Hormonal imbalance can reduce the size of women

Menopausal symptoms

Menopausal symptoms(Estrogen deficiency syndrome, climacteric syndrome): Physical and psychological complaints during menopause (climacteric). They usually last between 6 months and 3 years, i. H. until the body has got used to the new hormone levels. Around every third woman going through menopause wants treatment for her symptoms.

Of premature menopause (Climacterium praecox) is what doctors say if the menopause begins before the age of 40. If ovaries are surgically removed or rendered inoperable for the treatment of a disease, much younger women also go through the menopause abruptly. The symptoms and treatment options are the same as for "regular" menopausal symptoms.

Leading complaints

Only hot flashes and sweats can be specifically assigned to menopause. About 75% of women suffer from it, a third of them severely.

The following symptoms can occur during menopause, but do not have to be:

  • Increasingly irregular and less frequent menstruation
  • Bleeding heavier or weaker
  • Spotting just before the menstrual period.

Menopause to menopause:

  • Hot flashes, sweats
  • Dizziness and racing heart
  • Dryness and itching in the genital area
  • Depressed mood
  • insomnia
  • Loss of libido
  • Irritability and nervousness
  • Declining efficiency.

Post menopause:

  • Dryness in the genital area and lack of moisture despite sexual arousal
  • Back and joint problems
  • Weight gain
  • Tension in the chest
  • Hair loss on the head
  • Possibly hair growth on the face ("lady's beard").

When to the doctor

In the next few weeks if the said complaints

  • occur before the age of 40.
  • are a burden.
  • bleeding occurs again after a prolonged period of more than 6 months without bleeding.

The illness

causes

From the age of 45 onwards, fewer and fewer follicles mature in the ovaries and menstrual cycles often run without ovulation (anovulatory cycles). No corpus luteum is formed without ovulation; the level of the corpus luteum hormone (progesterone) drops. However, since sufficient estrogens are still being formed at this point, the lining of the uterus continues to grow and menstrual bleeding takes place. Due to the imbalance of estrogen and progesterone, too much mucous membrane is built up, so that more bleeding occurs in this phase.

In the following years, the production of estrogen also decreases. The bleeding becomes more irregular, which eventually stops completely. The last bleeding is called menopause. After that, pregnancy is no longer possible. On average, menopause occurs at the age of 51, significantly earlier in some women and later in others. Menopause can only be determined retrospectively: if menstruation has stopped altogether for 12 months, the last bleeding was menopause. If this event occurs before the age of 40, there is a "premature menopause".

It is believed that the time of the last menstrual period is hereditary: it occurs in mothers and daughters around the same age. The onset of menopause is also likely to be influenced by the number of births, which is why it starts earlier on average for women in countries with higher birth rates.

A connection between heavy smoking and early menopause is also being discussed. The length of the cycle or overweight and underweight may also influence the beginning. So far, however, there is no clear evidence of this.

Estrogens have a variety of effects on the organ systems of the female body. Due to the hormonal changes during menopause, these effects diminish over time.
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Complications

While most symptoms go away after a while, the absence of sex hormones accelerates arteriosclerosis and the breakdown of bone tissue (osteoporosis). This makes it easier for bones to break in old age, most often in the vertebrae, while at the same time body size decreases and the curvature of the spine changes. In extreme cases one speaks of a widow's hump.

Some sources claim that menopause increases the risk of cardiovascular disease. This is true insofar as postmenopausal women may have a higher risk of heart attacks, but the reason most likely lies in increasing age.

Menopause of men?

Even if it is said again and again: Men do not have menopause, as the decline in sex hormones occurs very gradually over the course of 30 years and fertility is maintained, at least in principle, for life. However, a premature decrease in testosterone production occasionally occurs between the ages of 45 and 65. Then there can be "menopausal-like" symptoms.

Diagnostic assurance

Medical history and smear. Usually the gynecologist can make the diagnosis of menopausal symptoms from the description of the symptoms. By examining cell material from a vaginal swab, the doctor can tell whether there is already an estrogen deficiency.

Blood test. If the symptoms are not unusual for, i.e. before the age of 40, measurements of the hormone concentrations in the blood are not absolutely necessary. The result only shows whether and in what phase of menopause the woman is. However, it does not say anything about whether she can still get pregnant or how much longer she must use contraception.

