Although menopause is known as the end of menstrual bleeding and therefore reproduction in women, physical, mental and sexual changes occur during menopause or in the following years. Although menopause begins between the ages of 45-55 in most women, early menopause refers to menopause occurring before the age of 40 and its frequency is around 1%.
Although the causes of early menopause are not known for certain, familial predisposition is important. Autoimmune diseases, congenital malfunction of the ovaries, infections, metabolic diseases and some treatments are blamed. The relationship between the age of menopause and various factors such as genes, nutrition, lifestyle, smoking, environmental factors, menstrual regularity, surgical removal of the uterus, and the number of births has been investigated.
The age of menopause is directly related to genetic coding, and the person's menopause age. It has been reported that the mother's menopausal age is similar. The tendency for early menopause has also increased in daughters of women who experienced early menopause before the age of 46. Vegetarian diet and weak body structure are also among the factors that accelerate menopause. No relationship was found between age at first menstrual period and age at menopause. Increasing number of births and menstrual irregularities starting in the forties have been associated with early menopause. It is claimed that women who undergo hysterectomy or endometrial ablation for various reasons experience early menopause, possibly due to decreased blood flow in their ovaries.
Contents
- What May Experience During Menopause Complaints
- Hot Flashes, Sweating
- Changes in the Sexual Area and Sexual Dysfunctions
- Psychological Complaints
- Effects of Menopause on Bone Metabolism
- Effects of Menopause on the Cardiovascular System
Complaints That May Be Experienced During Menopause
Estrogen deficiency occurs in approximately 70-80% of women during menopause. complaints arise. Although complaints related to estrogen deficiency occur immediately with the decrease in ovarian functions, complications related to cardiovascular diseases and osteoporosis, which cause severe damage and death in the post-menopausal period. atologies are seen in later periods.
Complaints During Menopause:
- Hot flushes, sweating
- Changes in the sexual area and sexual dysfunctions
- Psychological complaints
- Effects of menopause on bone metabolism
- Effects of menopause on the cardiovascular system
Hot flushes, Sweating
75% of women in menopause and approximately 40% of women in the menopause transition period complain of hot flashes. These complaints can be seen in 60% of women even before changes in menstrual cycle begin. 31% of late reproductive women experience hot flashes. Hot flashes become severe 1 year before the last menstrual period and continue at a high rate for the next 3 years. Hot flashes are characterized by the sudden onset of a feeling of warmth or burning in the face, neck and chest, followed by an attack of sweating that affects the whole body, more prominently in the head, neck, upper part of the rib cage and back. Its duration is variable, usually lasting 1-5 minutes, and lasting longer than 6 minutes in only 6% of women. Hot flashes occur more frequently at night and during times of stress. Although many theories have been put forward about the pathophysiology of hot flashes, no definitive conclusion has been reached yet.
Although it has been suggested that hot flashes occur as a result of many mechanisms, the main cause is thought to be dysfunction of the temperature-regulating center in the hypothalamus due to decreased estrogen levels. Estrogen withdrawal rather than low estrogen levels is the cause of hot flashes. This view is supported by the fact that hot flashes decrease with estrogen treatment and that hot flashes do not occur in cases where estrogen is very low, such as in women whose ovaries do not work from birth.
Women whose ovaries do not work from birth can only experience hot flashes by giving estrogen and then stopping it. Clinical studies do not support that women in surgical menopause experience more severe hot flashes.
Changes in the Sexual Area and Sexual Dysfunctions
23 - 40% of women in menopause have at least one complaint in the reproductive and urinary systems. has. Accurate diagnosis often cannot be made, inadequate or are treated inappropriately. The external genitalia and urinary tract contain many estrogen receptors. Changes in the external genital area and urinary tract begin close to menopause and intensify in the post-menopausal period. Various degrees of atrophic changes occur in the vaginal epithelium in postmenopausal women. The vagina becomes shorter and narrower over time. The vaginal skin has become thinner and the rugae have become flat. Rupture of surface vessels may cause irregularly distributed spot bleeding and brownish discharge. Minimal trauma due to vaginal douche or sexual intercourse may cause mild vaginal bleeding.
As a result of estrogen deficiency, not enough glycogen can be stored in the vaginal epithelial cells. Normal vaginal flora decreases as sufficient food environment for Döderlein bacilli is lost. The acid reaction of the vagina regresses. For these reasons, vaginal atrophy and local bacterial spread may initiate vaginal discharge and itching. The color of the cervix, called the cervix, also becomes pale, like the vagina. Generally, the cervix becomes smaller and there is a decrease in cervical mucus secretion. This situation increases vaginal dryness, which may cause complaints of pain during sexual intercourse.
