What is Menopause? Symptoms, Stages, Diagnosis and Treatment Methods

Menopause is not a disease; it is a natural part of the reproductive process. Some women may enter menopause without showing any symptoms or with only mild symptoms. However, other women may experience symptoms such as hot flashes, night sweats, sleep problems, joint and muscle discomfort, mood swings, and irritability. Menopause is generally not a condition that requires treatment, but some women may need hormonal or non-hormonal therapies. Therefore, consulting an obstetrician and gynecologist starting from the perimenopause period, known as the menopause transition, is beneficial for navigating the process more easily.

What is Menopause?

Menopause can be defined as the cessation of a woman's ovulatory activity and the absence of any menstrual bleeding for 12 months. This process, which marks the end of a woman's natural reproductive cycle, is also known as the climacteric period. The regularity and length of the menstrual cycle vary throughout a woman's reproductive life. However, according to World Health Organization data, the age of entering menopause worldwide is between 45 and 55. Some women may enter menopause earlier due to chromosomal abnormalities, autoimmune disorders, or other unknown factors. Early menopause is defined as occurring at age 40 or younger.

The transition to menopause can be gradual and usually begins with changes in the menstrual cycle. If no medical intervention occurs, the natural menopause process has four stages. These stages can be listed as premenopause, perimenopause, menopause, and postmenopause. The following information can be provided regarding the stages of menopause:

Premenopause: This is the stage that refers to the period from menarche, known as the beginning of the menstrual cycle, to the start of the perimenopause period. It is also known as the pre-menopause period. During this period, the ovaries release an egg each month. If pregnancy does not occur, the uterine lining sheds, and monthly menstrual cycles develop. During premenopause, the ovaries produce three main hormones: estrogen, progesterone, and testosterone. Premenopause is often confused with the perimenopause period. However, premenopause covers the period before perimenopause. Classic symptoms such as insomnia, hot flashes, and delayed periods are not seen in this phase.

Perimenopause: Perimenopause, or the menopause transition period, is the stage from the onset of irregular periods and vasomotor symptoms such as night sweats and hot flashes until 12 months after the last menstrual period. The duration of perimenopause varies for every woman. It generally covers the 3-5 year period before menopause. Most women enter this stage in their late 40s. Hormone levels differ from the monthly patterns seen in the premenopause period. Many tissues and organs in the body, including the uterus, vagina, breasts, bones, bladder, brain, and skin, develop sensitivity to changing hormone levels. This causes the emergence of many symptoms that can affect physical and emotional states. Women in the perimenopause period can get pregnant. If pregnancy is not desired, protection should be provided with various birth control methods until the menopause period.

Menopause: Menopause is the stage where no menstrual bleeding has occurred for 12 months, independent of reasons such as illness, medication use, or pregnancy. Menopause symptoms are quite distinct. Pregnancy is not possible at this stage because the ovaries no longer release eggs and stop producing high levels of estrogen. Although pregnancy does not occur during menopause, it is possible to contract sexually transmitted infections. The thinning of the vaginal wall increases the likelihood of lesion development and tearing, which increases the risk of HIV transmission. Therefore, the use of a condom is recommended during intercourse to protect against sexually transmitted diseases, even if there is no possibility of pregnancy.

Postmenopause: This is a term used to refer to the period after menopause. As the body adapts to lower hormone levels, menopause symptoms may decrease or disappear completely. However, some women may continue to show symptoms even years after the menopause period. The risk of osteoporosis increases in the postmenopause period because the estrogen hormone, which is necessary for bone health, cannot be produced sufficiently. The postmenopause period covers the rest of life. It occurs on average around age 52.

What Are the Symptoms of Menopause?

Menopause symptoms may vary depending on how women manage the perimenopause process. Lifestyle changes, such as limiting caffeine intake and using a portable fan to alleviate hot flashes, can be beneficial in reducing symptoms. For some women, menopause symptoms can be more severe and last for years. The severity of symptoms varies according to race, ethnicity, genetic predisposition, and individual differences. Premenopause symptoms are negligible. Symptoms usually appear during the perimenopause and menopause periods. Symptoms of entering menopause can be listed as follows:

Changes in the length of the menstrual period may develop. Periods may become shorter or longer.

