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Your menopause guide

The changes you go through after the end of the reproductive stage of life are called menopause. The main signs of this period, problems that arise in the process and options for their solution – in the new Encyclopedia's text for the School of Women's Health Dr. Silina.

What is menopause

The term menopause describes changes during the end of a woman’s reproductive period. It’s about the cessation of the menstrual cycle, hormonal changes in the body and the corresponding transformations in your physiology. Relatively speaking, it is about the ovaries falling asleep. 

There is an offensive association in Ukrainian society: menopause equals aging and loss of everything in a woman’s life. In the word  «everything» a woman puts the loss of sexuality, and ability to work, the losses in the quality of life and transformation into caricatured Old Witch. The classic fairy-tale prototype of a woman dissatisfied with life, has hunched back, a bunch of wrinkles, no teeth, the one who is engaged in intrigues and spoils the lives of others. During consultations, some women use this word.
«Doctor, I am afraid that my ovaries will stop working, and I will turn into Old Witch».
Indeed, changes in posture, deformation of the spine, deterioration of teeth, irritability and mood disorders can be the consequences of menopause. Although just if they are not corrected in a timely manner.

Gynecologist-endocrinologist, founder of the School of Women’s Health Natalia Silina

The age of menopause

Normally, menopause starts after 40 years, if it happens earlier – it is called premature menopause. It is a gradual process that can take from four to twelve years. It is usually divided into premenopause, menopause and postmenopause. The duration of the transition depends on many factors, including ethnicity, weight and lifestyle. In Ukraine, the average age of menopause is 45 years.

менопауза menopause
In general, menopause is an absolutely natural process that every woman goes through

Modern medical science will help to make it easy and eliminate problems that arise on the way

It is important to remember that in the civilized world, 45 years is a period that is considered to be the beginning of the blossoming in a woman’s life. I remember when Sheila Dillon, a journalist of BBC Radio 4 told me:
«Only at the age of 40 I’ve realized what I truly wanted and started my career at the BBC».
Sheila has been born in the last year of the World War II and now produces cool investigative programs about food. I advise you to watch it. Moreover, Sheila is a member of the jury of The BBC Food & Farming Awards. It’s an award for the top food producers who improve health in the community. For example, in 2022, the nominee was an organization that promotes deer meat with the motto «venison is not food just for the rich». The company has established affordable supplies to schools in Scotland so that children can eat lean meat, rich with protein and high iron content. Sheila is also the author of The Food Program podcast.
For those who have not had time to calculate her age. Sheila is 78 years old, and she is an example for me personally how a woman becomes more beautiful with age, both professionally and personally. Therefore, stop thinking that menopause is the age of losses. This is the age of losses, if we, women, support this statement and do not change our habits.

Gynecologist-endocrinologist, founder of the School of Women’s Health, Natalia Silina.

Causes of menopause

Eggs are running out

Menopause occurs when the ovaries run out of functional follicles. When a girl is born, she usually has from one to three million follicles, but by the time she reaches the age of menarche, there are about 400 thousand of them left. Approaching menopause, a woman has about 10 thousand follicles.

A small percentage is lost through natural ovulation, but most die in a process called atresia. During it, the body gets rid of follicles unable to develop and release an egg. It is also a normal and regulated process in our body. Without it, ovulation would stop in a few months.

There are diseases when follicular atresia is not normal, but is a sign of the disease and the cause of infertility. For example, polycystic ovary syndrome or thyroid dysfunction or stress activation of the adrenal glands, which is common during the war. But follicular atresia, as a type of ovarian dysfunction, is also common among the women in Britain, France, Italy, and other countries where women have excessive loads of various social stereotypes and requirements. Therefore, episodes of follicular atresia after 40 are a variant of the age norm, but earlier are a reason to start working with your doctor.

Gynecologist-endocrinologist, founder of the School of Women’s Health Natalia Silina

Hormonal changes

Additionally, with the approach of menopause, eggs become more resistant to follicle-stimulating hormone (FSH), and the ovaries themselves dramatically reduce the production of the main female hormones: estrogen and progesterone. No estrogen – no menstruation, while sexual desire decreases. The latter is also affected by the fact that the ovaries reduce the production of testosterone.

Symptoms

If you have not had your period for 12 months, and you have no health problems or pregnancy – all of this may indicate the onset of menopause. There are women who do not have any symptoms at all, but about 90% have some signs. This definition is given by many websites. But the absence of menstruation for 12 months even at the age of 45 is not always about the ovaries falling asleep.

Below, we will talk about conditionally specific complaints signing of menopause and premenopause.

What does approaching menopause look like?

The first symptoms usually appear months or years before menopause itself. However, women whose menopause occurs later may skip the premenopause stage altogether. At the same time, for those who have the changes earlier, the transition may last several years.

