There is also a new openness to menopause through anonymous communication in social media. Photo: Fabian Sommer/dpa
Recently built near the water? Suddenly awake at three or four in the morning, although sleep problems haven’t been a problem so far? A witch’s hair suddenly grows on her chin – or even two? At the latest with the first heat wave, affected women realize: menopause is here.
The good news is that you will no longer have problems with PMS, recurring abdominal cramps, laundry bleeding or birth control. You can have spontaneous sex and no longer have to buy tampons.
Many women therefore find menopause liberating. A new phase of life begins: children leave home and personal independence grows. They deal with hormonal changes in a completely different way than their mothers: namely, invigorating, active and without false shame. And in the end, everything takes its natural course – so it’s not awkward to start tearing off your cardigan and opening the office window.
Half of the women in this country have their last period at 52. And about half of women go through menopause without symptoms or with minor symptoms. Others, however, cannot understand the above description. Because that’s the bad news: about a third of women suffer from serious illnesses that seriously affect their quality of life.
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Understand what is happening
“It really is a hot topic – not only because hot flashes are considered a cardinal symptom,” says Dr. Katrin Schaudig. The gynecology and obstetrics specialist specializing in gynecological endocrinology sits on the board of directors of the German Menopause Society and knows many stories of unhappiness from her own practice. At the start of the German Hormone Week from September 24 to October 1, she also encourages those affected in an online press conference. “Women need to understand what’s going on there,” Schaudig said. “Once they understand what’s going on with them, things are much easier.”
Hormones are involved. The most important are estrogen and progesterone, but also androgens like testosterone. They control the female menstrual cycle, which allows an egg to mature in the ovaries, the so-called follicles, each month. If pregnancy does not occur, menstrual bleeding begins about every four weeks to expel the uterine lining and egg that have accumulated as a precaution. From birth, the number of follicles in a woman is determined individually – that is, also how often she can ovulate in her lifetime. When the follicles are exhausted, the hormonal control circuit changes until the menstrual period stops and the body stops producing estrogen.
This can have consequences. According to the large American Swan study, the most common symptoms of menopause are the proverbial sweats and hot flashes, which last an average of 7.4 years. Mood swings, anxiety, trouble sleeping, and heart palpitations can occur, along with back and joint problems.
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Those affected are ashamed
Sexual apathy and problems in the intimate area are taboo: the vaginal skin becomes thinner and drier, it loses its elasticity. The outer vulva may become less sensitive to touch, burning, and itching. Some women find intercourse painful. “Patients are ashamed to bring up the subject,” says Schaudig. “You have to be proactive about it.”
The individual manifestation of the symptoms is different – the therapeutic decision must be individual accordingly, says the specialist, who does not hide being a supporter of hormone replacement therapy (HRT): “Hormones are much better than people say But many women are said to be afraid of the risks – like developing breast cancer or having a stroke. This mainly concerns the Woman’s Health Initiative Study (WHI study) published in 2003. However, the risks calculated at the time were to be classified as “rare side effects” according to the WHO definition. In addition, doctors now have access to new, modern hormonal preparations. Thromboses and embolisms “can almost be avoided”, the risk of breast cancer is “manageable”, says Schaudig: “It took years and a multitude of data before concluding that for most women today, the benefits of an HET outweigh the risks.”
It is important to have the balance sheets done. In addition, the expert recommends regular ultrasound examinations of the breast. This is a hedgehog service that patients have to pay for themselves. But there are also exclusion criteria, such as a history of breast cancer. And the gynecologist warns against applying testosterone therapy “to all women who don’t feel like it”. You have to be very careful – because sexual desire or aversion can have many causes.
In addition to whole body hormone therapy, there are also local hormone therapies as long-term therapy. For example, creams, tablets or suppositories containing estrogen can help with vaginal dryness. A ring can be inserted into the vagina which releases small amounts of estrogen for three months. Since local hormone therapy acts almost exclusively locally, an effect on the body as a whole should not be expected.
Care in the intimate area
Those who want to do without hormones can, for example, use hyaluronic acid creams and gels for the vagina as well as greasy care creams for the vulva. And the same goes for menopause: a healthy lifestyle with a balanced diet and lots of exercise helps you get through this period better. Women should also talk to their doctor about herbal alternatives. Monk’s pepper, for example, is used for premenstrual syndrome and symptoms before the onset of menstrual bleeding, black cohosh extract for hot flashes. Sage reduces sweating and lavender calms nerves and promotes healthy sleep. Drug-grade preparations are available from pharmacies.
Incidentally, plants also produce estrogen: the best known is the isoflavone contained in soybeans, which can be very effective against hot flashes. However, there are no long-term studies and its use in hormone-sensitive breast cancer is controversial to say the least.
Three phases
Menopause, known as climacteric in technical jargon, describes the period of hormonal change at the end of the fertile phase of a woman’s life. It is divided into three periods: first perimenopause just before the cessation of menstruation, followed by menopause. This is the moment of the last menstruation not followed by bleeding for at least twelve months. Then comes post-menopause.
Alternative procedures
Acupuncture can have a positive effect on the symptoms of menopause. Exercises such as yoga, qigong, autogenic training and other methods of relaxation are also recommended, which aim to help maintain mental and physical balance.