We need to talk more about menopause – at least that is the assessment of the German Society for Menopause, an institution that seeks to eliminate taboos surrounding the topic and place it on the agenda of health policy makers.
In 2021, according to the World Health Organization (WHO), 26% of the global female population was aged 50 or over. This means that around 1.3 billion were going through menopause or had already gone through it. But, after all, what happens at this stage of a woman’s life?
When does menopause start?
To answer this question, first of all, it is necessary to clarify the terminology, says gynecologist Anneliese Schwenkhagen. Based in Hamburg, she is a specialist in gynecological endocrinology: hormones – the main agents behind menopause – are her area of expertise.
Menopause is defined as the last menstrual period. According to the German Menopause Society, this happens on average between the ages of 51 and 52. In rare cases, it can reach around 40 years of age.
It marks the point at which monthly ovulation ceases, which leads to infertility. But the drop in a woman’s fertility already begins during perimenopause, which can occur many years before menopause.
The term perimenopause also refers to the 12 months after the last menstrual period. It is only after this period of one year that we start talking about post-menopause. The term menopause encompasses almost all of these phases together, and the time at which it occurs can therefore only be determined retrospectively.
What are the symptoms of menopause?
For around two-thirds of women, menopause is an unpleasant transition: a third complain of severe symptoms.
It all starts in perimenopause, mainly due to the fluctuating activity of the ovaries. Estrogen hormones, especially estradiol, are produced in ovarian follicles that mature in the ovaries. During perimenopause, the cycle becomes more irregular, either longer or with no bleeding.
This causes hormonal fluctuations, which in turn lead to symptoms such as breast tenderness, fluid retention, mood swings and sleep disturbances.
“Many women at this stage, which can sometimes begin at age 40, don’t even know that their symptoms may be related to hormonal changes at the beginning of menopause,” explains Schwenkhagen.
During menopause, former patients of psychiatric illnesses such as depression or anxiety disorders may also experience a relapse.
“Statistically speaking, menopause is a high-risk situation for psychiatric illnesses, due to hormonal instability, which makes the brain more vulnerable.” Migraine is one of the illnesses that can worsen at this stage.
One of the main symptoms of postmenopause are hot flashes and sweating. The skin and mucous membranes become increasingly dry. “This particularly affects the vagina and bladder. There may be pain during sex or recurrent urinary tract infections,” says Schwenkhagen. Many also complain of joint pain. All of this is a reflection of a constantly low level of estradiol – with the follicles exhausted, there is no longer any production of this hormone.
How to treat menopause?
Hormone replacement therapy (HRT) can alleviate many symptoms. In it, estradiol is prescribed in the form of tablets or administered through the skin using gels, sprays or patches. “If the uterus is still present, corpus luteum hormone therapy is also applied to protect the uterine lining.”
According to the gynecologist, vaginal dryness responds well to local treatment with suppositories, pills or creams containing estrogen. The method can also reduce the risk of recurring urinary tract infections.
For a long time, hormonal therapies did not have a good reputation. And, in fact, they may slightly increase the risk of thrombosis and breast cancer. Women who have previously had precancerous lesions or breast cancer are therefore not advised to undergo HRT. On the other hand, hormone therapy also has some positive health effects, and for Schwenkhagen and other experts the benefits outweigh the risks.
Nowadays, it is known, for example, that hormone replacement therapy started shortly after the last bleed can even have a protective effect on the cardiovascular system, points out Schwenkhagen, and even reduce the risk of diabetes. This additional protective effect also extends to the bones, as a lack of estrogen tends to negatively affect bone density, increasing the risk of osteoporosis.
Does menopause have benefits?
But, beyond various conditions over the years: is there anything positive about menopause? Hormonal symptoms, after all, often coincide with transitions between different stages of life – children who have grown up and are leaving home, for example. This often puts years-long relationships to the test. “At work, many oscillate between boreout and burnout”, in other words: between boredom and total exhaustion.
For Schwenkhagen, menopause can be seen as a turning point, which women can take advantage of to take a look at themselves and redefine themselves. A turning point that requires a new examination of one’s own body and health. Yes, but what about the complaints? Fortunately, the gynecologist guarantees, they respond well to treatments.
