What are the signs that a woman is already in the climacteric period?  

The start of the climacteric, or menopause, may present differently in each woman, but there are certain signs that should make a woman aware that she is in this period of her life. These signs include, for example, uneven menstrual cycles: a change in the menstrual cycle is one of the first signs of menopause. Cycles may became more irregular, longer or shorter, or stronger or weaker bleeding than usual may occur. Also hot flashes and night sweats, mood swings, feeling anxious or depressed. Menopause can affect sexual desire and function, which may present as lower libido or sexual dysfunction.

A decline in oestrogen can lead to dryness, burning and discomfort in the genital area. Menopausal women often report difficulty sleeping due either to night sweats or to difficulty falling asleep or interrupted sleep. Of no less importance, there are changes in body weight and body composition: Weight gain or changes in the distribution of body fat may occur, especially in the abdominal area.

How long does the climacteric period last in most cases? Is it individual?

The duration of the climacteric period is individual. The perimenopause period, i.e. the period prior to menopause, when the first symptoms start to appear, can last several years. Menopause is defined as the moment when a woman has not had menstruation for a period of twelve consecutive months. After that period, a woman is in post-menopause. Generally, the duration of the climacteric period ranges from several months to years, with varying intensity of the symptoms. It is always important to seek support and advice, ideally from a gynaecologist.

What exactly is a “hot flash”?

Hot flashes are one of the most common and most characteristic symptoms of menopause. This involves a sudden, brief feeling of intense heat, which may be accompanied by reddening of the skin, increased sweating (especially on the upper half of the body), increased heart rate and sometimes even anxiety or dizziness. These flashes can last from several seconds to several minutes and can occur several times a day or only occasionally.

Most women experience excessive sweating. Is there any way to mitigate this symptom? And what about night sweats, which are common and very unpleasant? Do women just have to “survive” that or is there some form of relief?

• Changes in lifestyle: Avoiding triggers such as hot foods and beverages, alcohol, caffeine and smoking. Maintaining a cool and well-ventilated environment (especially the bedroom!) and, among other things, wearing breathable clothes made of natural materials can bring relief.
• Regular exercise: Regular physical activity improves one’s overall well-being, which can lead to decreased frequency and intensity of hot flashes.
• Proper diet: A healthy, balanced diet rich in whole-grain products, fruits, vegetables and omega-3 fatty acids can have a positive impact on the symptoms of menopause.
• Relaxation techniques: Techniques such as deep breathing, yoga, tai chi, meditation and progressive muscle relaxation can help to manage stress and decrease the frequency of hot flashes.
• Hormonal therapy: I am currently very much inclined toward hormone-replacement therapy for women who have the previously mentioned problems. Not only does hormone-replacement therapy relieve these problems, but it also demonstrably and significantly reduces the risk of cardiovascular disease.
• Alternative and supplementary treatments: Some women can find relief in alternative or supplemental treatments, such as phytoestrogens (plant-derived oestrogens) and other herbal supplements.

It is always important to discuss your symptoms and treatment options with a gynaecologist and it is always necessary to take an individual approach to treatment.

Does getting more exercise help women who are going through menopause?

Yes, increased physical activity and a change in diet can significantly help women during the climacteric period, not only with weight loss (though that is difficult in menopause), but also with overall improvement of their quality of life. Physical activity can help to mitigate some symptoms of menopause, such as hot flashes, problems with sleeping, mood swings and increased irritability. Exercise also supports mental health, improves mood and reduces the risk of depression, which are issues that women frequently encounter during this period.

Is it also good to change one’s diet in order not to gain weight during this period?

With respect to changing one’s eating habits, a diet rich in whole-grain products, fruits, vegetables and protein from high-quality sources, together with limiting the intake of processed foods, sugars and saturated fats, can help to not only prevent weight gain, but also to improve one’s overall health. It is important to focus on having a balanced diet that supports a stable blood-sugar level and provides sufficient fibre, vitamins and minerals.

Omega-3 fatty acids, which are found in fish, flaxseeds and nuts, can help in the fight against mood swings and contribute to better emotional health. It is also important to get enough calcium and vitamin D, which are crucial for maintaining bone health, which can be negatively impacted by menopause.

It is clear that a combination of regular exercise and a healthy diet can provide significant benefits during menopause. It not only can help to prevent weight gain, but also improves one’s overall physical and mental health.

Are the manifestations of menopause also connected with genetics? Can a woman ask her mother about her experience with menopause and expect to have a similar experience?

Yes, the manifestations of menopause can be partially influenced by genetics. Studies indicate that there is a certain genetic predisposition to how women experience menopause, including the age of onset and the type and intensity of symptoms, such as hot flashes, night sweats and mood swings, among other things. If your mother or another close relative experienced certain symptoms of menopause or if they reached menopause at a particular age, this could be an indicator of how you might experience menopause.

However, it is important to recognise that genetics are not the only factor. Lifestyle, diet, overall health and other environmental factors also play a significant role in how women experience menopause. For example, smoking, excessive alcohol consumption, insufficient physical activity and obesity can worsen the symptoms of menopause regardless of one’s genetic predisposition.

Menopausal women use dietary supplements or hormonal medications (hormone-replacement therapy, or HRT) to mitigate the manifestations of menopause. Do you recommend this to your clients? How can such products help women?

Dietary supplements and hormonal medications provide significant relief from many common symptoms of menopause. It is important to realise that every woman is unique and what helps one may not necessarily work for another.

Hormonal therapy is recommended to women who have problems and symptoms caused by a decline in female sex hormones. It certainly is not prescribed to women only as a way to “prevent ageing”.
With the right indication, it can alleviate hot flashes and night sweats. It can help to mitigate vaginal dryness and the associated discomfort during sexual intercourse, improve vaginal health and promote better urinary function. Long-term hormone-replacement therapy is also used to treat osteoporosis.

The connection between hot flashes and increased risk of cardiovascular disease is currently a topical issue. Studies show that HRT can even have a beneficial effect on reducing the risk of cardiovascular disease in women up to the age of 60 who began with HRT soon after the onset of menopause. This positive effect can partly be attributed to oestrogen’s effect on maintaining the health and elasticity of blood vessels, which can help to prevent atherosclerosis.

It is important to emphasise that the decision to initiate HRT should be individualised, with thorough consideration of the potential benefits and risks for each particular woman. This includes evaluation of her overall health condition, family medical history, personal risk of cardiovascular disease and her personal preferences.

Where dietary supplements are concerned, we use supplements containing phytoestrogens (plant-derived compounds similar to oestrogen, such as the isoflavone found in soy). These can help some women to mitigate hot flashes.

Other vitamins and minerals: Supplements containing vitamin D and calcium can promote bone health. Omega-3 fatty acids can help to mitigate mood swings and support overall heart health.

Herbal supplements: Some women find relief from the symptoms of menopause by using herbal supplements such as black cohosh, red clover and feverfew. These supplements can help with hot flashes and mood swings.

      Dr. Tereza Čeledová, gynaecologist, Canadian Medical