What is menopause?

Menopause is the last menstruation in a woman's life. It is determined backwards, after the woman has had no more menstrual periods for 12 months. Thus, a woman can not know exactly when she is experiencing the menopause.

The menopause is a sign that the ovarian function, where mature eggs or female genital cells and sex hormones develop, has ceased. About 400,000 egg cells are in the ovaries. Over the years, the number of egg cells is decreasing. Menopause occurs when the ovaries no longer contain egg cells and cease their normal hormonal function. Due to the lack of hormones, menstruation fails. When the menopause occurs, the woman no longer has a natural fertility.

The transition to menopause is marked as a period of physiological change when a woman reaches a reproductive biological age. During this period, the woman faces transient changes in her health and quality of life. Most problems are associated with an estrogen deficiency.

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Hormonal changes

The ovaries produce the female sex hormones estrogen and progesterone. Their production is regulated by the reverse connection hypothalamus-hypophysis-ovary. This, together with the uterus, becomes dysfunctional during the menopause and stops functioning in a healthy woman much earlier than other female organs.

The amount of estrogen begins to decrease even before the symptoms of menopause are observed. The result is an increase in the amount of the FSH (follicle-stimulating hormone). The FSH values above 30 IU/L are characteristic for menopause.

Estrogen and progesterone play an important role both for the sexual organs and for the whole organism. They are crucial in conceiving and maintaining pregnancy, building bones and fat metabolism and affecting the cardiovascular and nervous system.

After the onset of menopause, the woman spends the rest of her life in a hormonal deficit that reflects differently on the quality of her life. If a woman had her ovaries surgically removed due to illness or irradiation, she will enter the menopause regardless.



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Hormonske spremembe

V jajčnikih nastajata ženska spolna hormona estrogen in progesteron. Njuno nastajanje uravnava povratna zveza hipotalamus-hipofiza-jajčniki. Ta skupaj z maternico postane v menopavzi nefunkcionalna in preneha z delovanjem pri zdravi ženski veliko prej kot ostali ženski organi.

Količina estrogena se začne zmanjševati, še preden opazimo simptome menopavze. Posledica je povečanje količine hormona FSH (folikel stimulirajoči hormon). Vrednosti hormona FSH nad 30 IE/L so značilne za pomenopavzo.

Estrogen in progesteron imata pomembno vlogo tako za spolne organe kot za celoten organizem. Ključna sta pri spočetju in vzdrževanju nosečnosti, izgradnji kosti in presnovi maščobe ter vplivata na srčno-žilni in živčni sistem.

Po nastopu menopavze ženska preživi ostanek življenja v hormonskem primanjkljaju, ki se različno odraža na kakovosti njenega življenja. Če ženski zaradi bolezni ali obsevanja operativno odstranijo jajčnike, tudi takšna ženska vstopi v menopavzo.



When does it occur?

In the developed world, menopause occurs between the ages of 48 and 52. In Europe, the average age when menopause occurs is 50.5 years. We talk about "premature" menopause when it occurs before the age of 40, and "early" when it occurs before the age of 45. In "treatment-induced" or iatrogenic menopause, there is a permanent loss of menstruation due to surgery on the reproductive organs, irradiation or chemotherapy.

 

Kdaj nastopi?

V razvitem svetu nastopi menopavza med 48. in 52. letom starosti. V Evropi je povprečna starost nastopa menopavze 50,5 leta. O »prezgodnji« menopavzi govorimo, kadar ta nastopi pred 40. letom, o »zgodnji« pa, kadar nastopi pred 45. letom. Pri »z zdravljenjem povzročeni« oziroma iatrogeni menopavzi pride do trajne izgube menstruacije zaradi operacije na rodilih, obsevanja ali kemoterapije.

 
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Time periods of menopause

PERIMENOPAUSE

This is a period that begins 2 to 5 years before menopause and lasts for 1 year after the menopause. The average perimenopause lasts about 4 years.

TRANSIENT MENOPAUSE PERIOD

This is the period before the menopause. During the reproductive period, most women have regular menstrual cycles and low FSH hormone levels. An irregular cycle occurs approximately two years before the onset of menopause. The values of the FSH hormone are already elevated, but rather fluctuate. Most women experience mild symptoms of menopause then.