You may experience the following vasomotor symptoms (VMS):

  • Hot flashes. These are waves of heat felt throughout the body, especially in the head and neck area, accompanied by flushing and sweating;
  • Irregular menstruation. Your periods may be too heavy or too light. One month you may not have them at all, and another month there will be a pause of only a couple of weeks between them. The duration also begins to fluctuate: from one or two days to more than a week;
  • Dryness in the vagina. The tissue thins due to a decrease in estrogen, so you may experience itching in the intimate area and unpleasant feelings during sex;
  • Breast pain. It is different from the pain you might feel before your period. It is usually a feeling of irritation and burning in one or both breasts. You may also experience increased breast sensitivity;
  • Dry skin, eyes or mouth. This can happen, but not always. The blame is on the decrease in estrogen secretion. 

Dry eyes, by the way, may be the only symptom of falling estrogen. But because of this clinical sign of entering to menopause a woman goes to the ophthalmologist and treats «dry eye syndrome» for months, losing time and the therapeutic window to start menopausal hormone therapy

The Head of “Lior” Medical Center, Natalia Silina
  • You want to go to the restroom more often. The structure of the internal organs around the bladder changes, and it becomes more difficult for them to hold it. You may even have the symptoms of incontinence;
  • Mood changes. It is caused by hormones, but physiological changes do not add joy either;
  • Problems with sleep. In fact, under the above conditions, it is not surprising that problems with sleep begin. Hot flashes, urge to urinate, unpleasant feelings you are not very used to, in addition to normal life situations – can cause insomnia in anyone.
menopause
Knowing these common triggers will help you to reduce hot flashes episodes

Menopause

At least 12 months have passed since the last menstruation. During this stage, the symptoms that were observed in the previous stage may persist. You may also notice the following signs:

  • Fatigue. The usual things you used to do now make you tired earlier.
  • Pain. In the head, in the muscles, in the joints – your body is changing, adjusting to a new period of life. Additionally, women at this time have a greater tendency to osteoporosis.
  • Rapid heartbeat. With age, arteries stiffen, while cholesterol plaques may accumulate in the vessels. However, if you lead a healthy lifestyle and follow a proper diet, there is no reason to worry.

Unfortunately, Russian military actions on the territory of our Ukraine lead to significant environmental pollution and, as a result, inflammation in the body, which changes the state of blood vessels. Therefore, I advise everyone, regardless of gender, over the age of 35 to undergo ultrasound examination of the vessels of the head and neck with Doppler ultrasound. This allows to see the changes in the vessels in time, and not to lose the therapeutic window to prevent possible strokes or heart attacks at a young age. Now I clearly realize that 45 is just the beginning of life, and we all need healthy vessels.

Gynecologist-endocrinologist, founder of the School of Women’s Health Natalia Silina
  • Weight gain. Although there is no confirmed scientific evidence that menopause affects weight gain, many women do face extra pounds during this period. Metabolism slows down with age, we become less active, and levels of the “hunger hormone” ghrelin are significantly higher among menopausal women compared to premenopausal and postmenopausal women;
  • Decreased libido or less pleasure from sex. The reproductive system that has encouraged you to have sex for years now stops its hard work. Plus vaginal dryness that makes sex unpleasant;
  • Hair loss. This is due to consistently low levels of estrogen and progesterone and increased testosterone production. Such hormonal changes lead to thinning and brittle hair, hair loss, or even sometimes to “peach fuzz” on the face or chin hair. Studies show that more than half of women over 50 face the problem of hair loss. But the problem of androgenic alopecia is quite well corrected with a course of plasma therapy by the Swiss system.

Postmenopause

Normally, postmenopause occurs after menopause. At this stage, previous symptoms, such as hot flashes, usually decrease. However, a significant decrease in estrogen levels increases the risk of certain diseases, such as heart disease and osteoporosis.

In general, the signs that persist during postmenopause do not differ from those that you observed in the previous stages, but some of them may worsen. This applies primarily to hormone-dependent symptoms, including dry skin and mucous membranes, thinning and loss of hair, and weight gain. Emotional disorders can lead to depression, and frequent urge to urinate can lead to urinary incontinence.

Important! A timely visit to a specialist, although it will not turn back the clock, can significantly alleviate symptoms during the menopausal transition, as well as reduce the risk of serious diseases.

Therapy during menopause

So, you can fully count on symptom relief from the beginning of the first signs of menopause. It is important that all prescriptions should be made only by an experienced doctor you trust. I will give you the options that can be offered to you. Just remember that each woman goes through this period in her own way. All the prescriptions should be individual.

Hormone replacement therapy (HRT), or menopausal hormone therapy

This method is prescribed to replenish the body with hormones, which production decreases during menopause. Your doctor will weigh the benefits and risks and prescribe the doses of hormones that are right for you. These are usually medicines with estrogen and progestin, which must be taken orally.