Endoscopy. If vaginal bleeding occurs again after menstruation has been paused for at least 6 months, tumors in the uterus are excluded by a uterine specimen.

Bone density measurement. The measurement identifies the onset of osteoporosis, which usually only becomes noticeable clinically many years after the menopause. It is recommended to many women, but whether it is medically useful is controversial.

EKG. If there are heart problems, especially cardiac arrhythmias, these should be clarified by a cardiologist or internist.

treatment

Therapy for menopausal symptoms has two goals: on the one hand, it aims to alleviate acute symptoms and, on the other hand, to prevent long-term negative effects on bones and blood vessels. In the case of pronounced psychological complaints, the doctor will recommend an accompanying psychotherapeutic examination and treatment.

Pharmacotherapy

Hormone replacement therapy. Since the symptoms are mainly due to a hormone deficiency, this was the case Hormone replacement therapy (HRT) with estrogens for years as a natural answer to hormone decline during menopause; the therapy primarily served to alleviate typical menopausal symptoms. In the 1980s, the opinion gained acceptance that hormones also protect against serious illnesses after menopause - for example against osteoporosis, against coronary artery disease (CHD), but also against dementia. After all, more and more women took hormones longer and longer - even if they had no menopausal symptoms at all.

That only changed with the Women's Health Initiative Study (2002). The study came to the conclusion that prolonged hormone treatment does not prevent old-age diseases, but actually increases the risk of heart attacks, strokes and thromboembolism.

Pure estrogen treatment also very often leads to growths of the uterine lining, which can lead to endometrial or uterine body cancer. These growths can be prevented if progestins are taken in addition to estrogens. That is why today hormone replacement therapy consists of a combination of both hormones. However, this treatment is only recommended for particularly severe menopausal symptoms and premature onset of menopause - and then only for a few months. Estrogen treatment alone is safe only in women who have had their uterus removed.

Tablets, gels, creams, nasal sprays, syringes, vaginal suppositories and plasters are available as dosage forms. Women who suffer from high blood pressure, coagulation disorders, severe obesity, pronounced varicose veins or liver diseases become just like smokers Not treated with hormones. If a woman has or has already had a breast or uterine tumor, for example, her menopausal symptoms must not be treated with hormones. Because this cancer may be sensitive to hormones.

Estrogen spray. The prescription-only estrogen spray Lenzetto® has been available since June 2016. Sprayed once a day on the forearm, an active ingredient depot forms in the skin for 24 hours, from which the active ingredient is continuously released into the bloodstream. One advantage of the spray over oral intake is the lower dosage and thus the reduction in side effects.

Artificial hormones. An alternative to hormone therapy is treatment with tibolone, an artificial hormone that works in a similar way to estrogen or progestin. Studies show that tibolone relieves hot flashes. Possible side effects include spotting. Long-term treatment with tibolone is at risk of stroke and recurrence of breast cancer in women over the age of 60. In Germany, tibolone is prescribed relatively rarely; in some countries, such as Switzerland, the drug is also approved for the prevention of postmenopausal osteoporosis.

"Bioidentical" hormones. For some years now there have also been "bioidentical" hormones such as progesterone. Like estrogen, progesterone is a female sex hormone; it is obtained from the yam root through a chemical conversion process. Even if the term "bioidentical" suggests otherwise, it is also a chemically manufactured product.

More medication. Studies have shown that drugs such as venlafaxine (for depression) or gabapentin (for epilepsy) also help against hot flashes and sweats. However, in Germany they can only be used as individual healing attempts (also called off-label use).

For the treatment of dry and itchy vaginal mucosa, locally effective hormone preparations such as creams, suppositories or rings are used. Hormone-free alternatives are vegetable oils, lubricants, and creams that moisturize the vaginal lining.

