A Smooth Transition

In recent years, there has been a positive change in women's awareness of menopause symptoms. More women tend now to share, talk about how they are feeling and even seek help from professionals. However, there is still a great deal of ignorance and lack of clarity regarding symptoms that appear around menopause and the variety of treatments available.

"Every week I meet women around the age of 50 in the clinic who complain of many diverse symptoms such as muscle pain, decreased vitality, fatigue and poor sleep, but when I ask them if they know why they are experiencing this, they always have a rational explanation for the symptoms: pressure from work, family, the war and more. No one connects the symptoms to menopause. If you ask why, the answer is that you go to the doctor when you're sick, and age isn’t a disease," says Dr. Esti Maor Sagi, a senior physician in the Obstetrics and Gynecology Department at Hillel Yaffe Medical Center.

Some facts

Menopause is the stage when there is a sharp decline in the production of ovarian hormones, leading to irregularity in menstruation until it stops. Usually, menopause occurs between the ages of 45 and 54. According to the data, about one-third of women in Israel are over the age of 50 and, in fact, spend a significant portion of their lives around menopause. With increasing life expectancy, the proportion of women and the length of time a woman will live with menopause is increasing, so it's important to recognize and know what hormonal and psychological changes a woman may experience during this period.

When women are fertile, the ovaries secrete two main hormones: estrogen and progesterone, which lead to ovulation and then enable pregnancy. During menopause, there is a decrease in the production of these two hormones, which results in the loss of fertility as well as immediate symptoms and long-term effects. Some symptoms will eventually disappear, but others can last a long time and, in some women, even for the rest of their lives.

The symptoms

"Because estrogen receptors are found in many organs in the body, each woman experiences the symptoms differently and to varying degrees. Sometimes, symptoms of menopause can appear even when women still have a regular menstrual cycle, several years before menstruation stops. We generally divide the symptoms into four main groups: vasomotor symptoms, various physical and psychological complaints, irregular bleeding and urogenital symptoms. An additional group worth noting is bone loss. The most common complaints at the beginning of menopause are vasomotor symptoms, mainly hot flashes, feelings of rapid heartbeat, and night sweats, complaints of depressed or fluctuating mood.

Later, urogenital symptoms become more prominent such as vaginal dryness, itching, urinary tract infections and a tendency toward osteoporosis. The hormonal deficiency also affects other systems such as the brain, vascular system, bones and connective tissue. Consequently, the hormonal deficiency has a significant impact on the decline in quality of life, and as previously noted, a large proportion of women do not realize that the symptoms are related to age and therefore are not treated accordingly.

Hormonal profile: Is it really necessary?

One of the most common requests from women after they describe the symptoms they are experiencing is to run a hormonal profile. Note that symptoms can appear even while having regular periods and when the profile is normal. Therefore, a hormonal profile is not necessary to provide appropriate treatment for their symptoms. If a woman is under 40 or has atypical symptoms, then it’s worth performing this test.

The treatments

Hormonal treatment, and particularly the approach to treatment, has changed a great deal over the years. The standard approach among scientific associations on whether and when to begin treatment is that most women should be advised to start before turning 60, while they are less than 5-10 years from the end of menstruation. At these stages, the benefit of hormonal treatment outweighs the risks, assuming there is no medical prohibition against hormonal treatment. Determining the exact treatment is personal, depending on the woman's stage in menopause, and of course, the main symptoms she is experiencing. Treatment can be in the form of pills, patches or a combination of suppositories, creams and pills.

For how long is treatment provided?

Most symptoms that make women see treatment will gradually resolve, and women can try to stop or continue treatment according to their specific complaint. Complaints of vaginal dryness usually appear later and can be treated locally very effectively. However, if you discontinue the treatment and your symptoms recur, you can always resume treatment. It is important to note that there is no single method for discontinuing treatment. Some women prefer to stop immediately and others to stop gradually. The response to treatment is evaluated every few months and depending on the patient's condition decisions are made about continuing or changing treatment. In addition, an annual breast screening and ultrasound should be performed to check the thickness of the uterine lining.

In short, Dr. Maor Sagi says, "In addition to hormonal treatment, non-hormonal treatment options based on various plants are also available, but they are nowhere near as effective as controlled hormonal treatment. It is important to understand that menopause is not a death sentence. Talk to your doctor, share your symptoms, and together try to find the hormonal/non-hormonal treatment that’s best for you. While menopause is not a disease, it can definitely affect quality of life and lead to various long-term complications that can be prevented with appropriate treatment, so there’s no reason to compromise. Don't be afraid to share and try different treatments until you find the one that’s right for you."