At some point, a woman enters menopause. The definition of menopause says that it is a period without menstruation for a period of one year and thus also the end of a woman's reproductive age. When does menopause begin, how long does it last, what is perimenopause and postmenopause.

When does menopause begin?

For most women, symptoms begin to appear about four years before their last cycle. Symptoms often persist even three years after the last cycle. Some women experience menopausal symptoms up to ten years before menopause actually occurs, and 1 in 10 women experience menopausal symptoms 12 years after their last period. There are many factors that help determine when you start menopause, including genetics and the health of your ovaries.

Perimenopause occurs before menopause

Perimenopause is the time when hormones begin to change in preparation for menopause. This period can last from several months to several years. Many women start perimenopause sometime after the age of 40, others even skip perimenopause and start menopause straight away. It is very individual.

It used to be 1% of women who started menopause before the age of 40, which is called premature menopause or primary ovarian insufficiency. Today, this number is higher and it is up to 10% of women who reach this period before the age of 40.

Perimenopause vs. menopause vs. postmenopause

During perimenopause, our menstrual cycles are irregular. Menstruation can be late, or you can completely miss one or even more cycles. The cycle can also be longer or shorter and the flow heavier or lighter.

Menopause is defined as not menstruating for one full year.

Postmenopause is called the period after menopause, the period of peace, when the production of hormones from the ovaries is minimal. The average age of menopause in Slovakia is approx. 49-51. r. and the lower limit of physiological menopause can be between 37-42. r.

Why does menopause occur?

Menopause is a natural process when the ovaries produce less reproductive hormones. The body begins to go through several changes in response to the lower levels:

• estrogen
• progesterone
• testosterone
• follicle-stimulating hormone (follitropin, FSH)
• luteinizing hormone (LH)

One of the most significant changes is the loss of active ovarian follicles. Ovarian follicles are the bodies that produce and release eggs from the ovarian wall, enabling menstruation and fertility.

Most women will first notice that the frequency of their periods becomes less consistent as the flow becomes heavier and longer. In some cases, menopause can be induced or caused by injury or surgical removal of the ovaries and related pelvic structures.

Common causes of induced menopause

• bilateral oophorectomy or surgical removal of the ovaries
• ovarian ablation, or cessation of ovarian function, which can be done with hormone therapy, surgery, or radiation therapy in women with estrogen receptor-positive tumors
• radiotherapy of the pelvis
• pelvic injuries that also seriously damage or destroy the ovaries

How do we diagnose menopause?

We recommend talking to your gynecologist if you have difficulties or problems with menopause.

There is also a blood test known as the PicoAMH Elisa diagnostic test. This test is used to determine the ovarian reserve, which can be used to evaluate whether a woman has entered menopause or is approaching it. The doctor may also do a blood test that measures the level of certain hormones in the blood, usually FSH and a form of estrogen called estradiol. Consistently elevated levels of FSH in the blood of 30 mIU / ml or higher, associated with a lack of menstruation for one year in a row, usually means confirmation of menopause. Saliva tests and over-the-counter (OTC) urine tests are also available on the market and are not very reliable. Their price is also higher.

During perimenopause, FSH and estrogen levels fluctuate daily, so most doctors diagnose the condition based on symptoms, medical history, and menstrual information. Therefore, it is necessary to always be honest with your doctor and not omit any information. Depending on your symptoms and medical history, your doctor may also perform additional blood tests to help rule out other underlying conditions that may be responsible for your symptoms.

Menopause and its treatment

If the symptoms are severe or affect your quality of life, it is definitely necessary to start treatment. Hormone therapy can be an effective treatment in women younger than 60, or within 10 years of menopause, to reduce or manage:

• hot flashes and hot flushes
• night sweats
• redness
• vaginal atrophy
• osteoporosis

Medicines may be used to treat more specific symptoms of menopause, such as hair loss and vaginal dryness.

• topical minoxidil 5%, used once a day for thinning and hair loss
• anti-dandruff shampoos, commonly 2% ketoconazole and 1% zinc pyrithione, used for hair loss
• eflornithine - cream for excessive hair growth
• selective serotonin reuptake inhibitors (SSRIs), commonly paroxetine 7.5 milligrams for hot flashes, anxiety, and depression
• non-hormonal vaginal moisturizers and lubricants
• low-dose estrogen-based vaginal lubricants in cream, ring, or tablet form
• for vaginal dryness and painful intercourse, estrogens are prescribed (locally or overall) and possible rejuvenation
• prophylactic antibiotics for recurrent urinary tract infections
• sleeping pills for insomnia
• calcitonin and medicines containing vitamin D or calcium can be used for post-menstrual osteoporosis

Home "treatment" and lifestyle changes

• coolness and comfort – dress in loose, layered clothing, especially at night. This can help manage hot flashes. The bedroom should be at a lower temperature, avoid heavy duvets, this will reduce the chances of night sweats.
• exercise and weight management – reduce your daily intake by 400 to 600 calories. It is very important to exercise for 20 to 30 min. daily - at a moderate pace. It helps to supply energy, get a better night's sleep, or improve mood.
• communicating your needs - talk to a therapist or psychologist about any feelings, depression, anxiety, sadness, insomnia and mood swings.
• dietary supplements – take lots of vitamins and our ioy.MENOPAUSE in combination with the ioy.GOOD MOOD drink, a combination that supports healthy hormonal activity and vitality of a woman during menopause
• practicing relaxation techniques – practice relaxation and breathing techniques (yoga, so-called box breathing, meditation and others...)
• skin care - use moisturizers daily to reduce skin dryness. You should also avoid excessive bathing or swimming.
• sleep care - the body distinguishes between day and night - the so-called circadian rhythm. As night approaches, the hormone melatonin begins to be produced, which cleanses the body during sleep and is triggered by darkness. When you look at "blue light" before going to sleep (e.g. emitted by LCD displays but also light bulbs), the production of melatonin stops. Do not look at blue light an hour before bed, warm yellow or red light is fine. Blue light emits e.g. phone, PC, tablet, TV and other electronic devices.
• stop smoking and limit alcohol consumption – avoid passive smoking. Exposure to cigarette smoke can worsen symptoms. You should also limit your alcohol intake, heavy drinking during menopause can increase the risk of health problems.
• avoid trigger of hot flashes and hot flushes. Triggers include, for example, spicy foods, caffeine or alcohol.
• natural supplements and nutrients that can help reduce menopausal symptoms include: soy, vitamin E, isoflavone, melatonin, or flaxseed.

SOURCE: Ivana Bartošová, www.kusok.love