesterone are used to turn a girl into a mature woman. As hormone levels fall gradually with menopause, the body also changes. These changes are perceived by many women as very drastic, so that in some cases, hormonal support by drugs must be used to better adapt to menopause.

Read also:
Basics on menopause questions

symptoms

As in puberty and pregnancy, not every woman reacts in the same way to hormonal changes during menopause. While one third of women completely dispense with menopause without symptoms, one-third experience mild symptoms that do not require treatment, while the last third are so severe that hormonal treatment becomes necessary. Therefore, it is not always easy to associate changes in the body and mental mood with menopause.

Slow expiration of the period

The first sign that women often notice when they enter premenopause, about seven years before the last menstrual period, is the change in cycle length. At the beginning of menopause, the rule is often initially shortened. Later, the intervals between the individual bleeding become longer and the bleeding itself stronger. Also inter-bleedings, which can impress as spotting, occur more frequently. At some point the period will be completely gone.

Due to the lack of hormones and in particular by the sinking level of estrogens, there are individually very different symptoms and changes.

These include:

  • Hot flushes and sweats, which often last only a few minutes, but can occur in very high frequency during the day and also at night. In the process, a heat wave spreads from the head and face over the upper body, causing sweating and usually ends in a slight shiver. With about 5 to 7 out of 10 women, these menopausal symptoms occur most frequently.
  • Mood swings that are triggered by mild external stimuli and can lead to depression in severe cases. In many cases, groundless nervousness and uncontrollable irritability also occur.
  • Insomnia and sleep disorders that are not caused by external events such as stress or illness. In the morning after a night of waking up, there is often a few hours after getting up to great fatigue, which is accompanied by a reduction in concentration and lack of drive.
  • decreasing efficiency, which can range to exhaustion and can often be closely related to sleep disorders
  • Dizziness, circulatory problems and tachycardia
  • Decreased production of vaginal fluid, which leads to dryness of the vagina even with sexual arousal. This can lead to further problems such as penetration problems and pain during sexual intercourse as well as more frequent urinary tract infections. Furthermore, the hormonal change often leads in addition to a loss of libido and painful tension in the chest.
  • Osteoporosis. The sinking level of estrogen leads to a reduction of the bone substance and thus to an increased susceptibility to bone fractures. In particular, the spine can be damaged in later stages by the postmenopausal osteoporosis.

Many women also find the phase of menopause a kind of era of reorientation. Dissatisfactions from the "old life" are perceived and processed more strongly. However, while some women experience this phase as a kind of spirit of optimism releasing many energies and energies, others feel overwhelmed and exhausted. Seek help if you are uncomfortable with your body and your new life situation.

More about this topic can be found here:
Frequently asked questions about menopausal symptoms

diagnosis

Trust that you will feel for yourself when the menopause begins. A medical examination of the complaints is not necessary in every case. If you feel comfortable in your body despite physical and mental changes, you do not necessarily have to have the diagnosis "climacteric" confirmed by a gynecologist.

With specific questions about the right diagnosis

For your treating gynecologist it is easy to determine if the menopause has already begun. Often, the synopsis of your age, a verbose conversation detailing your condition, and a gynecological exam are enough to make a diagnosis. Your doctor will pay particular attention to the following points:

  • Are you 45 years or older?
  • Do you suffer from cycle disorders?
  • Do you suffer from other complaints such as hot flashes, mood swings, decreased libido?
  • Do the gynecological examination show typical changes in the vagina, uterus or breasts?

The time of the last menstruation (menopause) is determined by a doctor only retrospectively, if since the last rule a year without further bleeding has passed.

If in doubt, a blood test helps

If the synopsis of the findings does not provide a clear answer, an additional blood test for the concentration of certain female hormones may be helpful. Typically, the concentration of estrogen or its precursors decreases estradiol and estrone, while FSH is elevated.

For a detailed overview of changes in hormone levels, see the following table:

estrone
<40 pg / ml
estradiol
5-20 pg / ml
follicle stimulating hormone (FSH)
> 50 mlU / ml
Luteinizing Hormone (LH)
20 - 100 ml / ml
progesterone
<1 ng / ml
testosterone
<0.8 ng / ml

Units: pg = picogram (one trillionth of a gram); ng = nanogram (one billionth of a gram); ml = mililiter; IE = international units, also abbreviated to IU.

Here you can find more:
Menopause: diagnostics, examinations, tests

treatment

The menopause (climacteric) does not always cause severe discomfort requiring treatment. Only about one third of all women need medical assistance in terms of hormone replacement therapy (HET). One-third suffer from mild ailments that are often well managed by herbal remedies and lifestyle changes. And the last third feels only barely noticeable changes that are not in need of treatment.

1. Hormone replacement therapy (HET)

discretionary

The HET is used only in very severe cases of menopausal symptoms and only after medical prescription because it is not free of risks. About 30% of all women need to take an HET because the menopausal symptoms are so severe that it affects their quality of life.

If you find that you can not handle your symptoms with common home remedies and a lifestyle change, consult your gynecologist to get a clear idea of ​​the pros and cons of HET.

Since a modified hormone balance is responsible for the menopausal symptoms, HET uses artificial hormones to intercept the heavy drop, in particular the estrogen level. However, the HET does not serve to create hormonal conditions as they existed before the onset of the climacteric, but is said to relieve the symptoms until the body has become accustomed to the altered hormone levels.

The goal of HET is, among other things, to relieve agonizing symptoms such as hot flashes, sweats, mood swings, irritability and depression and to reduce the risk of osteoporosis.

