Menopause usually occurs in women between the ages of 45 and 60. During this time, the body’s production of sex hormones decreases and the ability to reproduce recedes. At the same time, but also four to five years earlier, more or less pronounced complaints such as hot flashes, sweating and emotional changes can cause problems.
What causes the typical complaints?
Climacteric and menopausal symptoms are caused by the ovaries initially limiting their function and then very gradually ceasing to function. The sex hormones they produce (estrogens and progestins) have multiple physiological roles that go far beyond reproduction. Conversely, this means that not only does pregnancy become impossible, but other impairments are also possible, e.g. to the uterus, the vagina, the mammary gland and also to non-sex-specific organs such as the bones, the liver and the circulatory system.
What are the typical menopausal symptoms?
- Hot flashes (70%),
- Sweating (55%)
- Dizziness (45%)
These complaints arise as a result of hormone deficiency first and last about 3 to 5 years. How strong the symptoms are pronounced, is quite different from woman to woman and depends strongly on the individual vegetative and psychological constitution. After 10 to 15 years, other symptoms may appear. For example: arteriosclerosis, a lowering of the uterus, bladder dysfunction such as a violent urge to urinate, recurrent infections, as well as a drying out of the vagina or osteoporosis.
Phases of menopause
Menopause progresses over several years in different phases.
- Premenopause refers to the time when the change is announced. Around the age of 40, the first symptoms may appear. It can then come to bleeding irregularities and various complaints.
- The term menopause refers to the very last menstrual period. To be really sure whether it is menopause, you still have to wait about a year. If you are unsure, you should consult your doctor.
- Postmenopause includes the decade after menopause. In the ovaries are now formed smaller and smaller amounts of estrogens and progestins, until the production is finally completely stopped.
Treatment of menopausal symptoms
An integral part of a treatment of the symptoms are the so-called non-drug measures:
- Switching to a healthy diet with little caffeine, alcohol and nicotine.
- Stress avoidance and more exercise
- Conscious relaxation e.g. with yoga, acupuncture, etc.
These measures also serve to maintain health and well-being for a long time.
Hormone therapy
If primarily the declining hormone production in menopause is responsible for the physical and mental discomfort, it seems reasonable and logical to replace these missing hormones, thus combating troublesome symptoms through hormone administration. Combination preparations with an estrogen and a progestin component are predominantly used. Today, pure estrogen preparations are generally only prescribed for women who have had their uterus surgically removed. In order to individualize the therapy, it should first be taken into account in which phase of menopause the woman is. Study results from the USA and the discussion they have sparked in the media about the relationship between the benefits and risks of hormone replacement therapy have prompted the Federal Institute for Drugs and Medical Devices (BfArM) to publish the following indications and conditions of use for hormone replacement therapy with estrogen-progestin combinations:
1. for menopausal symptoms:
- Only in the case of pronounced individual suffering pressure.
- Only after exclusion of risk factors (cardiovascular diseases, venous thromboembolic complications, cancer) and after informing the patient about the possible risks
- Duration of application as short as possible (e.g., 1 to 2 years and, if necessary, discontinuation attempts).
- Choose the estrogen dose as low as possible
2. to prevent osteoporosis (bone loss):
- For the prevention of osteoporosis, estrogen-progestin combinations should no longer be used in postmenopausal women
- For women at increased risk of osteoporosis, other available options should be considered as alternatives.
3. if there are signs of regression of the urinary and genital organs:
On the subject of protective function for the cardiovascular system, the BfArM states that the prevention of cardiovascular disease is not one of the approved indications for the estrogen-progestin combinations commonly used in Germany. Based on the current data, treatment for the purpose of prevention was not justified, it said.
Possible side effects
- Thrombosis, weight gain, high blood pressure.
- Increased risk of uterine or breast cancer (only with estrogen alone in women whose uterus is still present ).
- Skin reactions, breast tenderness
- Headache, dizziness
- Gastrointestinal complaints, liver dysfunction.
Contraindications to hormone therapy
Important contraindications to hormone replacement therapy include:
- Severe liver disease
- Increased risk of thrombosis, previous or existing thrombosis or embolism
- Estrogen-dependent tumors
- Endometriosis
- Diabetes mellitus with manifest vascular damage
- Difficult to adjust high blood pressure
Herbal medicines
In the treatment of menopausal symptoms, herbal medicines are also available today. Phytotherapy is particularly suitable for treating the immediate reactions after the cessation of estrogen production, such as sweating, hot flashes and dizziness.
Black cohosh
However, herbal medicines are also significant for women who are not allowed or do not want to take hormone preparations in principle, for example, women with a tendency to vascular occlusion or certain liver diseases. Cimicifuga racemosa (black cohosh) is of greatest importance in the treatment of menopausal symptoms. Climacteric symptoms usually improve after a period of use of 4 to 6 weeks. Medicines containing the active ingredient of black cohosh can, incidentally, also be taken together with hormone preparations, since no corresponding interactions or contraindications are known.
St. John’s wort for depressive moods
In addition to Cimicifuga, St. John’s wort (Hyperici herba) plays an important role in the treatment of mental disorders. It remedies states of anxiety and tension as well as depressive moods. The effect sets in after about one to two weeks. When taking St. John’s wort, intense sun exposure should be avoided, especially for fair-skinned people, due to a possible photosensitizing effect.
Homeopathics
Homeopathic remedies are also successfully used in the treatment of climacteric symptoms, most commonly Acidum sulfuricum, Aristolochia, Cimicifuga, Lachesis, and Sepia, respectively. An initial worsening of the symptoms does not have to occur, but on the other hand it is a good sign for the therapy and means that the appropriate remedy has been found for the patient.
Bach Flower Therapy
Bach Flower Therapy causes a spiritual harmonization between the core of the patient and his daily behavior at the personality level. The flowers are selected depending on the patient’s state of mind. Physical symptoms, on the other hand, do not play a role.
Summary
There are a variety of ways to influence menopausal symptoms, and especially the combination of different therapeutic directions can yield increased effectiveness and an even more individualized therapy. The individual situation is crucial, and the patient’s wishes regarding the direction of therapy should be taken into account.
