What is menopause?
It is a life period that includes hormonal, psychic, physical and cognitive changes, characterized by the cessation of menstrual bleeding as a result of the end of the functions of the ovaries in women. As human life gets longer, one-third of women's lives are spent during menopause.
What are the conditions for considering a woman to be in menopause?
Menopause is diagnosed when a woman does not have a menstrual period for twelve months or when some hormones called gonadotropins are above the threshold value.
How long does the menopause process take?
Generally, the transition to menopause is a gradual process. This process, which begins around the age of 47, can last up to four years. The average age of menopause is 51. The most important factor determining the age of menopause is genetic factors. The entire period of perimenopause, menopause and postmenopause is called climacterium. Malnourished people, vegetarians and smokers enter menopause earlier. Cessation of menstruation before the age of 40 is called early menopause.
What are the symptoms of menopause?
Although they vary from woman to woman, the most disturbing complaints are hot flushes, night sweats and palpitations, which are seen in approximately 80% of women. On average, it takes one to two years, sometimes it can take up to five years. We call these vasomotor symptoms. In addition, due to the lack of estrogen hormone in the genital and urinary systems, we may experience vaginal dryness, increased vaginal infections, itching, burning, pain during intercourse, decreased libido, and increased urinary tract infections. Psychological symptoms may include mood changes, irritability, depression, loss of concentration, and insomnia. In the long term, due to estrogen deficiency, bone loss, which we call osteoporosis, may occur, resulting in an increase in bone fractures. Additionally, there is an increased risk of cardiovascular diseases and Alzheimer's disease in the long term.
What can be done medically to eliminate menopause complaints?
The patient's complaints are evaluated and the risks he or she will face in the long term are shared with the patient. The basic treatment is from the ovaries here. It replaces the estrogen hormone, the female hormone whose secretion has ceased. Combination treatments containing progesterone are given to balance estrogen in women with a uterus. In addition, we can recommend preparations containing calcium and vitamin D to protect bones.
How can estrogen hormone be given, what should be checked before treatment?
The patient is examined gynecologically and smear is taken. Possible gynecological cancers are excluded. In particular, it is evaluated whether there are systemic diseases such as hypertension, diabetes and heart disease. The patient's mammography is requested. The breast film is checked to see if there is any obstacle to estrogen treatment. The patient's blood tests are requested. Hemogram, blood lipids, sugar levels, kidney and liver functions and, if necessary, bone densitometry are checked. As a result of all these evaluations, the patient is informed and if treatment is required, the type of treatment is determined. Estrogen hormone can be administered orally, transdermally, vaginally or through the nose with nasal sprays. Intermittent or continuous regimens with no bleeding can be applied. In patients with high blood pressure and high blood lipids, it is more appropriate to treat with hormone-containing patches attached to the skin, which we call transdermal route. Local preparations can be used for urogenital atrophy. The basic principle in menopause treatment is to individualize the treatment and organize the treatment according to the needs of the person. The main goal is to prevent vasomotor symptoms.
Is there any group for which we cannot recommend hormone therapy? What is the alternative treatment in these cases?
Hormone therapy in tumors that we think are estrogen-dependent, such as breast cancer and high-risk endometrial cancer. not recommended. In addition, hormone therapy is not suitable for those with serious cardiovascular disease, uncontrolled hypertension, problems due to vascular occlusion, acute liver disease, and unexplained vaginal bleeding. Herbal treatments that do not contain estrogen may be recommended for this group of patients.
What alternatives can be recommended for menopause treatment?
Exercise is an effective method in the treatment of hot flashes and sweats that disturb patients in the early stages. Besides Exercise is beneficial for patients as it protects the muscles, bones and cardiovascular system. On the other hand, healthy nutrition is very important. A balanced diet that prioritizes weight control, does not smoke and restricts alcohol is extremely important for a healthy menopause period. Complex carbohydrates should be preferred instead of simple carbohydrates. For example, bulgur pilaf should be preferred instead of legumes, brown bread and rice pilaf. When consuming meat, care should be taken to ensure that the meat is lean, and boiling, steaming or grilling methods should be preferred as cooking methods. Hazelnuts, dried figs and dairy products are important sources of calcium. It is beneficial to restrict salt and choose green leafy plants and nuts that contain phytoestrogens. Care should be taken to increase fluid consumption. Benefiting from sunlight will also protect the patient against osteoporosis.
Does hormone therapy cause cancer?
If the patient does not have risk factors, these drugs can be used safely under the supervision of a doctor until the age of 60. In a study by the World Health Organization, the combined use of estrogen and progesterone in people over the age of 60 may cause a very small increase in the risk of breast cancer. In patients over 60 years of age, the benefit and harm should be calculated.
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