Your pharmacy recommends

What you can do yourself

Remember, menopause is a normal part of every woman's life and, most importantly, not a disease that needs treatment. Try to make this phase of your life as positive and active as possible. Do not miss the opportunity to give this important stage in life your own imprint that will fill you with satisfaction. This also includes accepting the physical changes and as far as possible not assigning any symptoms to any disease value. Incidentally, menopause is different for every woman and the spectrum ranges from complete freedom from symptoms to severe physical and mental impairments. Comparative studies have shown that one's own lifestyle, personal circumstances, but also culture and country of origin have an impact on menopausal symptoms. The following tips help many women with mild to moderate symptoms:

  • Dress. If you suffer from hot flashes, dress according to the onion skin principle and wear underwear made from natural materials (e.g. cotton, silk) that will keep you warm even when it is damp. The clothes should be comfortable and cut rather wide.
  • Nutrition. Put soy and other legumes (e.g. peas, beans), but also oatmeal, rye and wheat on the menu; they are said to have a phytoestrogenic effect (complementary medicine). There is also evidence that regular consumption of these foods reduces hot flashes.
  • Move. Physical activity alleviates hot flashes, lets you sleep better, reduces stress, strengthens the heart and circulation, prevents obesity, sheds excess pounds and reduces the risk of osteoporosis. Endurance sports (e.g. walking, cycling, jogging, swimming) are best. Often a lot is gained if you ensure more exercise in everyday life, e. For example, do without the elevator, instead take the stairs and / or do errands on foot or by bike.
  • Physical measures. Depending on the symptoms, physical measures that can also be taken at home with little effort can help. Have proven such. B. cool washings or lukewarm half baths as a means of quick self-help with hot flashes or increased tendency to sweat; Alternate showers in the morning and regular brush massages on damp skin (e.g. while showering) to stimulate the circulation or alternate footbaths in the evening for sleep disorders. Moor baths improve blood circulation in the genital area and relieve itching. Regular visits to the sauna are also recommended.

Complementary medicine

Herbal medicine.

Herbal medicine offers a range of remedies, some of which have been scientifically proven to have therapeutic benefits for menopausal symptoms. But even if their benefits have not yet been proven, that doesn't mean they aren't effective. Sometimes it's worth a try.

St. John's wort extract (Hypericum perforatum, e.g. Aristo®, Hyperforat®, Jarsin®): The effectiveness of St. John's wort in depressive moods has been proven.

Monk pepper extract (Vitex agnus-castus, e.g. Agnolyt ®) is particularly suitable for alleviating the symptoms at the beginning of the menopause. For an optimal effect, the long-term intake of standardized ready-made extracts is recommended.

Black cohosh (Cimicifuga racemosa, e.g. Remifemin®): Some products are approved as herbal medicinal products in Germany. So far, however, there has been no evidence that black cohosh relieves menopausal symptoms. Recent studies have shown that black cohosh supplements don't work any better than a placebo. It was also shown that 5 out of 100 women who took such preparations complained of headaches, gastrointestinal complaints, nausea, reddening of the skin and dizziness. These symptoms usually go away when the medication is discontinued. Serious side effects such as liver damage also occur occasionally. The European Medicines Agency therefore recommends discontinuing the preparation immediately and seeing a doctor if you experience tiredness, loss of appetite, yellowing of the eyes or skin, noticeably dark urine, as well as upper abdominal discomfort and nausea. It is also not advisable to take black cohosh at the same time as estrogens. Similarly, women with breast cancer should not take black cohosh supplements.

Evening primrose oil (Oenothera biennis) and ginseng (Panax ginseng): So far it has not been scientifically proven that evening primrose oil and ginseng have a relieving effect on hot flashes.

Dong Quai (Angelica sinensis) or Maca (Lepidium meyenii): So far there is no evidence for either preparation that they alleviate menopausal symptoms. With some preparations there is also a risk of side effects or interactions with other drugs. Bleeding can occur if you take ginseng and anticoagulant drugs such as heparin or acetylsalicylic acid at the same time.

Kava kava (Piper methysticum, Rauschpfeffer): In Germany, regulatory authorities have withdrawn corresponding preparations from the market because of allergic reactions, skin problems, liver damage and nerve problems.

Phytoestrogens.

They are considered a "gentle" alternative to hormone replacement therapy. Phytoestrogens act like the body's own hormones - but slightly weakened. Soy and red clover contain isoflavones, plant-based ingredients that are also known as phytoestrogens because their chemical structure is similar to the human hormone estrogen and therefore also have a hormone-like effect. In Germany, the substances are only approved as food supplements or dietetic foods and not as pharmaceuticals. For this reason, it is also difficult to assess the benefits and risks of phytoestrogens.

