Menopausal symptoms

A better understanding of the physical and emotional changes during this phase may make it easier to experience the menopause as a natural and positive part of ageing. We therefore provide you with an overview of what happens in your body during the menopause, what typical menopausal symptoms can occur and what (medical) treatment options and measures are available to make the “change” positive and healthy.

What is the menopause?

The menopause is not a disease, but a natural phase in every woman’s life. They refer to a period around the age of 50 when the supply of eggs in the ovaries finally runs out. This is accompanied by a decrease in the production of various hormones, particularly oestrogen, in the ovaries. Finally, the menopause occurs. The menopause is defined as the last menstrual period in a woman’s life; the postmenopause describes the stage of life in which the egg supply has been used up, her periods are permanently absent and she can no longer become pregnant spontaneously.

The reduced response of the ovary to the signals sent by the pituitary gland makes menstruation more irregular. This could be the first thing you notice. The period may be shorter or last longer. You may bleed more or less than usual. All of these are usually normal changes during the menopause.

Some women have no or only mild menopausal symptoms. For other women, the transition to the menopause can bring with it various symptoms, including hot flushes, night sweats, sleep disorders, joint and muscle pain, pain during sexual intercourse, mood swings and irritability, forgetfulness, difficulty concentrating or a combination of these symptoms.

Menopause: When does it start?

The menopause usually begins gradually and is noticeable through changes in the menstrual cycle. There is no way of predicting the start, the specific course or the length of the transition to postmenopause. For most women, the menopause begins between the ages of 45 and 55 and extends over a period of around 8 years, although there are major individual variations. On average, most Swiss women are 52 years old when they have their last menstrual period (= menopause).

For some women, the menopause also occurs significantly earlier or later. The onset of menopause before the age of 40 is referred to as “premature”. The age at which a woman has her last menstrual period is determined by many factors. The leading factor is heredity, i.e. the genetic factor. This means that the menopause occurs at approximately the same age in mothers and daughters. There is also evidence that the menopause occurs earlier in women who smoke. Being overweight or underweight can also influence the onset and length of the menopause.

Terms relating to the menopause

• Pre-menopause: Variable period before the last menstrual period.
• Peri-menopause: Variable period before the menopause to one year after the menopause.
• Menopause: time of the last menstruation. This date is determined retrospectively if a woman has not had a menstrual period for 12 months.
• Post-menopause: period after the last menstrual period

Menopause woman: further phases

• Early menopause: onset of menopause before the age of 45
• Late menopause: last menstrual period after the age of 55

Women with an early onset of menopausal symptoms suffer from severe symptoms more frequently and often over a longer period of time. Compared to white women, black women are more likely to go through the menopause earlier, suffer from more severe menopausal symptoms and the symptoms last longer, while Asian women are less likely to suffer from menopausal symptoms.

The global average is 7.5 years from the onset of symptoms to menopause. In rare cases, bleeding after the menopause can be a sign of uterine cancer or cervical cancer and should definitely be checked by a doctor.

Symptoms of the menopause in women

Cycle disorders in perimenopausal women are often accompanied by strongly fluctuating hormone levels, particularly oestrogen. During this time, typical symptoms such as hot flushes and sweating or even bleeding disorders occur. After the menopause, oestrogen production slowly stops and very low oestrogen levels occur. Then complaints such as vaginal dryness, dry eyes or repeated urinary tract infections come to the fore. In general, however, the various symptoms can occur at any time during the menopause.

Overview of common symptoms of the menopause

Typical symptoms of the menopause are

• Cycle irregularities are often the first sign of the menopause even before, for example, hot flushes occur. This can affect various aspects of the menstrual cycle, e.g. the frequency and/or intensity of menstrual bleeding.
• Hot flushes and night sweats. Hot flushes and night sweats (also known as vasomotor symptoms) are among the most common symptoms of the menopause. A hot flush is a sudden feeling of heat, usually in the upper body and face. Your face and neck may be reddened. Red spots can form on the chest, back and arms. Heavy sweating and cold chills can follow. Night sweats are often combined with hot flushes that occur at night and can disturb sleep. Most hot flushes last between 30 seconds and 10 minutes. They can occur several times an hour, a few times a day or only once or twice a week. Although it is not clear why hot flushes occur so frequently during the menopause, they are probably due to the altered and fluctuating hormone levels that irritate the temperature regulation center locally in the brain. Hot flushes can occur for many years after the menopause.
• Dry mucous membranes, vaginal dryness: A prolonged hormone deficiency can lead to changes in the vaginal mucous membranes in women. 50 percent of affected women are familiar with these complaints. Possible consequences include pain during sexual intercourse and an increased susceptibility to urinary tract infections.