The regularity of menstrual periods may be disrupted. Two periods may start at dates very close to or very far from each other.

Bleeding during menopause may be heavier or lighter than normal.

Menopause is characterized by vasomotor symptoms known as hot flashes and night sweats. Hot flashes usually occur in the upper body and face. Red patches may appear on the chest, back, and arms. Hot flashes can last from 30 seconds to 10 minutes. They may occur several times an hour, day, or week.

Cold chills may develop following intense sweating.

Loss of bladder control, known as incontinence, may develop. Consequently, bladder and urinary problems may arise. Unwanted situations such as a sudden urge to urinate, or urinary incontinence during exercise, sneezing, or laughing may develop.

Various sleep problems may arise. These problems can be listed as difficulty falling asleep, waking up too early, or difficulty falling back asleep after waking up at night.

As the menopause period approaches, the vagina may become drier. This can make sexual intercourse uncomfortable. An increase or decrease in sexual desire may develop.

Due to hormonal changes, psychological symptoms such as mood swings, low self-esteem, anger, fatigue, and depression may develop.

Body changes such as muscle loss and an increase in fat ratio, thickening in the waist area, skin dryness, and feeling of stiff, weak, and painful joints and muscles may be observed.

There may be memory and focus problems.

Heartbeats may suddenly become more noticeable.

Urinary tract infections may recur more frequently.

Sensitivity and pain may develop in teeth and gums.

Breast tenderness may occur during menopause.

How Does Menopause Occur?

When women reach their late 30s, their egg reserves begin to decrease, and the amount of hormones produced in the ovaries also drops. The decrease in the levels of hormones called progesterone and estrogen makes it difficult to get pregnant. The main cause of menopause is the natural depletion or aging of the amount of eggs in the reserves. Some external interventions cause this process to accelerate.

A surgical procedure called an oophorectomy, which involves the removal of the ovaries, can cause early menopause. Menstrual bleeding stops, and hot flashes and other menopause symptoms can appear suddenly and severely. A hysterectomy, where the uterus is removed but the ovaries are not, generally does not cause a sudden menopause transition. Although menstrual bleeding stops, the ovaries continue to release eggs and produce hormones. Early menopause can develop after various gynecological procedures such as endometrial ablation and uterine artery embolization.

Cancer treatments such as chemotherapy and radiation therapy can also cause menopause. Menopause symptoms may be seen during or immediately after treatment. In some cases, menstrual periods return after chemotherapy. Therefore, pregnancy may occur after treatment. Radiation therapy directed at the pelvis, abdomen, and lower spine can cause menopause. Total body radiation therapy for stem cell transplantation can also result in menopause. However, radiation therapy applied to body areas such as breast tissue, head, or neck generally does not affect the menopause process.

How is Menopause Diagnosed?

A diagnosis of menopause is usually made by tracking and discussing cycles over the last year. Distinguishing symptoms also help in the diagnosis stage. Tests are generally not necessary to diagnose menopause. However, doctors may sometimes request various blood and hormone level check tests during the diagnosis stage. For example, blood tests can be applied to determine thyroid-stimulating hormone levels. This is because hyperthyroidism can cause symptoms similar to menopause symptoms. The tests applied are useful in diagnosing whether there is another underlying health problem for the symptoms. Follicle-stimulating hormone levels increase during the menopause period, while estrogen levels begin to decrease. Doctors may request various tests to see the levels of these two hormones during the diagnosis stage.

What Should Be Considered During the Menopause Process?

There are some points to consider to alleviate uncomfortable symptoms during the menopause process. Alleviating symptoms is beneficial in improving quality of life and preventing problems that may occur during daily activities. Some women in the menopause period may experience itching, pain, and various problems during sexual intercourse due to vaginal dryness. This situation should be discussed with an obstetrician and gynecologist. Doctors can provide personalized advice, apply appropriate hormone treatments, and recommend various lifestyle changes.

