What happens and at what age
- Perimenopause is a period of cycle instability before menopause; may last several years, it is at this time that the first symptoms usually appear
- Menopause is the last independent menstruation; established retrospectively, after 12 months of absence of menstruation
- Postmenopause - the entire subsequent period of life
- The average age of menopause is about 50 years
- Early menopause - before 45 years of age
- Premature ovarian failure - cessation of menstruation before age 40; requires mandatory examination and, as a rule, hormonal therapy
It is worth mentioning separately about perimenopause: it is during this period that the cycle becomes irregular and the symptoms are most pronounced. It is important to remember that pregnancy is still possible at this time, so contraception remains relevant.
Symptoms
- Hot flashes, usually to the face and upper body, with sweating
- Night sweats and associated awakenings
- Insomnia and decreased sleep quality
- Mood swings, irritability, anxiety, depression
- Decreased concentration and memory
- Vaginal dryness, discomfort and pain during intercourse
- Decreased sex drive
- Frequent urination, recurring cystitis, urinary incontinence
- Irregular cycles, changes in the nature of menstruation during perimenopause
- Pain in joints and muscles
- Dry skin, thinning and hair loss
- Weight gain, especially in the abdominal area
- Rapid heartbeat
Мочеполовые симптомы — сухость, дискомфорт, учащённое мочеиспускание, циститы — заслуживают отдельного внимания. В отличие от приливов, они не проходят со временем сами, а прогрессируют. При этом они прекрасно поддаются лечению местными эстрогенами, о чём многие женщины просто не знают.
Long-term consequences of estrogen deficiency
- Osteoporosis and increased risk of fractures - bone loss is particularly rapid in the first years after menopause
- Increased cardiovascular risk
- Adverse changes in lipid profile
- Insulin resistance and increased risk of diabetes
- Genitourinary syndrome: mucosal atrophy, recurrent cystitis, urinary incontinence
- Pelvic organ prolapse
- Deterioration of the condition of the skin and mucous membranes
Survey
- Examination by a gynecologist, Pap test and HPV test - screening continues during menopause
- Ultrasound of the pelvic organs with measurement of endometrial thickness
- FSH and estradiol - with atypical course and early menopause
- TSH - exclusion of thyroid diseases, the symptoms of which are similar
- Lipid profile, glucose, glycated hemoglobin
- Blood pressure and cardiovascular risk assessment
- Densitometry - assessment of bone density
- Mammography according to age schedule
- Complete blood count and ferritin
- Endometrial biopsy for bleeding or thickening of the endometrium
- Assessment of symptoms of depression during severe emotional manifestations
The diagnosis of menopause in a woman of typical age is made clinically, by the cessation of menstruation, and hormone tests are usually not needed for this. They are prescribed for early menopause, atypical symptoms, and to resolve the issue of therapy.
Treatment: what's available
- Menopausal hormone therapy (MHT) is the most effective method for severe hot flashes; prescribed by a doctor taking into account indications and contraindications
- Local estrogens - for dryness, discomfort, recurrent cystitis; act locally and have minimal systemic influence
- Non-hormonal drugs for contraindications to MHT
- Moisturizers and lubricants
- Calcium and vitamin D supplements
- Drugs for the treatment of osteoporosis with a confirmed decrease in bone density
- Regular physical activity, including strength and weight-bearing exercises
- Quitting smoking - it speeds up the onset of menopause and bone loss
- Limiting alcohol, caffeine, and spicy foods for hot flashes
- Body weight control
- Cognitive behavioral therapy for sleep disorders and anxiety
- Pelvic floor muscle training for urinary incontinence
About hormone therapy without myths
- MHT is most effective and safe when started in the first years after menopause, in women under 60 years of age
- It significantly reduces hot flashes, improves sleep, the condition of mucous membranes and protects bones
- The decision is made individually: age, time since menopause, cardiovascular risks, family history are assessed
- Contraindications include breast and endometrial cancer, thrombosis, severe liver disease, bleeding of unknown origin
- Before starting, mammography, ultrasound, assessment of the endometrium, lipids and pressure are required
- Therapy requires regular monitoring rather than a one-time prescription
- Local estrogens for genitourinary symptoms have significantly fewer restrictions and are suitable for most women
Страх перед гормональной терапией во многом основан на устаревших данных и их упрощённой интерпретации. Современный подход — индивидуальная оценка соотношения пользы и рисков, а не отказ по умолчанию. При этом решение всегда за врачом и пациенткой совместно, и оно не является обязательным: многим женщинам достаточно негормональных методов.
Where to watch in Tashkent
During this period, regular gynecological monitoring, cervical screening, endometrial assessment and attention to the bones and cardiovascular system are important.
In Tashkent, such observation and selection of treatment is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Remember one rule: any bleeding a year or more after your last menstrual period requires seeing a doctor, even if it is just a few drops. Otherwise, menopause is not a reason to endure discomfort: most symptoms are well controlled today. Clinic contacts are below.
