Interview
Menopause: a natural event in a woman's life
A natural passage, and a manageable one. What are the symptoms and how are they treated? Gynaecologist Anna Athanasaki talks about the treatment plan and about relieving all the unpleasant symptoms so that, with the right information and psychological support, we can better understand and manage this stage of our lives.
What is the menopause and at what age does it appear?
It is the period during which a woman stops having periods for more than 12 months. This marks the end of the production of ovarian hormones, which is responsible for a series of physiological changes: in the vagina, in the internal genital organs, in the bones, in the skin, and it may also affect her cardiovascular system as well as her psychological state.
In our country the average age at which a woman enters the menopause is 48-51 years, but it can occur between the ages of 45 and 55. However, due to genes, illness or medical procedures (surgical removal of the uterus, removal of the ovaries, radiotherapy or chemotherapy), some women go through the menopause at a younger age.
What are the symptoms?
Hot flushes, in a large proportion of women. This is a sensation of heat, mainly in the face or across the rest of the body, lasting a few seconds. It may of course be accompanied by facial flushing, sweating and palpitations.
Vaginal dryness and a reduction in vaginal secretions, resulting in discomfort or even pain during sexual intercourse.
- Thinning and dryness of the skin.
- Changes in the shape and texture of the breasts.
- Changes in mood, irritability, anxiety, migraines, weight gain.
- Reduced sexual desire (libido).
- Urinary disturbances, night-time incontinence, bedwetting, more frequent urinary infections.
What gynaecological problems can follow as a result?
In the cardiovascular system, where the lack of oestrogen has a harmful effect, because oestrogens act beneficially on the coronary vessels as well as on lipid metabolism. This is why an increase in cholesterol and triglycerides is often observed, together with an increase in cardiovascular events. There is also loss of bone mass, that is a reduction of calcium in the bones, leading to osteopenia or osteoporosis, with pathological fractures as a consequence.
The effects on the genital system are atrophic changes of the vagina and the cervix and a reduction in the size of the ovaries. Muscle tone in the pelvic floor is progressively lost and vaginal laxity appears.
Treatment
Treatments focus on relieving the symptoms and on preventing or managing chronic conditions that may appear with the menopause, and they include:
Hormone therapy. Treatment with oestrogen, with or without progestogen, is the most effective therapeutic option for relieving, above all, the hot flushes of the menopause. As an alternative, plant oestrogens are given. The administration of oestrogen has a beneficial effect on vaginal and vulvar atrophy and is contraindicated in breast cancer, endometrial hyperplasia, liver disease, clotting disorders and a history of thromboembolic events. In women with varicose veins of the lower limbs and in smokers, the risk of a thromboembolic event should be emphasised. The choice of HRT (Hormone Replacement Therapy) must be individualised and preceded by gynaecological and haematological testing.
As for dietary supplements, there is a wide variety - for example soy isoflavones combined with melatonin and magnesium, which also reduce the feeling of chronic fatigue and improve sleep.
Vaginal oestrogens. To relieve vaginal dryness, oestrogen can be administered directly into the vagina, using a vaginal cream, tablet or ring. This treatment releases only a small amount of oestrogen, which is absorbed by the tissues of the vagina. It can help relieve vaginal dryness and discomfort during intercourse. Alternatively, there are lubricating and moisturising treatments for the vagina, as well as modern vaginal tightening treatments with laser and the injection of hyaluronic acid.
What does early menopause mean for a woman and what problems does it bring?
It is the menopause that appears before the age of 40, and the causes are usually genetic, hereditary or related to autoimmune diseases. Every woman in early menopause should seek the advice of her gynaecologist for treatment and of her endocrinologist, so that osteopenia or osteoporosis can be diagnosed in time.
Is there a difference between the menopause and the climacteric?
The climacteric is the period before the menopause becomes established and includes irregular cycles (frequent periods, infrequent periods, heavy bleeding), vaginal dryness and fluctuations in mood, over 1-5 years.
Which factors influence the menopause?
They are mainly hereditary, but also genetic, and of course medical causes (for example surgery on the ovaries or the uterus).
Does a healthy lifestyle - diet and physical exercise - help improve the symptoms?
Very clearly, a healthy diet and physical exercise can contribute to managing many symptoms, such as hot flushes, vaginal laxity and changes in fat distribution, but above all they help reduce cardiovascular disease.
The menopause, then, is a natural event, a very important one in a woman's life, which should not be met with awe, fear and anxiety, but with proper information about how the symptoms can be managed.
