Definition of menopause

On average, one-third of a woman’s life is spent during menopause. Age at menopause has not changed much in the world and since ancient times and is around 45-55 on average. Menopause before age 40 is defined as “premature menopause”. Menopause is generally recognized as a natural stage of life. Indeed, menopause is a natural stage of a woman’s life after the ovulation functions have ended. However, some changes that occur in menopause affect the life of women deeply and so negatively that this situation causes many diseases to occur and decreases the quality of life of women. Today, menopause is accepted as a disease whose negative effects are tried to be prevented and treated. Since menopause is a natural part of women’s life, watching it without doing anything is now a thing of the past. This concept has come to the fore especially with the production and use of female ovarian hormones under laboratory conditions. By replacing the ovarian hormones that decrease in menopause, all negative changes and diseases related to menopause can be easily prevented or minimized.

The main change in menopause is the decrease in estrogen, the female hormone, as a result of the cessation of ovulation. Thus, in woman

  • Hot flashes, sweating, palpitations, insomnia, nervousness, (mental depression) depression, forgetfulness, weakness, irritability

  • Sometimes a decrease in sexual desire (libido)

  • Bone resorption (Osteoposis)

  • Tendency to develop atherosclerosis

  • Withdrawal (atrophy) of the genitals, dryness, painful intercourse

  • Atrophy of the urinary tract, up to urinary incontinence


Women do not find themselves in menopause when they wake up one morning. Menopause is the period in the middle of 20 years of changes. After the age of 40, women begin to experience irregular menstrual bleeding, intermittent hot flashes and sweating, and psychological changes due to the decrease in ovulation. Later, the complaints gradually increase and menstruation is completely stopped. In this period, the absence of menstrual bleeding for 1 year is sufficient for the diagnosis of menopause. A definitive diagnosis is made by investigating menstrual delays for more than 6 months and measuring estrogen and ovulation-stimulating hormone (FSH) levels in the blood. However, menstrual irregularities or irregular bleeding should not be considered normal with the thought of entering menopause; Considering that these changes can also be seen in pregnancy and cancers of the female genitals, these diseases should be carefully investigated by consulting the patient’s doctor.


With the decrease in the estrogen hormone in menopause, the risk of atherosclerosis and heart attack increases by 60%, since the protective effect of this hormone on cardiovascular diseases disappears in women. As a result of the studies, it was found that the externally given estrogen hormone reduces the risk by 25-50%. Estrogen hormone reduces harmful fats in the blood and increases beneficial fats. Estrogen also has a relaxing, positive effect on the veins directly. Coagulation factors and fibrinogen in the blood were also found to be less in those using estrogen, and it was reported that the protective effect from heart attack was also due to the decrease in the risk of clot formation in the vascular bed.

Bone lysis in menopause (OSTEOPOROsis)

Postmenopausal Osteoporosis, which is the problem of approximately 25 million women in the United States, is roughly the permanent loss of calcium, the essential mineral of bone tissue, as a result of aging and estrogen deficiency in menopause. While bone loss is 4-8% per year in the first 5-8 years, then it decreases partially, and the woman loses approximately 1% of her bone tissue every year, and by the age of 75 she has lost 30% of her bone tissue at the age of 35 on average. Accordingly, as a result of rapidly increasing bone resorption with menopause, silent spine fractures, low back pain, shortening in height and hunchback occur. After menopause, a woman’s height decreases by an average of 4 cm until the age of 65, and by 9 cm until the age of 75. The patient may develop respiratory distress as a result of the humpback and deterioration of the bone structure of the rib cage due to compression fractures in the spine bones. Women may also be more easily exposed to hip, wrist and other bone fractures as a result of impact and fall during menopause. The most serious of these fractures is hip fracture and 12-20% of patients die within 2 years after hip fracture. Some of the remaining patients who have had hip fractures need ongoing care. For this reason, the annual treatment and rehabilitation expenditures in the USA amount to 20 billion dollars and this figure is increasing every year. In this respect, protection emerges as the most economical, humane and easiest method. Risk factors that predispose to osteoporosis:

  • multiple childbearing

  • Smoking, alcohol use

  • Nutritional disorders (diet low in calcium)

  • Lack of sunbathing habit

  • Lack of exercise habit

  • Diseases that cause long-term confinement to bed

  • Some endocrine (hormonal) disorders (hyperparathyroidism, hyperthyroidism (goiter), excessive work of the adrenal gland or long-term use of steroid hormones as drugs, etc.)

  • Connective tissue diseases (rheumatoid arthritis, sarcoidosis), cirrhosis, kidney diseases, early menopause

  • Genetic factors (Familial presence of Osteoporosis)


The deficiency of the estrogen hormone also affects the urinary tract and bladder functions due to its proximity to the female organs and its physiological association. The supporting tissues of the vagina and urinary opening (urethra) weaken, bladder functions deteriorate and urinary incontinence may increase or occur if there is any. In this period, bladder herniation, uterine and vaginal sagging due to atrophy may also be a cause of urinary incontinence. However, the most common cause of urinary incontinence seen in menopause is excessive activity (detrusor instability) due to untimely contraction of the bladder. These patients usually cannot catch up when they are stuck and leak their urine at the toilet door. This condition, which is seen in 10% of women in the premenopausal period, is encountered in 20-30% of women after menopause. Vaginal or oral estrogen hormone reduces or corrects the complaints.


The most important prerequisite for minimizing the negative effects of menopause is to diagnose it at the earliest stage and start early treatment. Because the losses in menopause are greatest in the first years. Menopause is basically caused by the cessation of ovulation (natural) or the removal of the ovaries (surgery) or when they are damaged too much to function. A woman who has not had a menstrual period for 1 year after the age of 40 and has complaints can be considered menopausal without further research. During the transition to menopause, pregnancy and malignant diseases that cause irregular bleeding should be distinguished. For this reason, if the ovarian stimulating hormone (FSH, LH) levels are increased in the blood taken on the 3rd day of menstruation of a woman who has infrequent menstruation, hot flashes, palpitations, sweating and psychological changes, the diagnosis will be made more precisely and earlier, and treatment can be started immediately. If the FSH is above 40 pg/ml in a woman with irregular (usually infrequent) menstruation, the diagnosis of menopause is definitely made. If the FSH value is between 25-40 pg/ml, it is thought that the menopausal process has started, but ovulation and pregnancy may also occur, albeit rarely. However, in any case, pregnancy and other diseases that cause irregular bleeding should be investigated with pregnancy test, ultrasonography and endometrial biopsy (abortion), etc.


Since the main disorder or deficiency is the decrease of estrogen hormone, the main treatment is to give estrogen hormone. As soon as the diagnosis is made, if there is no inconvenience for the patient;

  • Oral

  • With tapes or gels applied to the skin

  • vaginally

It is essential to begin estrogen replacement therapy.

Conditions that prevent the use of hormones:

  • Those who have had a recent heart attack (myocardial infarction)

  • Transient ischemic attack

  • Previous stroke (cerebrovascular accident), cerebral vascular occlusions

  • impaired liver function

  • Presence of tumor progressing with estrogen (Breast, uterus)

  • Thromboembolism (vascular occlusion with intravascular coagulation)

Situations to be used with caution and control:

  • Ischemic disease of the heart (nutritional disorder due to atherosclerosis)

  • Hypertension (high blood pressure)

  • Gallbladder diseases and stones

  • Diabetes Mellitus

  • Hyperlipemia (high blood fat, cholesterol, ratio)

  • Migraine headaches

  • Myoma (tumor in the uterus)

Before starting hormone therapy, the patient should be aware of the possible side effects of these drugs and the conditions that may arise due to their use for many years, and preliminary preparations should be made.