Menopause – other symptoms in women

• Sleep disorders: The menopause causes sleep disorders in 50 percent of women, which can be exacerbated by hot flushes at night. The depth of sleep can also decrease. Affected women can therefore feel exhausted and less productive in the morning. Sleep disorders often occur as an early symptom of the menopause.
• Sexuality during the menopause: Reduced desire for sex, pain during sex due to vaginal dryness and orgasm problems are a very common problem for menopausal women. However, these are often not caused by hormonal changes, but by psychosocial changes during this phase of life. 40-50% of perimenopausal and postmenopausal women are affected.
• Weight gain: Menopause is often associated with weight gain due to a combination of hormonal, metabolic and lifestyle factors.
• Urinary incontinence, bladder problems: The drop in estrogen levels during the menopause can weaken the muscles and tissues in the pelvic area, including those that are important for normal bladder and urethral function. These changes during the menopause can lead to urinary incontinence, i.e. involuntary leakage of urine.
• Bone loss (osteoporosis): The decrease in oestrogen during the menopause significantly accelerates bone loss and increases the risk of osteoporosis. On average, women lose up to 10% of their bone density in the first 5 years after the menopause.
• Joint pain: Joint pain is a common symptom during the menopause. They are due to hormonal changes, ageing and lifestyle.
• Muscle pain: Menopause, muscle pain and altered movement patterns are closely linked. Other causes are changes in muscle mass or joint diseases such as arthritis.
• Irritability: Irritability is a common psychological menopause symptom. Women can react more sensitively during this time.
• Mood swings: The menopause is often accompanied by mood swings and even depressive moods. Affected women are sometimes additionally (and possibly unfoundedly) plagued by anxiety. Hormonal changes can affect serotonin and noradrenaline levels, which are closely linked to depression.

Menopause diagnosis: recognizing and treating symptoms

Although a relatively wide range of established and new therapies are available, menopausal symptoms often remain untreated. It is estimated that 75% of menopausal women do not seek medical advice or treatment for their symptoms and around 50% delay seeking treatment for more than six months. Depending on the indication and symptoms, we can find out together which treatment measures are suitable for you. Menopausal symptoms are diagnosed by your doctor first taking your medical history and discussing typical symptoms such as hot flushes, sleep disorders or cycle changes with you. A physical examination and blood tests for hormones such as FSH and oestrogen can help to find the optimal treatment strategy. This will also clarify whether other illnesses such as thyroid problems could be causing the symptoms. Age and the intensity of the symptoms also play a role in the choice of therapy. If necessary, further examinations will be arranged to confirm the diagnosis or rule out other causes.

Prevention of menopausal symptoms: When to see a doctor?

You should speak to your gynecologist if your menopausal symptoms are affecting your daily life. You should definitely see your doctor if you have vaginal bleeding after the menopause.

Treatment: Menopausal symptoms

Menopausal symptoms can be treated in a variety of ways. The choice of the appropriate method depends on your individual symptoms, medical history and personal preferences. It is advisable to discuss with your doctor which treatment options are most suitable for you. Here you will find an overview of proven measures and new approaches to alleviating menopausal symptoms.

Herbal medicines for menopausal symptoms

Many women who suffer from menopausal symptoms initially try to treat these symptoms with over-the-counter preparations. Cimicifuga (black cohosh), for example, can relieve hot flushes, sweating or sleep problems and reduce mood swings. These products are based on herbal ingredients and are becoming increasingly popular. There are now a large number of herbal preparations available for the treatment of menopausal symptoms. However, it is important to know that not all of these products are approved medicines. Many are merely dietary supplements whose benefits have not been clearly proven scientifically. You should therefore discuss with your doctor whether and which of these products make sense for you.