There are also such medications as an estrogen cream, pads or gel that you put into your vagina to help with dryness. Please do not confuse it with transdermal estrogen cream.

The action of estrogen should relieve vasomotor symptoms, particularly hot flashes, as well as reduce vaginal dryness and strengthen bones. Since estrogen alone can increase the risk of endometrial and uterine cancer, progesterone is prescribed. Other side effects of these hormones include irregular bleeding, headaches, bloating, swelling and pain in the breasts. You may even get artificial periods, depending on the dose of hormones. Hormone therapy may also increase the risk of heart disease or breast cancer if a woman is not properly screened before starting treatment or the therapeutic window is lost. That is why you should take the lowest dose that works for the shortest possible time – and this should be determined by your doctor.

The large-scale study by the Women’s Health Initiative on the effects of HRT showed rather contradictory findings. For instance, heart attacks, strokes, blood clots and breast cancer were more common in women who took combined HRT. At the same time, taking estrogen alone slightly increased the risk of stroke and blood clots and did not increase or decrease the risk of heart disease. No increased risk of breast cancer was found for women taking estrogen therapy alone. Another conclusion: replacement therapy is more effective and has a lower risk of side effects in the early stages of menopause.

менопауза menopause
Menopause is not the end, but a new stage of your life

Non-hormonal therapy

There are a number of oral and spot medications that aim to relieve menopausal symptoms. There are many of them, remember. Therefore, they should be prescribed by a doctor who is familiar with your medical history, so I will not give examples. Never self-medicate!

There is a method available to every woman to go through this period and feel good after it:

Improve your lifestyle

If you haven’t gotten rid of bad habits yet, it’s time to do it. The older you get, the worse they will affect your health and well-being. So, here’s what you can do to make menopause affect you as little as possible:

  • During hot flashes, drink cool water, regulate the air temperature with an air conditioner or fan, and dress in layers;
  • Use an over-the-counter vaginal moisturizer against vaginal dryness;
  • Exercise regularly to sleep better and at the same time prevent heart disease, diabetes and osteoporosis;
  • Strengthen the pelvic floor muscles with Kegel exercises to resist urinary incontinence;
  • Stay socially and mentally active to prevent memory problems;
  • Quit smoking. Tobacco can cause early menopause and increase hot flashes;
  • Limit alcohol to reduce the chance of getting breast cancer and sleep better;
  • Eat a variety of foods and maintain a healthy weight to ease hot flashes;
  • Relax with meditation, deep breathing, yoga or massage.

Remember, menopause is a completely natural state. So do not hesitate to seek advice and support from friends and doctors you trust.

A happy woman is healthy and educated!

You can learn more about your health after 35 years in Natalia Silina’s course All about you 35+. You can learn about other important stages of a woman’s life from the courses: A girl becomes a woman, All about you. What it’s like to be a Woman.

Encyclopedia

POLYCYSTIC OVARY SYNDROME (PCOS)

One of the main causes of infertility for hundreds of thousands of women around the world is polycystic ovary syndrome (PCOS)

  • Наталя Сіліна
  • November 18, 2022

What is PCOS?

One of the most common endocrine disorders among women of reproductive age in the world. In 1935, physicians Irving Freiler Stein and Michael Leventhal published an article entitled “Amenorrhea Associated with Polycystic Ovaries”. In this groundbreaking paper, they described their observations of seven women with amenorrhea, hirsutism, obesity, and ovarian cysts. This was one of the first descriptions of this disease, which for some time was called Stein-Leventhal syndrome. Since then, thousands of publications have been created on this topic, however, the exact causes of PCOS are still unknown.

General information

On the ovaries of women with the syndrome, many capsules with fluid about 8 mm in size are formed. These follicles with immature eggs are called cysts. The follicles are often unable to release eggs, which is why ovulation does not occur.

You may not have your period for several months. Or your period will last for two weeks. All this is accompanied by hormonal imbalance: male hormones – androgens – are secreted excessively. At the same time, the pregnancy hormone progesterone is not produced enough.

The syndrome significantly affects a woman’s reproductive health, metabolism and cardiovascular system. This condition is incurable, but it is quite possible to treat it and reduce this impact.

PCOS
Polycystic ovary syndrome

Causes of PCOS

The exact causes are unknown, but certain factors indicate that PCOS is a hereditary disorder. If your mother had it, there is a high probability that you will have it too.

There are other risk factors that are associated with the development of polycystic ovary syndrome.

Insulin resistance. The hormone insulin is produced by the pancreas. It let your body process sugar – the main source of energy for the body. If the cells are resistant to its action, the sugar level rises and the pancreas starts to produce more insulin. As a result, the ovaries increase the production of androgens, which in turn complicate the process of releasing eggs.

