Menopause: what happens and what actually helps

Mikhail Derebenchenko — GP, obstetrician-gynecologist

Perimenopause starts earlier than people think

The transition begins several years before the final period. The cycle usually changes first, becoming irregular, shorter or longer. Alongside come hot flushes and night sweats, disturbed sleep, mood swings and anxiety, reduced concentration, vaginal dryness and discomfort during sex, and bladder symptoms. Women often do not connect these symptoms with one another and see several different specialists.

Are tests needed

In a woman over 45 with a typical picture the diagnosis is clinical, and hormone tests are not required — levels fluctuate and can mislead. Testing is needed in other situations: suspected premature ovarian insufficiency before 40–45, an atypical presentation, or the need to exclude other causes, principally thyroid disease and anaemia. At the clinic a menopause diagnostic profile is AED 540 and a thyroid function panel AED 300.

What happens to bones and the heart

Falling oestrogen accelerates bone loss and changes the lipid profile. A conversation about menopause is therefore not only about hot flushes: it includes cardiovascular risk assessment, blood pressure and cholesterol control, adequate calcium and vitamin D, and resistance exercise. This part is usually the most underestimated and the most important in the long run.

Hormone therapy: what changed

Fear of menopausal hormone therapy largely stems from early interpretations of studies from the early 2000s, later reappraised. The current position of professional societies is that for most women under 60, or within 10 years of menopause, who have troublesome symptoms and no contraindications, the benefits outweigh the risks. The decision is always individual and takes account of history — thrombosis, cancer, liver disease, smoking.

Local therapy for genitourinary symptoms deserves separate mention: it acts locally and suits a considerably wider group of women, including many for whom systemic therapy is not appropriate. It is a simple solution that is undeservedly rarely discussed.

What helps besides hormones

Regular physical activity, weight control, stopping smoking, work on sleep, reducing alcohol and caffeine where flushes are troublesome — and, in a hot climate, sensible clothing and attention to temperature control. Non-hormonal medication for significant flushes exists where hormones are contraindicated.

Where to discuss it

At GMS an obstetrician-gynecologist consultation is AED 600 and a specialist consultation AED 750; ultrasound is done in the clinic, and lab tests are taken there too. Open daily 9:00–21:00, in English and Russian.

Further reading

• The Menopause Society. Hormone Therapy Position Statement
• ACOG. The Menopause Years

FAQ

Do I need hormone tests to confirm menopause?

Usually not if you are over 45 with a typical picture: levels fluctuate and can mislead. Testing is needed for suspected premature ovarian insufficiency before 40–45, an atypical presentation, or to exclude thyroid disease and anaemia.

Is hormone therapy dangerous?

Much of the fear stems from early interpretations of studies from the early 2000s that were later reappraised. For most women under 60 or within 10 years of menopause, with troublesome symptoms and no contraindications, the benefits outweigh the risks; the decision is individual and considers thrombosis, cancer, liver disease and smoking.

What helps besides hormones?

Regular physical activity, weight control, stopping smoking, work on sleep, and less alcohol and caffeine where flushes are troublesome — plus sensible clothing in a hot climate. Non-hormonal medication for significant flushes exists where hormones are contraindicated.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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