Menopause: The end of fertility, but a new period of possibilities

The menopause is a slow transition involving physical and emotional changes. Hormone replacement therapy, exercise and herbal remedies can all help with symptoms but every woman has different needs, say two specialists. Plus, there are upsides to this new chapter of life. Berlin (dpa) – The menopause marks the end of a woman's reproductive years. While many people immediately think of symptoms associated with the hormonal transition preceding it, such as hot flushes and mood swings, it's not an illness, but of course perfectly natural. "It's a gradual process that doesn't start only after a woman's last menstrual period," says gynaecologist and author Dr Sheila de Liz.  As early as her mid- to late 30s, a woman's menstrual cycle begins to change. The number of her ovarian follicles, each of which contains an egg cell already present at her birth, has become depleted over the years. Ovulations, when an ovary releases a mature egg, become less frequent. Some women don't notice these changes until their mid- or late 40s. Intervals between their menstrual cycles can fluctuate, the length and/or amount of menstrual bleeding can become irregular – all of which is normal. This natural transition into the menopause is known medically as the perimenopause. The average age of a woman's last menstrual period is 51 years, and the menopause is said to have been reached when she has gone 12 consecutive months without a period. Until then, natural pregnancy is possible. During the perimenopause, the ovaries gradually stop producing the primary female sex hormones oestrogen and progesterone, which regulate menstruation. And: "We now know that hormone receptors are found on all organs, including the brain," says physician and medical journalist Dr Suzann Kirschner-Brouns. Oestrogen acts on neurotransmitters such as serotonin and dopamine, which are important for emotional well-being. Progesterone is commonly thought of as the "relaxing hormone," as it promotes sound sleep and a steadier, calmer mood. A drop in progesterone levels can lead to mood swings, irritability, difficulty sleeping and occasional anxiety. Some perimenopausal women have the feeling they're changing, since their body is going through an important transition. Lower oestrogen levels can cause symptoms such as joint pain, digestive problems, skin changes, night sweats and occasional difficulty concentrating, not to mention the infamous hot flushes. Women experience this life phase very differently. "A third of them have no symptoms, a third have mild to moderate symptoms, and a third have symptoms so severe as to upend their daily life," says Kirschner-Brouns. Fortunately, the hot flushes, excessive sweating and mood swings gradually diminish in almost all of the affected women and eventually go away. Seeing a doctor is advisable in cases of heavy bleeding, impaired sleep over weeks or months, extreme difficulty concentrating, depression, or panic attacks that make life difficult. But what if your doctor doesn't seem to take you seriously enough, dismissing your complaints along the lines of "you're still too young for that, you're still getting your period"? Then Kirschner-Brouns recommends that you look for another doctor. "Women today no longer have to silently suffer," she says. "There's a whole range of helpful remedies for menopause symptoms." Combination hormone replacement therapy (oestrogen and progestin, a synthetic form of progesterone) is the most effective way to treat hormone-related symptoms, according to Germany's Health Ministry. Since it carries risks, women should weigh its potential up- and downside with their doctor. De Liz encourages women to inform themselves about the therapy and speak with their doctor about it. "You can easily try it out – the positive effect is quick," she says. If hormone replacement therapy isn't the answer for you, alternatives include psychotherapy and cognitive behavioural therapy. A number of websites and apps can also be helpful, but not all of them are medically sound. As for self-help, Kirschner-Brouns first and foremost recommends stress reduction or management. Many women also find relaxation techniques, breathing exercises, yoga and meditation to be helpful. A dietary change can bring relief as well, such as replacing animal-source protein with plant-based alternatives. In other words, eat less meat and sausage, and more legumes, vegetables and vegetable oils. "This strengthens your gut microbiome, which is good for your mental health too," says Kirschner-Brouns. Regular exercise, particularly muscle-building, is especially valuable in this life phase. It provably helps you to relax and can boost your mood. Fairly mild menopause symptoms – any postmenopausal symptoms are typically mild, by the way – can be treated with plant-based remedies such as hop preparations or monk's pepper (Vitex agnus-castus), according to Kirschner-Brouns, or with herbs and tea for excessive sweating, for instance. Various plant-based compounds and dietary supplements said to alleviate menopause symptoms are available in chemists and pharmacies. Their effectiveness hasn't been scientifically proven, however, and some can have side effects or are subject to drug interactions. Phytoestrogens, naturally occurring plant compounds that mimic oestrogen, should be taken only after consulting a doctor, because they dock onto the same oestrogen receptors in the body as conventional hormone replacement preparations. Both de Liz and Kirschner-Brouns recommend that women talk openly about menopause and its associated symptoms – at their workplace, with their family, and with their spouse or partner. "Dealing with it frankly takes pressure off of you," says Kirschner-Brouns. Communication with your spouse or partner is especially important. If vaginal dryness due to oestrogen deficiency causes discomfort during sex, you should discuss it with them. Otherwise they could take your reluctance to have intercourse personally, unnecessarily straining your relationship. Many women discover new freedoms and possibilities in life after menopause, and not just because contraception's no longer an issue. With an average life expectancy of around 80 years, a third period of life begins that, "while requiring greater attention to body and soul, can be a fulfilling time with many activities and advantages," says Germany's Professional Association of Gynaecologists (BVF). "The chapter is yours to write." The following information is not intended for publication dpa/tmn wib xxde bzl lue amc ob arw

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