The last year before the onset of menopause, the absence of menstrual cycle occurs for more than 60 days, and the FSH hormone level increases to more than 30 IU/I. In this period as many as 75 % of women have the following symptoms: hot flashes, night sweats and vaginal dryness. Common symptoms include energy decline, psychological problems, and poorer concentration.

POSTMENOPAUSE

It is the period after the last menstrual cycle, which lasts for the rest of a woman's life. For the early postmenopausal period, which lasts four to five years, elevated levels of FSH are characteristic that occasionally continue to fluctuate. After the onset of menopause, there are typical symptoms, including hot flashes, night sweats, sleep disorders, irritation, and memory and concentration problems. During the late menopause period, FSH hormone levels are elevated but stable. At the time, there are often problems with the reproductive organs and the urinary tract, which are seen as a shortening of the vagina and reduced elasticity and resistance. The vaginal mucous becomes thin, pale, has poorer blood circulation and less moisture. The folds of the mucous membrane disappear and the pH rises above 4.5. A feeling of dry, burning, itchy vagina and a painful sexual intercourse can occur. The urethra function is worsening.

CLIMACTERIUM

The climacterium is a period of several years before and 5 to 10 years after the menopause.

Symptoms of menopause

A woman may experience menopausal symptoms for several months or several years, but in average for 4 years. 10 % of women experience symptoms of the menopause even up to 12 years.

EARLY MENOPAUSAL ISSUES

A hot flash is the result of a sudden extension of the facial and neck vessels and usually takes 1–5 minutes. It is associated with strong sweating. The cause are lower estrogen and inhibin values and a higher FSH value. These signs are characteristic for the early menopause period. For some women, they can last much longer. The problems are more frequent in smokers and women with increased body weight.

This period is also characterized by insomnia. It most often occurs as a result of night sweats.

Mental issues such as anxiety, depression, mood swings, irritation and lack of energy occur mainly in women who have been prone to these problems in the past.

General fatigue and memory and concentration problems are also common menopausal issues and are associated with lower estrogen values.

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ISSUES IN THE MIDDLE PERIOD

Issues of genital organs and the urinary tract

Decreased estrogen levels affect the function of the vagina, urethra and bladder. A shortening of the vagina and reduced elasticity and resistance of the vagina occur. The mucous membrane in the vagina becomes thin and pale, the folds of the mucous membrane disappear. The result is dryness, painful sexual intercourse, an itching and burning vagina, and recurrent urogenital infections. In one term, these problems are called urogenital syndrome. Hot flashes and night sweats during the postmenopausal period eventually disappear, but the urogenital changes do not. This can lead to serious problems in the field of sexuality and quality of life. Often the sexual appetite and the ability of arousal are reduced, which leads to problems and disagreements in relationships.

Changes in the urethra are indicated as symptoms of the need for urination, frequent urination, urinating at night, and burning urination. Urinary infections and incontinence are also more frequent.

Weight gain

Obesity is much more prevalent during the postmenopuase period than the perimenopause. The cause lies in less physical activity, muscular atrophy and slower metabolism due to decreased estrogen levels. Most often, fat tissue increases in the abdomen. During this period, the shape of most women changes.

Cognitive functions

The decrease in memory and concentration in the menopause is associated with lower estrogen values during this period.


ISSUES DURING THE LATE PERIOD


Osteoporosis

Postmenopausal osteoporosis occurs due to the lack of the female sex hormone estrogen that is involved in the incorporation of calcium into the bones. Osteoporosis is a disease in which the mineral density and bone quality are reduced. The minimum bone mineral density (BMD) is highest at about the age of 25 years, then it slowly decreases until the menopause, and faster afterwards. The consequences are chronic pain, quicker muscle fatigue, loss of height, thoracic kyphosis, limited mobility and loss of independence. The most common are vertebral fractures, spinal deformity, femur, hip and larynx fractures, which lead to dependence and increased mortality.

Cardio-vascular disorders

The reduction of estrogen levels leads to the narrowing of blood vessels, therefore women develop high blood pressure problems shortly after the onset of menopause. LDL cholesterol and triglycerides (TG) cholesterol levels increase and the level of HDL cholesterol is reduced, which are risk factors for cardiovascular disease. The likelihood of a brain stroke in the first decade after the onset of menopause is 2 times greater than before and higher in women than in men. Mortality is also highly increased due to coronary heart disease.