Soy: A therapeutic benefit of soy preparations that exceeds the effect of a dummy drug (placebo) has not yet been scientifically proven. While soy isoflavones appear to reduce the severity and frequency of hot flashes in some women, this effect is most likely due to what women expect. A short-term intake of soy isoflavones seems harmless, with long-term intake and high doses doctors do not rule out side effects such as gastrointestinal complaints. Above all, an increase in estrogen-dependent diseases such as breast or uterine cancer, which at least threatens if the soy preparations are used in higher doses and for a longer period of time, is particularly worrying.It is therefore recommended to take preparations with soy isoflavones for a maximum of 10 months at a maximum dose of 100 mg per day. If estrogen-dependent diseases are known in the family environment, for example breast or uterine cancer, phytoestrogens should be avoided as a matter of principle.

Red clover (Trifolium pratense, e.g. Menoflavon®): Red clover preparations also contain isoflavones, which act in the body in a similar way to estrogens. A therapeutic benefit against hot flashes or sweating has not yet been proven. Possible side effects of red clover have so far hardly been researched.

Rhapontic rhubarb (Rheum rhaponticum e.g. Phytoestrol® N). A further herbal remedy has recently become available with a dry extract from the roots of Rhapontik rhubarb, which is said to have the same hormonal effects as artificially produced (synthetic) estrogens. It is primarily intended to help with hot flashes, depression or anxiety. Apart from the fact that its effectiveness has not yet been adequately proven, side effects such as those with conventional hormone replacement therapy cannot be ruled out at the moment, and the preparation is therefore not (yet) recommended.

Tea blends.

Various tea blends have proven effective to alleviate menopausal symptoms, e.g. B. from lady's mantle (Alchemilla vulgaris), yarrow (Achillea millefolium) and sage (Salvia officinalis), as well as teas for the targeted alleviation of individual symptoms, e.g. B. with St. John's wort (Hypericum perforatorum) to lighten the mood, hop blossoms (Humulus lupulus), valerian (Valeriana officinalis) and lemon balm (Melissa officinalis) against sleep disorders, sage (Salvia officinalis) for increased tendency to perspire and hawthorn (Crataegus) for nervous heart problems.

Homeopathy.

Homeopathy recommends z. B. Pulsatilla, Sepia, Belladonna and Cimicifuga. It also offers ready-made complex remedies (e.g. Cimicifuga Pentarkan®).

Relaxation procedure.

Relaxation methods such as progressive muscle relaxation according to Jacobson, yoga and autogenic training, but also yoga, mindfulness training and massages help - if used regularly - to reduce tension and nervous restlessness, improve the body feeling and promote psychological balance. In addition, relaxation exercises appear to have a positive effect on hot flashes. However, it takes 2-3 months for such a relaxation technique to work.

Pelvic floor training.

Regular pelvic floor training has proven effective for bladder weakness and incontinence.

Acupuncture and electro acupuncture.

The two procedures acupuncture and electro acupuncture relieve hot flashes and other menopausal symptoms; an at least temporary improvement has now been scientifically proven.

Prevention

Orthomolecular medicine.

Orthomolecular medicine calls vitamin E to reduce hot flashes; scientific proof is still pending. What is certain, however, is the preventive effect of regular adequate calcium intake against osteoporosis. Calcium-rich foods include fresh milk, cheese, and other dairy products.

Healthy lifestyle.

Reduce your nicotine, coffee and alcohol consumption or stop it altogether - but don't forbid yourself anything! Everything is allowed in moderation.

Further information

  • www.gut-durch-die-wechseljahre.de - Commercial but very informative website from Berlin: With a discussion forum, lots of self-help tips and a free brochure to download (Brochures section).
  • M. Kiechle: Menopause as an opportunity. Droemer Knaur, 2003. Specialist advice with detailed information and practical tips on alternative drugs and therapies.
  • Consumer Central NRW (Ed., 2003): Menopause. What women should know In addition to all medical information and alternative therapies, there are tips on nutrition and lifestyle as well as a look at other cultures.

Authors

Dr. med. Astrid Waskowiak, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Description", "Symptoms and complaints", "When to see the gynecologist", "The disease", "Confirmation of diagnosis", "Treatment" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 10:46


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.