Menopause Is Not a Disease: Informed Choices Can Support Women’s Health and Wellbeing

The transition to menopause is a biological process that takes place over several years, during which ovarian function and sex hormone levels change. Menopause is defined retrospectively: it is established when 12 months have passed since the last menstrual period and there is no other reason for the absence of menstruation. The average age of menopause is around 51, although the timing and experience vary considerably between individuals. Symptoms may begin even before the final menstrual period.

Hot flushes and sleep problems are not the only symptoms of menopause

Hot flushes and night sweats are the symptoms most commonly associated with menopause, but hormonal changes can also lead to sleep disturbances, mood changes, palpitations and difficulties concentrating. Vaginal dryness, pain during sexual intercourse and urinary symptoms may also occur.

Symptoms vary from woman to woman and do not necessarily appear at the same time. If they begin to interfere with sleep, work, relationships or everyday activities, it is worth seeking medical advice. There is no need to wait until the symptoms become unbearable before asking for help.

Menopause is also a good time to pay greater attention to long-term health. Hormonal changes may be accompanied by changes in blood lipid levels, body fat distribution and bone metabolism. It is therefore important to monitor blood pressure, stay physically active, follow a balanced diet, get sufficient sleep and look after bone health.

Hormone replacement therapy can relieve symptoms

Effective treatment options are available to relieve menopausal symptoms. Systemic menopausal hormone therapy is the most effective treatment for hot flushes and night sweats and can also improve sleep and quality of life. During treatment, it helps reduce bone loss and the risk of fractures.

For genitourinary symptoms, such as vaginal dryness and related discomfort, local vaginal oestrogen may be appropriate. This treatment acts primarily at the site of application. The choice of treatment depends on the nature and severity of the symptoms, the woman’s health status, individual risk factors and personal preferences.

Hormone therapy is not necessary for every woman. It is also not prescribed solely to prevent cardiovascular disease or dementia, or for weight loss. The decision to start treatment should be based on an individual assessment of its potential benefits and risks.

Health risks must be considered when choosing treatment

When assessing whether hormone therapy is appropriate, a doctor considers the woman’s age, the time elapsed since menopause, whether the uterus is present, any bleeding patterns, and risk factors for cardiovascular disease, venous thromboembolism and breast cancer.

In general, the benefit–risk balance of systemic hormone therapy is more favourable for symptomatic women who start treatment before the age of 60 or within ten years of menopause, provided there are no contraindications. This does not mean that every woman should start treatment or that treatment is always ruled out at an older age. The decision depends on the individual circumstances.

The route of administration also matters. Oestrogen can be taken orally or administered through the skin as a patch or gel. Research suggests that transdermal oestradiol is generally associated with a lower risk of venous thromboembolism than oral oestrogen. However, individual risk factors must always be assessed.

For women who still have a uterus, systemic oestrogen is usually prescribed together with a progestogen to protect the uterine lining from excessive thickening. Possible side effects and long-term risks must also be considered when selecting a treatment regimen.

Treatment should be reviewed regularly

There is no single maximum duration of hormone therapy that is appropriate for all women. The decision to continue treatment depends on whether symptoms persist, how well the therapy is tolerated and whether health risks have changed over time. Treatment should therefore be reviewed regularly, with the aim of using the lowest dose that achieves the desired result.

Dr Kristina Kuhi emphasises that discussions about menopause should strike a balance between awareness and avoiding unnecessary fear. Menopause is not a disease that must be treated at all costs, but women do not have to accept troublesome symptoms either. The most important thing is that women receive reliable information about their options and work with their doctor to find a solution that suits their individual needs.

Menopause can be an opportunity to take a more proactive and informed approach to personal health, wellbeing and quality of life.