Insomnia, one of the uncomfortable symptoms of menopause, can lead to additional health problems such as memory gaps, low quality of life, and depression. Consulting a physician is recommended to prevent sleep problems. Foods containing melatonin can directly affect sleep quality positively. Foods such as eggs, fish, nuts, cherries, and strawberries have high melatonin levels. Yoga, meditation, relaxing physical exercises, and therapies applied by experts can be beneficial in alleviating anxiety and depression. The frequency of women experiencing urinary tract infections may increase during the menopause period. Therefore, it may be necessary to pay attention to personal hygiene and get support from various supplements to prevent infection.

Menopause can cause the metabolism to slow down. Weight gain may develop due to the slowing of the metabolism. Various studies have proven that the risk of obesity for women in the menopause period is five times higher than before menopause. Therefore, adopting healthy eating habits and balancing fat and carbohydrate intake can help maintain weight control and is also beneficial in protecting against chronic diseases related to lipid metabolism disorders. There is a possibility that cigarette consumption may prolong the duration of the uncomfortable symptoms of menopause. Therefore, a smoke-free lifestyle may be recommended for women who have a smoking habit.

Osteoporosis is a chronic health problem that can affect many women during menopause and can have serious consequences. The probability of developing osteoporosis is higher, especially in women with low vitamin D levels. Correcting vitamin D deficiency can reduce the risk of developing bone fractures related to osteoporosis. Getting adequate levels of B vitamins is beneficial in preventing cognitive dysfunction and retardation, which are common in menopause. Vitamin C is necessary for bone formation due to its role in collagen formation. Fresh fruits and vegetables that are sources of vitamin C, especially peppers, currants, and citrus fruits, can be included in the diet routine.

Frequently Asked Questions

A woman not having menstrual bleeding for 12 months for no reason is the primary indicator that she has entered menopause. Also, although not seen in every woman, symptoms such as hot flashes, insomnia, night sweats, anxiety, and depression can be harbingers of menopause. A woman who suspects she has entered menopause should first consult an obstetrician and gynecologist to ensure that her symptoms are due to menopause, as some diseases can cause menopause-like symptoms. Women diagnosed with menopause can use medications and supplements recommended by the doctor to alleviate symptoms and adopt healthy lifestyle habits such as regular exercise and a balanced diet. Menopause is a natural process that usually develops in women between the ages of 45-55. It can be seen at an earlier age in some women and at a later age in others. A woman who enters menopause does not get pregnant, but there is a possibility of pregnancy, albeit low, during the menopause transition period. If pregnancy is not desired, protection should be provided with various birth control methods. There is no cure for menopause. However, various practices can be performed to protect against the uncomfortable effects of symptoms. First, existing vitamin and mineral deficiencies should be corrected to protect general health. Then, foods that are good for bone health and insomnia can be added to the diet routine. A portable fan can be used against hot flashes. In the early times of menopause, that is, during the transition period, pregnancy can occur while menstrual bleeding occurs, even if irregularly. If no menstrual bleeding is seen for a year and menopause symptoms have begun to subside, the postmenopause (post-menopause) period may have been entered. Protecting during sexual intercourse is necessary not only to prevent pregnancy but also to prevent sexually transmitted infections that may occur. Therefore, it is necessary to continue protection even after entering menopause. In the perimenopause period, menstruation can occur at variable intervals. This situation varies from person to person. However, menstrual bleeding does not occur during the menopause period. This is because egg reserves are depleted and hormone secretions have decreased. In case of not menstruating, an obstetrician and gynecologist must be consulted because every case of not menstruating is not a symptom of menopause. It may be a harbinger of a more serious underlying condition.

Menopause is a natural phase of the female reproductive cycle. However, significant hormonal and biological changes can be experienced during this process, and some complaints may arise. It is recommended that women experiencing menopause symptoms consult our specialist physicians to obtain accurate information and have the necessary examinations performed. You can contact our Hisar Hospital Obstetrics and Gynecology specialists for a healthier menopause process.