Menopause is a word created by combining the Latin words meno and pause and adapting the word menopause, which means "stopping of menstrual bleeding", into our language. Menopause refers to the period when a woman's regular menstrual bleeding ceases. Menopause is one of the stages of a woman's life and is the result of a natural process. As a common belief in our society, menopause is seen as the beginning of old age. Considering the tendency for the average human lifespan to exceed the age of 80, it is realized that the menopause period actually covers a significant part of human life.
WHY DOES EARLY MENOPAUSE HAPPEN?
Never give birth It is observed that women who have not had menopause enter early. Studies show that mothers and daughters enter menopause at about the same age. This suggests that the age of menopause is closely related to hereditary characteristics. It is observed that women with nutritional disorders and those who adopt a vegetarian diet enter menopause at a relatively earlier age. Women who consume excessive alcohol enter menopause later. The most likely reason for this is that estrogen hormone levels are higher in these women due to the effects of alcohol on the liver. Underweight women tend to enter menopause earlier. This is due to the fact that these women cannot benefit from the contribution of fat tissue to estrogen production. Work life and other living conditions are not thought to affect the age of menopause. People living in high places enter menopause earlier. Women who have had a gynecological surgery that affects the blood circulation of the ovaries (such as hysterectomy) may enter menopause at an earlier age. Women born with intrauterine growth retardation (low weight) enter menopause earlier.
MENOPAUSE SYMPTOMS
Hot Flashes and Sleep Disorders
Menopause may cause insomnia or decrease in sleep quality due to the effects of hot flashes on the one hand, and a group of symptoms grouped as "strange symptoms" on the other hand. In addition, it is known that estrogen hormone deficiency directly affects the brain and negatively affects sleep characteristics. It is clear. In addition, hot flashes occur due to the increased LH effect.
When sleep disorders continue for a long time, they can lead to tension, irritability, fatigue, weakness, forgetfulness, waking up tired and concentration disorders.
Estrogen hormone is used in the treatment of sleep disorders that occur during menopause. Treatment has an important place. It has been shown in clinical trials that the estrogen hormone shortens the time it takes to fall asleep and improves sleep quality.
Genito-Urinary System Disorders
Difficulty in urination, burning sensation, itching, sexual reluctance due to estrogen deficiency, Difficulty and pain in sexual intercourse, called dysparania, are observed. Estrogen preparations used systemically and locally are very effective in their treatment.
Bone Resorption (Osteoropause)
Bone formation (osteoblastic) and bone destruction (osteoblastic) due to estrogen deficiency. Osteoclastic disease is a disease that occurs due to the imbalance between formation and destruction in favor. More detailed information about osteoporosis and its treatment is given below.
Cardiovascular Diseases
The risk of heart attack increases 5 times in women who have gone through menopause due to estrogen deficiency. is known. This situation is attributed to the imbalance of cholesterol, lipoproteins, low and high density lipoproteins due to estrogen deficiency. Therefore, women who have gone through menopause should have a check-up for cardiovascular diseases at least once a year.
Age at Menopause
The average age at which a woman enters menopause is accepted as 49.3 ±5 years. The average age of menopause in Turkey is 47 and in the USA it is 51. About 1% of women experience menopause before age 40. The age of menopause is determined hereditarily and is not affected by variables such as the age of first menstrual bleeding, breastfeeding, use of birth control pills, race, education, height and age at last pregnancy. Since smoking causes the death of egg cells, it has been determined that the age of menopause, especially for women who smoke 20 or more cigarettes a day, goes back 1-2 years.
Why Do Menstrual Bleeding Stop?
Menstrual bleeding, menstrual cycle It is a process that consists of bleeding out the inner layer of the uterus, which prepares for a possible pregnancy every month, in order to "refresh" it in case pregnancy does not occur. In each menstrual cycle, an egg cell enters the maturation process in the ovaries and begins to secrete estrogen hormone, and under the influence of this hormone, the inner layer of the uterus thickens. Ovulation occurs when the egg cell reaches a certain maturity. With the effect of the progesterone hormone, which comes into play after ovulation, the inner layer of the uterus becomes suitable for pregnancy. A girl is born with a certain number of egg cells in both ovaries. This cell community can be described as the "ovarian pool" for easy understanding.
While the number of egg cells in the pool is approximately 6-7 million during intrauterine life, it decreases to 1-2 million at birth. By puberty, the total number of egg cells in the ovaries has decreased to 300-400 thousand. Although the reason for this decrease in number is not fully known, it is likely that the egg cells with the most suitable genetic characteristics, that is, the highest quality, survive, while the others are disposed of to be unused. Thus, it is aimed to ensure that the new generation that will be formed after the fertilization of the egg cell is genetically perfect.
The decrease in the number of egg cells continues in the reproductive age, and in a woman, hundreds of primitive egg cells are mobilized every month throughout the reproductive age, 10 to 15 of which become antral follicles. Only one of them becomes the dominant follicle and ovulation occurs from this follicle. In other words, out of hundreds of thousands of primitive egg cells, only 400 can ovulate during a 30-year reproductive life. When the egg cells in the ovarian pool are completely exhausted, ovulation stops and since estrogen and progesterone hormones cannot be secreted, the renewal process of the inner layer of the uterus ends. Thus, menstrual bleeding disappears and menopause begins.
Follow-up in Menopause
Annual Complete Blood Count, biochemistry, cardiological screening, mammography once a year, Bone examination every 2 years. It should be done in the form of Mineral Densitometry, Transvaginal Ultrasonography, Hormone tests, Cancer markers (CA-125, CA-19.9 , CA-15.3 , CEA).
MENOPAUSE TREATMENT HOW IS VISI?
Today, there are 2 treatment indication criteria in menopause.
1-Hot flashes, insomnia, depression
2-Bone melting (osteoporosis)
Menopause Treatment
1-Hormone replacement therapy:
If there is no risk after menopause (these risks are the risk of breast, uterine, cardiovascular diseases). ) Estrogen therapy can be administered for 5 years. This treatment may be in oral, dermal, nasal, vaginal or injection form. It should especially be given before the age of 50. After the age of 55-60, hormone replacement therapy is not applied. This treatment should be done if there are hot flashes and osteoporosis as described above.
2-Phytoestrogens:
They are herbal estrogen-like drugs generally made from soy products. These drugs are known to prevent hot flashes and osteoporosis in patients, as well as to be effective in preventing breast and uterine cancers. This type of herbal products are also effective in prostate cancer in men.
3-Local estrogen creams:
They are especially effective in genital urinary system complaints. It is effective in complaints such as burning, pain, dryness and itching during sexual intercourse, burning during urination, urinary incontinence.
4-Non-hormonal drugs:
These act on the level of endorphins (livial tb.) and relieve menopausal complaints. and prevents osteoporosis and has positive effects on libido.
5-Nutrition habits:
Calcium-rich diet (more than 1000mg per day), milk and its products are especially effective in terms of bone loss.Soy. A rich diet is very important, especially in patients who cannot use estrogen.
6-Exercise:
Exercises corresponding to a 1-hour walk 5 days a week are very important in menopause.
7- Treatment in patients with osteoporosis:
If there is no risk, estrogen replacement therapy should be administered first, however, if osteoporosis is excessive, alendronate, calcitonin, active vitamin D3, 1gr calcium combinations should be administered every day and walking for 1 hour 5 days a week. It should be done.
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