Preliminary research:

  • General body and gynecological examination, blood pressure, weight, weight measurement

  • Liver functions (liver enzymes, fats, cholesterol in the blood are measured)

  • Blood and urine test (general control)

  • Cervical smear (swabs taken to investigate cervical cancer)

  • Mammography (Breast cancer screening)

  • Endometrial thickness measurement with endometrial biopsy and/or vaginal ultrasound (screening for uterine cancer)

  • Fasting Blood Sugar (Diabetes research)

  • Electrocardiography (Investigation of heart attack or malnutrition)

  • Bone density measurements if needed (to prevent fractures and to investigate the need for other medications)

These examinations are repeated at least 1 year intervals, depending on the patient’s condition.


It usually includes drugs and methods used not directly against menopause, but against the diseases it causes (Osteoporosis, etc.).

  • calcium supplement

  • bisphosphonates

  • Vitamin D


A diet rich in calcium is essential. It is tried to prevent bone loss with milk, yoghurt, cheese, etc. diet.


30 minutes of walking each day and simple weight lifting, muscle-strengthening movements are just as important as medications. Regular sunbathing is beneficial in order to benefit from sunlight (ultra-violet) in summer.


Although the aim is to prevent diseases, when they cannot be prevented, appropriate treatments are applied.


If a fracture has occurred, appropriate treatment is performed and rehabilitation is provided with physical therapy. It is tried to help the patient with physical therapy and appropriate tools for pain and respiratory distress caused by hunchback due to fractures. In order to prevent the formation of fractures, the house should be rearranged according to the patient. Arms are made to hold onto the sides of the stairs, the bathroom and the toilet. Lamps with special batteries or generators can be placed on the stairs to prevent bumps and falls that may occur during a power cut. Slippery covering materials (carpet, rug, etc.) on the floor can be fixed.

Urinary Incontinence

It varies according to sagging of the bladder neck or increased bladder activity (detrusor instability). Surgery in cases of increased bladder neck mobility; In urinary incontinence due to untimely contraction of the bladder muscle, medications, physical therapy and/or treatments based on electrical simulation of the bladder are appropriate. The choice of treatment should be decided by an examination performed by a specialist physician, laboratory and urodynamic studies (computer recording of bladder filling, voiding and incontinence pressures). In poorly selected patients, treatment may not improve urinary incontinence, but may increase it.


Disorders such as cessation of menstruation, hot flashes, sweating, and loss of childbearing ability, especially in the first years, may cause incomplete femininity, isolation, depression, introversion, insomnia, excessive irritability and aggression. In this case, the advice and treatment of a psychiatrist is needed. Trying to get used to it can deepen the problem.

Sexual Issues

Sexual desire is not affected by menopause. Sexuality is a learned behavior in women. It is quite natural that the sexual life of women in menopause becomes more colorful as a result of the disappearance of the fear of pregnancy in general, the decrease in the anxieties arising from professional life (career, making money, etc.), the decrease in physical dependence with the growing up of their children, the experience of years, and the fact that the spouses get to know each other better.

Knowing that there will be some decrease in sexual desire (libido) during periods of depression and adjustment period that may occur during menopause, it is the most rational way to seek appropriate counseling and treatments without panicking. Otherwise, feelings of lack of femininity, worthlessness, being sick, and decreased sexual desire may last for a long time or be permanent. Before the decrease in sexual desire, painful intercourse and a related reluctance may occur due to vaginal entrance and vaginal withdrawal (atrophy) and dryness in menopause. In such cases, the problem is solved with local hormone or lubricant gel applications. Remember “Life begins at forty”.

Menopause and Family

Menopause is a difficult problem for women to overcome alone. Spouse and children should be helpful and understanding to the woman during this period. A woman meets menopause most easily with the support and suggestions of her relatives. These support and suggestions may be in the form of providing psychological information, information or continuation of treatment.

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