Menopause is the permanent cessation of menstruation and is the result of the natural process of declining ovarian function. During the climacteric, the fertile period comes to an end and a new post-menopause phase begins, during which—thanks to longer life expectancy—women spend as much as a third of their lives. Menopause can therefore be called the “spring of the second half of life”, when, after completing the biological role of childbearing, a woman uses her experience and gained wisdom to fulfil her plans and wishes. The onset of menopause is determined retrospectively, when a woman has not had a period for at least one year; then the climacteric period begins.
Natural menopause can occur as early as after the age of 40, but on average women stop menstruating at 52. If menopause occurs before the age of 40, it is referred to as “premature” menopause; before 45, as “early” menopause. When permanent loss of menstruation is the result of surgery on the reproductive organs, radiation, or chemotherapy, it is the so-called “treatment-induced” or iatrogenic menopause.
During the climacteric period, which can last from a few to more than ten years, the ovaries produce less and less female (oestrogen and progesterone) and male sex hormones. Because the climacteric is a natural process in a woman’s life, the body responds to the changed state by having other tissues and organs take over the role of secreting sex hormones—the adrenal gland, fatty tissue, and muscles. How well these organs and tissues function depends on a woman’s physical and mental condition, her responses to everyday stress, genetic makeup, diet, and self-image. So it is not necessary that a woman has problems during the climacteric, but research shows that most face more or less pronounced climacteric symptoms.
Early symptoms:
Hot flushes (“valunge”) with sudden heat and flushing of the head and neck
Night sweats
Dizziness
Headaches
Heart palpitations
Insomnia, fatigue
Mood changes (low mood, irritability)
Concentration problems
Lower sex drive
Late symptoms:
Dry skin and vaginal dryness
Pain during intercourse
Bone and joint pain
Hormone replacement therapy (HRT) after menopause
For pronounced climacteric symptoms, and in premature, early, and iatrogenic menopause, hormone treatment is justified and is based on replacing missing sex hormones. With hormone replacement therapy (HRT), precautions must be considered—treatment is not suitable for cardiovascular, liver, and thromboembolic diseases, for hormone-dependent tumours (e.g. breast), and systemic diseases (rheumatic diseases ..). Regarding the risks, type, form, and duration of HRT, a woman should consult her gynaecologist or chosen doctor. Treatment should be monitored with regular check-ups and consultations and adjusted if needed. Current research shows that the positive effects of HRT nevertheless outweigh the negative ones. However, we can also “tackle” climacteric problems in a non-hormonal way:
Non-hormonal treatment of menopausal symptoms
Diet and regular physical activity are extremely important in addressing the effects of menopause, as are good psychological readiness and acceptance of changes that are inevitable in life. Some plants are also used that contain phytoestrogen substances, which are structurally and/or functionally similar to oestrogen and may have agonistic, partially agonistic, and antagonistic interactions with oestrogen receptors. Among the best-known sources of phytoestrogens are soy, red clover, ginseng, dong quai, evening primrose seed oil, and they are available on the market as dietary supplements to relieve climacteric symptoms. There are few suitable clinical studies on the effectiveness of these supplements in relieving climacteric symptoms, and even those have not convincingly shown a positive effect. Better evidence supports the effectiveness and safety of a medicine made from the rhizome of the medicinal plant Cimicifuga racemosa – black cohosh (CR), which has been on the market since 1956.
Research shows the following:
The highest level of agreement among natural preparations for relieving climacteric symptoms is for the natural remedy CR, followed by soy-based dietary supplements with a highlighted beneficial effect on lowering serum lipids. The natural remedy CR could be suitable for relieving climacteric symptoms in women after breast CA, as animal studies show an anti-tumour effect of CR, and safe use of CR has also been shown by findings from retrospective, observational, and case–control studies, but their level of agreement is low. Following the example of some menopause associations elsewhere in the world, we could also first recommend lifestyle changes to women with mild climacteric symptoms, along with the concurrent use of the natural remedy CR or dietary supplements with soy isoflavones. Prescribing HRT should remain the standard for treating moderate and severe climacteric symptoms (Vrabič Dežman L, 2008).
What can you do yourself for your health?
Helpful:
• Enough sleep: night-time rest should last at least 7-8 hours. Adrenal gland function is restored best after midnight, so it is recommended to go to bed by 10 PM;
• Quitting smoking: smoking reduces the function of glands that secrete sex hormones and speeds up the breakdown of sex hormones;
• Limiting refined carbohydrates (sugar, white flour …), alcohol, and caffeine (up to 2 cups of coffee a day! – caffeine leaches calcium from bones);
• A balanced diet: with whole foods, vegetables, and fruit. Regular meals are important—breakfast and an early lunch, plus at least two light snacks in between. Fasting when exhausted is not recommended.
Your daily menu should include:
• grains and potatoes,
• vegetables, legumes,
• fruit,
• milk and dairy products,
• alternating meat, fish, or eggs (Jošar, 2003).
Fat should be used sparingly. Use only a small amount of fat for cooking or spreading, and avoid hidden fats in salamis, ready-made meals, and various snack foods. You should drink at least 1.5 to 2 l of fluids daily, in the form of herbal and fruit teas, milk, and mineral water;
• Eating foods that contain plant oestrogens (phytoestrogens), i.e., eat enough soy and soy products, flax, nuts, oats, wheat, apples;
• Enough vitamins and minerals: antioxidants (vitamin C, vitamin E, selenium), B vitamins, vitamin A, calcium, magnesium, zinc—get them through a suitable diet or vitamin supplements;
• Regular weight-bearing physical activity: to maintain fitness, prevent stress, maintain body weight, and feel well, make sure you get enough movement and sport, plenty of fresh air, and relaxation. Walking, swimming, cycling, and weight training are sports that are recommended to keep the body in good condition despite advancing years. At least three times a week for 30 minutes, or twice a week for 40 minutes;
• Live in a supportive environment, as the company of well-disposed people has a positive effect on the immune system;
• Sun exposure: exposing the skin of the face and hands to moderate sun three times a week for 15 minutes meets vitamin D needs for maintaining bone mass; • Herbal preparations: some plant extracts (Cimicifuga racemosa) relieve climacteric symptoms;
• Methods of inner calming: yoga, meditation, autogenic training, breathing techniques.. ;
• A woman should regularly attend medical and gynaecological check-ups; The climacteric period is also an opportunity for a woman to face herself and reflect on what she has already achieved in life and what she still wants to experience. It is wise for a woman to also take care of maintaining her health, so she can fully make use of all the opportunities that the second half of life brings—starting with its “spring”, menopause (Pinter).
Mena Maribor Association – all about “meno”
The climacteric (meno) is divided into:
- PREMENOPAUSE (this is actually the period from regular menstruation to menopause). However, it is usually used for the period after the age of 40, when many women’s periods become irregular or very heavy.
- PERIMENOPAUSE (the period that spans several years on both sides of the last period). During this time, various vague symptoms appear that you only connect and understand later, why they were happening. Periods become irregular and hot flushes may begin.
- MENOPAUSE (this is your last period).
- POSTMENOPAUSE (the period that lasts from your last period until the end of life).