Overweight and obesity. It can be both a consequence of insulin resistance and a separate risk factor. In addition, it also affects the production of insulin – the body produces more of it if you are overweight. There is also a reverse effect: insulin preserves and expands fat reserves – so the more it is produced, the more weight you gain. Especially if you eat lots of carbohydrate products.

Low-grade inflammation. Studies show that glucose can cause oxidative stress and inflammatory response of mononuclear cells. Women with polycystic ovary syndrome have a certain type of long-term, mild inflammation that leads to androgen production.

Too much androgen. For a woman, this means excessive hair – hirsutism, acne, and difficulties with the release of eggs from the follicles, that is, a violation of the ovulation process. And PCOS.

Plus, a study of 237 mentally healthy women found a link between emotional violence against women in childhood and the development of polycystic ovary syndrome.

Symptoms

The main symptom is irregular periods or their complete absence for a long time. During ultrasound, cysts on the ovaries are detected. Usually, PCOS manifests itself quite early, from the first menstruation to 20+.

At the same time, other signs signal the syndrome:

  • Inability to get pregnant;
  • Excess weight, especially around the waist;
  • Hair in unusual places and hair loss on the head;
  • Acne;
  • Pain in the lower abdomen;
  • Sudden mood changes;
  • Dark spots on the skin of the neck, under the breast, groin or armpits (this is also a symptom of insulin resistance);
  • Increased appetite.

However, some women do not have any symptoms, and in obese women they are on the contrary stronger.

Complications

It is important to remember that reproductive health is not only about the ability to have children. Your overall health depends on the balance of hormones, including female hormones. Emotional, mental, and of course physical. As well as with symptoms, being overweight affects complications, not for the better.

Women with PCOS have a higher chance of developing the following health problems:

  • Infertility. Eggs are not released, so you can’t get pregnant;
  • Premature birth or miscarriage. If you do become pregnant, PCOS increases the risk of losing the baby;
  • Type 2 diabetes. About half of women with PCOS will have type 2 diabetes by the age of 40;
  • Metabolic syndrome. This is a medical term that combines diabetes, high blood pressure (hypertension), high blood cholesterol and obesity. The consequence is a greater risk of cardiovascular diseases: coronary heart disease, stroke and other diseases that affect blood vessels;
  • Endometrial cancer – the mucous membrane that lines the uterus;
  • Depression or anxiety. Hormonal imbalance, mood changes, symptoms of PCOS – all this does not add joy to life;
  • Sleep apnea;
  • Inflammation of the liver due to the accumulation of fat in it.

Treatment

I will immediately note the widespread advice from old school doctors: “have a baby and everything will pass”. This is a myth. But you do can take care of yourself, eat healthy, sleep enough, exercise, be attentive to your emotional state and get rid of bad habits, especially smoking. All this may protect you from any problems and complications of PCOS. In general, lifestyle management is the best prevention of the complications. Losing only 5% of excess weight helps to really improve the condition, namely to restore ovulation.

Since there is no cure that will help you completely get rid of the syndrome, we treat the symptoms. Control of insulin and blood pressure levels, regulation of emotional state. By the way, here you can use meditation or other tips from our article.

Therapy also depends on reproductive plans. If you are not planning pregnancy, your doctor may prescribe you combined oral contraceptives with estrogen and progesterone, which helps to reduce the level of androgens in your body. But choose this way if you need contraception! If you do not need protection from unplanned pregnancy, look for a doctor who will offer another method of correcting excess androgens in your body.

If you are planning a pregnancy, there are medications that can help solve this problem. Needless to say, they should be prescribed only by a specialist.

Surgery

In addition, you may be offered a surgical intervention – drilling. This is a small operation called laparoscopic ovarian drilling. Under general anesthesia, microscopic cameras – laparoscopes – are inserted through small incisions in the lower abdomen. Then, using a laser or ultrasonic scalpel, the doctor will make tiny holes (up to 2 mm) in your ovaries. This reduces the amount of luteal tissue that produces androgens. This stimulates ovulation. However, this procedure helps only a small percentage of women.

Remember, polycystic ovary syndrome is not a sentence. Adjusting your lifestyle and a good specialist could help you to forget about this problem.

Be always healthy!

More about your health and body is in the courses: A girl becomes a womanAll about you. What it’s like to be a WomanAll about you 35+.

I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com

You can always find your doctor at the Lior Medical Center.

Issued by Dr. Silina School of Women’s Health, journalist Maria Zavialova

All materials published on the website “Dr. Silina School of Women’s Health” were reviewed by a gynecologist-endocrinologist, the founder of the educational project, candidate of medical sciences, Natalya Silina.

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