Hormone therapy (HT) during the menopause

Scientific studies have repeatedly shown that hormone therapy is the most effective method of treating menopausal symptoms. There are numerous hormone preparations that work differently and differ in the composition of the active ingredients. Some preparations contain only oestrogens, others also contain progestogens.

The most common hormone preparations for menopausal symptoms/consequences contain a combination of both hormones. Women with a uterus must take this combination because oestrogen alone can lead to uncontrolled growth of the uterine lining and, in rare cases, to uterine cancer. This risk does not exist when using a preparation containing oestrogen and progestogen. In women who have had their uterus removed, progestogen administration can be dispensed with.

Like any therapy, hormone replacement therapy is also associated with risks. These are decisively influenced by personal history and family risk factors. It is therefore advisable to weigh up the possible advantages and disadvantages individually with your doctor and choose a therapy that takes medical criteria, risk factors and personal needs into account.

Treating hot flushes without hormones

Can hot flushes be treated effectively without hormones? This is now possible. Recent scientific findings show that, in addition to estrogen, the neurokinin B (NKB) messenger substance also plays an important role in the thermoregulation center of the brain. When this messenger substance binds to a specific receptor in the brain, a signal is triggered that causes hot flushes and night sweats. A targeted blockade of this mechanism acts directly on the brain’s “inner thermostat”, which regulates body temperature. This medication can therefore be used to effectively treat hot flushes and night sweats.

Nutrition and sport during the menopause

A healthy, balanced diet can help to maintain a healthy weight and alleviate some menopausal symptoms.

Eat plenty of fruit, vegetables, fiber-rich foods (e.g. whole grain products), dairy products or milk alternatives, various protein-containing foods (especially beans, peas and lentils) and small amounts of unsaturated fats (e.g. olive or rapeseed oil).

They should aim to provide all the nutrients you need through a healthy, balanced diet. There is no dietary supplement that provides the same nutritional value as a healthy, balanced diet. Such nutrition is not only important for your physical health, but also for your mental health and well-being. Only in rare cases is it necessary to take dietary supplements such as vitamin D and calcium, e.g. for osteoporosis.

An active lifestyle and exercise have been shown to improve many menopausal symptoms such as hot flushes, sleep and mood. In addition, regular physical activity is essential for middle-aged women to maintain good physical health. It improves mental health and general mental well-being and promotes participation in social life into old age. It also increases fitness and reduces the risk of chronic diseases associated with age and lifestyle, such as obesity, cardiovascular disease, type 2 diabetes, osteoporosis and certain types of cancer. Exercise therefore offers benefits for women’s quality of life on several levels that go beyond the treatment of menopausal symptoms.

Menopause after removal of the uterus (hysterectomy)

If your uterus is surgically removed, this has no effect on hormone production in the remaining ovaries. In rare cases, however, the ovaries are also removed before the menopause due to a tumor, for example. This means that the menopause occurs immediately, regardless of age. In this situation, hormones should generally be taken until at least the average menopausal age in order to avoid unfavorable effects, particularly of the estrogen deficiency, e.g. on the bones, but also on the cardiovascular system. Menopausal symptoms following removal of the ovaries can also be treated with hormone therapy. If your uterus has been removed so that the absence of bleeding can no longer be used as an indication of the menopause, blood tests can clarify whether the menopause has already occurred.

Menopause after chemotherapy and radiotherapy

Chemotherapy and radiotherapy can impair the function of the ovaries, which can lead to a treatment-induced menopause. This may be temporary or permanent, but depends on your age, the type of medication, the dose of medication and the duration of treatment. If chemotherapy and radiotherapy are necessary, the effects and treatment options should be discussed with you in advance. If ovarian function ceases at an early stage, this usually leads to osteoporosis with an increased risk of bone fractures if left untreated. Hormone therapy should therefore be continued at least until the expected menopausal age. Here too, hormone tests help to decide whether hormone therapy should be started.