What is menopause?

“From a medical definition, menopause means the last menstrual cycle a woman experiences in her life. In a broader sense, the term menopause or transition is used to describe the hormonal changes that usually take place between the ages of 40 and 60. It is the process leading to the natural cessation of the reproductive capacity of the female body. Gradually, the function of the ovaries, which produce the sex hormones progesterone and estrogen, is reduced, which manifests mainly by changes in the regularity of the cycle and later by the disappearance of menstruation," says Tereza Čeledová, MD, a gynaecologist at Canadian Medical.

INTERESTING FACT: During menopause, reproductive capacity decreases, but it's not impossible to get pregnant. That's why it’s usually recommended to stay on birth control until about a year after the last period.

Symptoms of menopause 

The first signs of menopause are changes in the menstrual cycle - irregularity, longer or shorter menstrual periods or heavier or weaker menstrual bleeding. This phase is known as premenopause and begins several years before the last menstruation.

Perimenopause occurs around the age of 50. During this phase, the menstrual cycle becomes more irregular, but it may also be accompanied by secondary symptoms caused mainly by sudden hormonal imbalances:

• hot flushes and sweating,
• fatigue,
• sleep problems,
• irritability, nervousness,
• dizziness,
• paresthesias (tingling sensation),
• heart palpitations,
• vaginal dryness,
• decreased sex drive,
• inflammations (urinary tract, vaginal mucosa),
• incontinence,
• indigestion (nausea, diarrhoea, constipation),
• joint and muscle pain.

"The symptoms accompanying menopause are very individual. Some women hardly notice they are in menopause apart from changes in their menstruation, while others, unfortunately, go through this phase of life with the short end of the stick. It must be said, that this is only a small fraction of women. However, there are various treatment options for more serious cases," explains Tereza Čeledová, MD.

How long menopause lasts also varies. The last menstrual period usually comes 3-5 years after the first noticeable fluctuations in the menstrual cycle. However, definitive confirmation of menopause is only possible retrospectively when menstruation has been absent for twelve consecutive months. This period is called post-menopause and usually during this time hormones stabilize and accompanying symptoms disappear.

Premature menopause

The hormonal changes that accompany menopause usually occur between the ages of 40 and 60 (the average age of onset of menopause is 51). If a woman goes through menopause before the age of 41, it is classified as premature menopause.

The exact cause is not always known, but often autoimmune diseases, genetic influences or the use of medications that suppress the body's defences (cytostatics) are to blame. Genetic predisposition also plays a role - in general, menopause often occurs in daughters at the same age as their mothers. Among the controllable factors are lifestyle, smoking, stress or very low body weight, all of which can manifest in premature menopause.

Premature menopause also occurs as a result of chemotherapy or after a hysterectomy (surgical removal of the ovaries or uterus). In this case, it is called induced menopause.

„Diagnosing“ menopause

Menopause is not a disease, but it does require special attention. Your gynaecologist will identify it easily at a regular preventive check-up, based on your age and other symptoms that you inform them about. If in doubt, they will recommend a blood test to check hormone levels (in addition to a decrease in progesterone and estrogen, women experience an increase in the production of follicle-stimulating hormone - FSH - during menopause). At-home tests for menopause are also available in pharmacies to detect the presence of FSH in urine. However, always consult your doctor for the most accurate result.

Treating menopausal symptoms

The need for treatment depends on the severity and nature of a woman’s symptoms. In mild menopause, there is no need to take any medications or products, and a healthy lifestyle (avoiding cigarettes and alcohol, healthy eating and plenty of exercises) is adequate.

Regular physical activity is also recommended to prevent cardiovascular disease and osteoporosis. These serious health concerns are also referred to as 'metabolic syndrome from estrogen deficiency and can cause damage to a woman's health and affect her life expectancy. Because of osteoporosis, care must be taken to ensure adequate exercise and intake of calcium and vitamin D - either in food, supplements or, in the case of vitamin D, by getting enough sun exposure.

"Osteoporosis affects up to a third of women after menopause. As a result of weaker bones, the body is more prone to fractures, which occur even in trivial situations. Often, these fractures are very difficult to treat and recover from.  Therefore, after menopause, it is also necessary to think about this risk, adapt their lifestyle to it and consult a doctor about appropriate prevention.

In recent years, it is being recommended for all women over the age of 60 to undergo a densitometric examination, and I would also recommend it. Caution is advised for women with a family history-it is reported that up to ⅔ of women with osteoporosis fractures have it in their blood line" warns Tereza Čeledová, MD.

The milder symptoms of menopause can be suppressed with natural dietary supplements. These usually contain extracts of meadow clover, flat-leafed grape extract or phytoestrogens - substances with an effect similar to estrogens. Certain herbs can also relieve the symptoms of menopause. Sage helps against sweating and hot flushes, St John's wort for the psyche and valerian for sleep. However, you should always consult your doctor about the use of natural remedies.

Some of the more uncomfortable changes are changes in the nature of the skin and mucous membranes of the genital area which can cause  pain during intercourse and sexual problems. The vaginal pH changes, as does the vaginal microflora, and resistance to infection decreases. Lack of oestrogens results in urological difficulties - urge to urinate, urinary incontinence, frequent inflammation of the urinary tract.

If the symptoms are severe and basic preventative measures do not help, we approach treatment individually focused on individual problems (we deal with incontinence, inflammation, osteoporosis), and as a last case, we opt for hormonal treatment. The missing hormones (oestrogens and progestogens) are supplemented in the form of tablets, patches or gels applied to the skin, injections, or gels, tablets, creams or suppositories inserted directly into the vagina. Hormone treatment for menopause is not suitable for every woman, and the use of it is therefore also decided by the doctor.