After menopause, the frequency of the uterus descending, the prolapse of the urinary bladder, and the bowel prolapse from the posterior wall of the vagina may increase. This condition is probably related to age-related slowing of cell division and decreased tissue elasticity, along with estrogen loss. Estrogen plays an important role in the maintenance of the bladder and urinary tract epithelium. Significant estrogen deficiency can cause atrophy of these organs. This can lead to atrophic cystitis, which is characterized by frequent urination, incontinence, and frequent urination without burning sensation. With sagging of the urinary tract and thinning of the epithelium, loss of urinary tract tone facilitates the formation of caruncles at the exit of the urinary tract, which causes burning during urination, sensitivity in the external urinary opening, and sometimes bloody urine.
During sexual stimulation, vaginal lubrication decreases. This is due to the thinning of the epithelium of the glands. Additionally, the secretions of the sebaceous glands decrease. As a result of the weakening of collagen and fatty tissue in the outer lips and vagina, dryness occurs with fluid loss, followed by thinning of the vaginal epithelium.
40% of women near menopause and in the early post-menopausal period experience sexual intercourse. There is a decrease in desire. During menopause, 27-55% of women experience vaginal dryness, 32-41% experience painful sexual intercourse, and 30-38% experience itching and burning. Many factors such as physiological, social, cultural, psychic and personal factors determine sexual activity in humans. Vaginal dryness and other changes in the outer lips and vagina may lead to a decrease in sexual interest, but in addition to these physical reasons, insomnia, hot flashes and sweating complaints that occur during menopause, chronic diseases (Diabetes mellitus, cardiovascular diseases, etc.) and emotional changes may also lead to a decrease in sexual activity. Although the decrease in sexual comfort and function is related to decreasing estrogen levels, another important reason is androgen deficiency. Testosterone levels peak in women in their 30s, but decrease with age, and the decrease in testosterone and androgens becomes evident after the age of 40. The decrease in androgen levels contributes to sexual dysfunction.
Psychological Complaints
The chain includes complaints such as appetite changes, irritability, headache, depression, restlessness, joint and muscle pain, palpitations and insomnia. It is called "menopausal syndrome". Although the decrease in estrogen level is an important factor in the formation of these complaints, their severity and diversity vary according to individual and culture. It has been shown that race, ethnicity and lifestyle (physical activity, smoking, diet, etc.) also affect hot flashes and psychosomatic complaints.
The relationship between estrogen deficiency and neurological functions has been tried to be explained by various mechanisms. There are estrogen, progesterone and testosterone receptors in some centers in the brain. Decrease in cerebral blood flow and vascular relaxation in peripheral vessels, increase in the risk of clots and atherosclerosis in brain vessels, withdrawal of estrogen from the nervous system development process after menopause, decrease in nerve connection density and serotonin level with decreasing estrogen level, brain-derived neurotrophic factors responsible for the degeneration of brain cells and nerve cells. Reduction in growth factors are various proposed mechanisms. Many menopausal women experience symptoms suggestive of impairments in memory and neurological functions. He complains about things. Subjective descriptions of confusion, agitation, irritability, forgetfulness, depression, loss of self-confidence and liking, loss of motivation and energy are common.
Sleep problems, such as hot flushes, increase in the late stages of the menopausal transition period and continue in the postmenopausal period. It does. The frequency of depression peaks during the menopausal transition period. It has been reported that 10% of women aged 45-55 experience depression. However, the reason for the relationship between depression and the menopausal transition period has not been fully explained. Many factors play a role in the emergence of depression. Estrogen level alone is not a factor. However, changes in estrogen levels have been associated with the occurrence of depressive moods. In menopausal women, psychological symptoms may occur with aging and loss of childbearing abilities, and anxiety about sexual inadequacy may set in.
Effects of Menopause on Bone Metabolism
Bone resorption, also called osteoporosis, balances the balance of bone formation and destruction to the detriment of bone formation. It is defined as the deterioration of the microstructure of bone tissue and a decrease in bone mass as a result of changes in bone tissue. Bone tissue, which has a dynamic metabolism, reaches its highest density between the ages of 25-35 in both genders. Although it is genetically coded, nutrition and physical activity in childhood and adolescence have a significant impact on the formation of peak bone mass. The development of osteoporosis depends on peak bone mass and the rate of bone loss at menopause. After the age of 30, the loss begins at a rate of 0.5% per year. After the age of 40, bone loss occurs at a rate of 0.3-0.5% each year in the slow phase and 2-3% in the rapid phase. After surgical removal of the ovaries, the average bone loss is 3.9%/year for the first 6 years and 1%/year in the following years.
Osteoporosis occurring in later ages may be osteoporosis due to menopause and osteoporosis due to old age. . While osteoporosis due to menopause is bone loss that occurs as a result of estrogen deficiency, osteoporosis due to aging is a physiological process seen in both men and women. By the age of 80, 30-50% of the skeletal mass has been lost.
The main factor in bone loss after menopause is estrogen deficiency, while the transition to menopause
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