For therapy, many different preparations are available. Most commonly used:

  • pure estrogen preparations
  • pure progestogen preparations
  • Estrogen-progestin combination drugs

Which of these preparations is best for you depends on a variety of factors. In addition to your age, the severity of the symptoms as well as the current phase of the menopause plays a crucial role. But also physical illnesses and risk factors are included in the decision for or against a drug or therapy itself. For example, your doctor may need to consider whether you still have your uterus or if it has been removed in a hysterectomy.

Once started, HET is usually continued for 3 to 5 years, then gradually reduced over several months and finally discontinued.

Per...

Advantages of HET are a good ability to influence vegetative symptoms such as hot flashes, dizziness or palpitations. Mood swings and depression can also be better controlled with the help of hormone replacement therapy. Furthermore, the artificial hormones also work to avoid the drying of the vagina and associated pain during sexual intercourse, which particularly sexually active women suffer.

Studies have also shown that long-term HET lowers the risk of developing certain diseases. These include:

  • osteoporosis
  • Diabetes mellitus type II
  • colon cancer

... and contra

However, HET not only benefits. The altered hormone levels also create risks and side effects that should not be overlooked when deciding on therapy.

Side effects that can occur under a HET are mainly:

  • Nausea and vomiting
  • Cravings and weight gain
  • Water retention, especially in the legs (edema)
  • Headache to migraine attacks
  • Tension in the breasts

Particularly estrogen-rich preparations can also lead to an increased coagulation tendency of the blood, which in addition to thrombosis can cause strokes and heart attacks. Especially if you are older than 60, you should be well informed about these risks. Furthermore, individual preparations have a slightly increased risk of breast and uterine cancer.

Ask your doctor for an exact explanation of the selected drug for you and weigh the pros and cons of a HET for yourself again in peace. Also report on pre-existing conditions that may be against hormone replacement therapy.

The contraindications of a HET include:

  • History of breast or uterine cancer
  • History of thrombosis or embolism
  • pronounced hypertension
  • Liver diseases that are associated with liver changes
  • Autoimmune diseases such as lupus erythematosus
  • Meningiomas of the brain or spinal cord

Because of the many aspects that speak for or against HET, there are no general recommendations as to when and with what drug should be treated for menopausal symptoms. Every therapy decision has to be weighed individually and should be questioned over and over again.

2. Herbal medicines

Herbal medicines are used in the context of phytotherapy for the treatment of mild to moderate menopausal symptoms as the sole form of therapy, but can also be given in addition to hormone replacement therapy for very severe ailments.

Varied help from nature

Chasteberry (Agnus castus) and black cohosh (Cimicifuga racemosa) are probably the most commonly used herbal medicines. They are also called phytohormones because they have an estrogen-like effect on the human body and can lead to relief of menopausal symptoms.

In order to treat specific symptoms of the climacteric, the following phytopharmaceuticals are also suitable:

  • In restlessness hops, lemon balm or passion flower can have a soothing effect.
  • Valerian has a sleep-inducing and relaxing effect and helps with impaired and insomnia.
  • St. John's wort may prove to be effective in mild depressive moods.

However, when taking phytopharmaceuticals, keep in mind that in the broadest sense, they are also medicines that can have side effects and interactions with other preparations. For this reason, also discuss a self-medication with herbal medicines in advance with your doctor.

3. What you can do yourself

Many women wonder, long before the onset of menopause, whether and what they can do themselves to better withstand the hormonal shift and face the coming time without fears. Especially for mild, but also for moderate to severe symptoms, the following measures can help you to be better prepared for the hormonal changes:

  • Strive for a normal weight (body mass index (BMI) of maximum 25). Overweight is associated with more pronounced climacteric symptoms such as sweating and hot flashes.
  • Learn to relax consciously. Especially autogenic training and progressive muscle relaxation according to Jacobson can help to overcome sleep disorders. Hot flashes also occur less often in the relaxed state and only slightly more pronounced than under tension and stress.
  • Move regularly in the fresh air. Good physical fitness seems to have positive effects on many ailments that can occur during the climacteric period. For example, regular exercise prevents depressive phases, reduces hot flashes, and regulates circulatory function.
  • Eat well and eat plenty of fresh fruits and vegetables. A soy-rich diet should contribute to the regulation of hormonal changes. Calcium and vitamin D-rich foods prevent osteoporosis and also help to regulate the hormone balance.

Read also:
Frequently asked questions about the treatment of menopausal symptoms

course

Like adolescence, menopause is a natural phase in the aging woman. However, the course of the climacteric can be predicted very difficult. In every woman, the transition from full sexual maturity to senium is different. The onset, duration and extent of menopausal symptoms that occur are individually different.

On average, the time from the onset of premenopause to menopause and completed postmenopause lasts about 10 to 15 years and begins between the 45th and 55th year of life. In most cases, the menopause is thus completed at the age of 70 at the latest.

Good to know:
Menopause in everyday life

Author: Lisa Wunsch

sources

Prof. Dr. B. Kleine-Gunk: Relaxed by menopause, G | U Verlag, 2017-12-17.

T. Weyerstahl: Dual Series Gynecology and Obstetrics, Thieme Verlag, 2013.

Guideline of the German Society of Gynecology and Obstetrics (DGGG): Hormone Therapy (HT) in the peri- and postmenopause, http://www.awmf.org/uploads/tx_szleitlinien/015-062k-2009-abgelaufen.pdf, last accessed on 01/23/2018.

K. Kraft: Cimicifuga, St. John's wort and other phytotherapeutics in the climacteric. Gynecological Endocrinology, Volume 6, 2008.