Menopause is a word formed by combining the words meno and pause in Latin and adapted to our language, the word menopause, which means “stopping menstrual bleeding”. Menopause refers to the period when a woman’s regular menstrual bleeding disappears. Menopause is one of the phases of a woman’s life and is the result of a natural process. In our society, as a common belief, the menopause period is seen as the beginning of the old age period. Considering the tendency of the average human lifespan to exceed the 80’s, it is noticed that the menopause period actually covers a significant part of human life.
WHAT CAUSES EARLY MENOPEASE?
It is observed that women who have never given birth enter menopause early. Studies show that mother and daughter enter menopause at about the same age. This suggests that the age at menopause is closely related to hereditary characteristics. It is observed that women with malnutrition and adopting a vegetarian diet enter menopause at a relatively earlier age. Women who use excessive alcohol enter menopause later. The most likely reason for this is that these women have higher estrogen hormone levels due to the effects of alcohol on the liver. Underweight women tend to enter menopause earlier. This is due to the fact that these women cannot benefit from the contribution of adipose tissue to estrogen production. Work life and other living conditions are not thought to affect the age at menopause. Those living at higher elevations enter menopause earlier. Women who have had gynecological surgery in which the blood circulation of the ovaries is affected (such as removal of the uterus) may enter menopause at an earlier age. Women born with intrauterine growth retardation (low weight) enter menopause earlier.
SYMPTOMS OF MENOPEASE
Hot Flashes and Sleep Disorders
Menopause can cause insomnia or a decrease in sleep quality with the effect of hot flashes on the one hand and the group of symptoms grouped as “strange symptoms” on the other. In addition, it is known that estrogen hormone deficiency affects the brain directly and negatively affects sleep characteristics. In addition, hot flashes occur with the effect of increased LH.
When sleep disorders continue for a long time, they can lead to tension, irritability, fatigue, weakness, forgetfulness, waking up tired and concentration disorders.
Estrogen hormone therapy has an important place in the treatment of sleep disorders that occur during menopause. It has been shown in clinical trials that estrogen hormone shortens the time it takes to fall asleep and improves sleep quality.
Genito Urinary System Disorders
Difficulty urinating due to estrogen deficiency, burning, itching, sexual reluctance, difficulty in sexual relations called dysparania and pain are seen. Estrogen preparations used systemically and locally are quite effective in their treatment.
Bone Resorption (Osteoropause)
It is a disease caused by the deterioration of the balance between bone formation (osteoblastic) and bone destruction (osteoclastic) due to estrogen deficiency, against the formation and in favor of the destruction. More detailed information about osteoporosis and its treatment is given below.
It is known that the risk of having a heart attack increases 5 times more in women who have gone through menopause due to estrogen deficiency. This situation is attributed to the deterioration of the balance of cholesterol, lipoproteins, low and high density lipoproteins due to estrogen deficiency. Therefore, women who have entered the menopause should have a check-up at least once a year in terms of cardiovascular diseases.
Age at Menopause
The mean age of a woman at menopause is considered to be 49.3 ±5 years. The average age of menopause is 47 in Turkey and 51 in the USA. About 1% of women go through menopause before the age of 40. Age at menopause is determined as hereditary and is not affected by variables such as age at first menstruation, breastfeeding, use of birth control pills, race, education, height and last gestational age. Since smoking causes the death of egg cells, it has been determined that the age of entering menopause decreases by 1-2 years, especially in women who smoke 20 or more cigarettes a day.
Why Are Menstrual Bleeding Interrupted?
Menstrual bleeding is a process that consists of bleeding out in order to “refresh” the inner layer of the uterus, which prepares for a possible pregnancy every month in the course of the menstrual cycle, in case pregnancy does not occur. In each menstrual cycle in the ovaries, an egg cell enters the maturation process and begins to secrete estrogen hormone, and the inner layer of the uterus thickens with the effect of this hormone. When the egg cell reaches a certain maturity, ovulation occurs. With the effect of progesterone hormone, which comes into play after ovulation, the inner layer of the uterus is made suitable for pregnancy. A girl is born with a certain number of egg cells in both ovaries. This group of cells can be referred to as the “ovarian pool” for easy understanding.
While the number of egg cells in the pool is approximately 6-7 million in intrauterine life, it decreases to 1-2 million at birth. When it comes to puberty, the total number of egg cells in the ovaries has decreased to 300-400 thousand. The reason for this decrease in the number is not known exactly, but probably the egg cells with the most suitable genetic characteristics, namely the highest quality, survive, while the others are disposed of unused. Thus, it is aimed to ensure that the new generation that will be formed by the fertilization of the egg cell is genetically perfect.
The decrease in the number of egg cells continues in the reproductive age and in a woman, hundreds of primitive egg cells are activated every month during the entire reproductive age, 10 to 15 of them become antral follicles, only 1 of them becomes a dominant (dominant) follicle and ovulation takes place from this follicle. In other words, out of hundreds of thousands of primitive egg cells, only 400 of them can lay eggs during their 30-year reproductive life. When the egg cells are completely depleted in the ovary pool, ovulation stops and the regeneration process of the inner layer of the uterus ends, as estrogen and progesterone hormones cannot be secreted. Thus, menstrual bleeding also disappears and the menopause period begins.
Follow-up in Menopause
Annual Complete Blood Count, biochemistry, cardiological screening, mammography every year, Bone Mineral Densitometry every 2 years, Transvaginal Ultrasonography, Hormone tests, Cancer markers (CA-125, CA-19.9 , CA-15,3 , CEA) .
HOW IS MENOPAUSE TREATMENT?
There are currently 2 treatment indication criteria in menopause.
1-Hot flashes, insomnia, depression
2-Bone resorption (osteoporosis)
1-Hormone replacement therapy:
After entering the menopause, if there is no risk (these risks are the risk of breast, uterus, cardiovascular diseases), estrogen therapy can be performed for 5 years. This treatment can be in the form of oral, dermal, nasal (nasal), vaginal or injection. It should be given especially before the age of 50. After the age of 55-60, hormone replacement therapy is not performed. As described above, this treatment should be done if there are hot flashes and osteoporosis.
They are herbal-derived estrogen-like drugs, usually made from soy products. These drugs are known to be effective in preventing hot flashes and osteoporosis, as well as preventing breast and uterine cancers. This type of herbal products are also effective in prostate cancer in men.
3-Local estrogen creams:
It is especially effective in genital urinary system complaints. It is effective in complaints such as burning, pain, dryness and itching during sexual intercourse, burning during urination, urinary incontinence.
These have positive effects on libido as well as preventing menopausal complaints and bone resorption by acting at the endorphin level (livial tb.).
Diet rich in calcium (more than 1000mg in 1 day), milk and its products are especially effective in terms of bone loss. Diet rich in soy is very important especially in patients who cannot use estrogen.
Exercises that correspond to walking for 1 hour 5 days a week are very important in menopause.
7-Treatment in patients with osteoporosis:
If there is no risk, estrogen replacement therapy should be performed first.