PREFACE Most women get their last menstrual period between the ages of 40 and 60; the average age is 51 years. The last menstrual period is also called menopause. Before and after the menopause there is a period of several years in which the hormones seek a new balance. This period is called the transition, the climacteric; its duration is different for every woman. These transition years are also the phase of life in which other important changes take place: the children become independent, parents require more care and you may also need to ask yourself how you want to move forward in your work. It is a period that can evoke mixed feelings. Some women feel the lack of menstruation as a relief, others may be sad because their fertility has now been permanently lost. In a quarter of the women, the menopause is accompanied by complaints that can disrupt daily life, others have no complaints at all. However, menopause is a natural phase in every woman’s life. What hormonal changes are there in the menopause, what symptoms can they cause and what can be done about it? This is discussed in this brochure. HORMONAL CHANGES At puberty, the female sex hormones begin to work and the first menstruation occurs. Menstruation is the result of a complex interplay between the brain, ovaries and uterus. During fertile life, the hormones estrogen and progesterone are made in the ovaries. Estrogen and progesterone also affect other tissues, such as the vagina (vagina), breasts, bones, skin, blood vessels and nerve cells. The ovary also makes testosterone: this hormone is important, among other things, for the libido, the desire to make love. When the stock of eggs in the ovaries decreases, less estrogen and progesterone are gradually produced. This is the beginning of the transition. The first manifestation of the menopause is usually a change in menstruation. Typical menopausal symptoms may occur, such as hot flashes and perspiration attacks. THE BEGINNING AND DURATION OF THE TRANSITION The average age of onset of menopause is 51/52 years. The duration of the menopause is different for every woman. The average time between irregular periods and menopause is four years. Menopausal symptoms can last five to ten years or sometimes even longer. MENSTRUATIONS DURING PEOPLE Menopause often begins with a change in menstrual pattern. The periods come closer together and often become heavier; sometimes there are also clots. Then they become more erratic and eventually they stay away altogether. If the menstrual periods are very heavy during the menopause, you can have an examination for another cause WHAT ARE ‘TYPICAL’ TRANSITIONAL COMPLAINTS? In addition to the changes in the pattern of menstruation, there are more symptoms associated with the menopause. hot flashes Hot flashes are sudden heat attacks that may be accompanied by a flushed face and a feverish feeling; this can be accompanied by heavy sweating. Hot flashes can occur at any time, but can also be triggered by stress or alcohol, for example. Some women only experience it occasionally, others have it ten to twenty times a day. A hot flash usually lasts a few seconds or minutes, but the symptoms can also remain for fifteen minutes or half an hour. Hot flashes can occur at night with heavy sweating attacks. In severe cases, this can cause sleep problems, fatigue and/or irritability. Dry skin and mucous membranes The skin may become drier and less elastic; wrinkles may form. Because less tear fluid and saliva is produced, the eyes and mouth can become drier. Complaints of the vagina and sexual changes Due to the decrease in estrogens, the inside of the vagina becomes thinner and drier. Many women suffer from itching and a burning sensation in the vagina and on the labia or when urinating. This makes the sheath and bladder more susceptible to infection. Due to these complaints and the drop in testosterone in the blood, the need for sex can decrease and intercourse can sometimes be painful. Complaints of the urinary tract With age, the pelvic floor muscles and the supporting tissues relax; this can cause the bladder to prolapse a bit. Because the mucous membranes of the urinary tract become thinner, bladder infections can develop earlier. Together, this can mean that the urine cannot be held for as long or that urine is lost when coughing, sneezing or exercising. CAN I DETERMINE BY AN INVESTIGATION WHETHER THE TRANSITION HAS BEGAN? Blood tests can determine hormones, but this test does not indicate how long it will take for the periods to stop, and it has the so it doesn’t make much sense. Your complaints in particular are the most important indications. TREATMENT OF TRANSITIONAL COMPLAINTS Irregular periods, hot flashes and sweating attacks are symptoms that naturally belong to the menopause and go away on their own. However, if you find them very annoying, there may be a reason to start taking medication. The shortage of estrogens is then supplemented by tablets, patches, nasal spray, implantable tablets under the skin, gel, vaginal suppositories, tablets, cream or ring. If only hot flashes exist, they can sometimes be treated with tablets without hormones (clonidine). Vaginal complaints, such as dryness, discharge or pain during intercourse, or urinary complaints due to frequent bladder infections can usually be treated with vaginal suppositories, cream, tablets or a ring. This treatment may take years. Hot flashes usually improve within a few days of starting treatment; complaints of the urinary tract and the vagina usually only improve after a few weeks. However, some women only notice that the complaints have completely disappeared after a few months. In the case of non-typical complaints (palpitations, weight gain, constipation, joint complaints, headache, insomnia, mood swings) a trial treatment of three months can be considered. HORMONES OR NO HORMONES? The menopause is a natural process in which the complaints will often disappear without medication. Talking to women in the same situation often gives recognition that you will be able to understand some complaints better. Homeopathic remedies for menopausal complaints sometimes provide sufficient improvement of your complaints. There are differing views on its effectiveness and little research has been done on it. Whether you want to use hormones is a decision that you have to make yourself. The most important argument here is the amount of nuisance you experience and whether there are any objections to using hormones. In the case of menopausal symptoms, discuss the advantages and disadvantages of hormone treatment in your specific situation with your doctor. . The side effects of estrogens can be very different. Some women experience fluid retention and breast tenderness or soreness; these symptoms are usually dose-dependent. If irregular bleeding occurs after menopause, you should always discuss this with your doctor. BACKGROUND AND USE OF THE ORDINARY PIL The bleeding will continue as long as you are on the pill. If the bleeding stops after stopping the pill, you could be menopausal. As long as this is uncertain, it is wise to use contraceptives until menstruation has been absent for more than a year. The chance of pregnancy in a woman of fifty is small, but not excluded. Medicines that are specially made for the menopause contain a smaller amount of hormones than the regular pill and are therefore usually preferred in case of complaints. However, they are not contraceptives. WHAT CAN YOU DO YOURSELF? Eat healthy and try to watch your weight. You will gain weight more easily after the transition. Try to get regular exercise that puts stress on the bones. Walking for half an hour every day, for example, strengthens the bones. Keep in mind that alcohol, coffee, tea, and spicy foods can trigger hot flashes. Don’t take too much on your fork. Take the time and rest to get used to all the changes. Try to get enough sleep as you can cope with the changes better when you are rested. Talk about any problems with your partner, a friend, your GP or a menopause consultant (ICG). If you have problems with urination, you can exercise your pelvic floor muscles, possibly with the help of a pelvic floor physiotherapist. Try to quit smoking. It is bad for the heart and blood vessels; the risk of cardiovascular disease increases after the menopause. ADDRESSES; WEBSITES Information Center Gynecology: www.icgynaecology.nl Osteoporosis Foundation: www.osteoporosestichting.nl Transition Net: http://europe.obgyn.net/nederland/mp/default.asp