Menopausal disorders

Menopause occurs naturally as the supply of eggs in the ovaries runs out, typically starting around age 40. As fewer eggs are released, oestrogen levels drop, causing changes in the menstrual cycle, vaginal dryness, and eventually the cessation of periods. Some women experience hot flashes during this process, although the exact cause is not fully understood. 

Premature menopause, occurring before age 40, can be caused by autoimmune disorders like Addison's disease, medical treatments such as chemotherapy, or unknown factors. 

The term "menopause" is commonly used to describe the entire transition, but it actually refers to the point when menstruation has ceased for 12 consecutive months. Symptoms before periods stop, known as "perimenopause," may include hot flashes and irregular cycles. Once menstruation ends, the reproductive system is no longer functional.

Common symptoms of menopause include: 

• Irregular periods 
• Hot flashes 
• Vaginal dryness 
• Dry skin, mouth, and eyes 
• Itching and burning sensations during urination or sex 
• Reduced sex drive 
• Mood swings 
• Sleep difficulties 
• Palpitations 
• Urinary tract problems 
• Osteoporosis 

The most notable signs are irregular periods and hot flashes, which can cause facial and chest redness and excessive sweating, particularly at night. Skin may become less elastic, leading to dryness in the mouth and eyes. The vaginal lining may also thin, increasing the likelihood of infections and decreased libido. Weakened pelvic floor muscles can contribute to bladder issues, while the decline in oestrogen affects bone health, leading to a higher risk of osteoporosis. 

While menopause is a natural process, certain measures can alleviate symptoms: 

• Diet and exercise: Eat iron-rich foods (red meat, leafy vegetables) and engage in daily physical activities like cycling, swimming, or walking for at least 30 minutes. 
• Vitamin D supplementation: Important for bone health, especially as older skin converts less sunlight into vitamin D. 
• Sleep and clothing: Ensure good sleep hygiene, wear moisture-absorbing fabrics like cotton, and use breathable bedding. 
• Avoid triggers: Reduce alcohol, spicy foods, and hot beverages, which can exacerbate hot flashes. 

For severe symptoms, hormone replacement therapy (HRT) may be prescribed. If vaginal dryness is a concern, oestrogen creams or suppositories may be used. For hot flashes, low-dose oestrogen tablets or patches are similar to contraceptive pills but without a pill-free week. HRT is typically limited to one or two years due to potential risks. 

Alternative treatments such as acupuncture are available, though not scientifically proven. 

Common side effects of HRT include headaches, nausea, tender breasts, fungal infections, depression, migraines, skin reactions, vaginal bleeding, changes in discharge, hypersensitivity, and fluid retention. The use of HRT may also increase the risk of blood clots. 

Long-term use of oestrogen-progestogen therapy has been linked to a higher risk of breast cancer, which decreases to normal levels five years after stopping treatment. It's important to regularly check for breast changes and consult a doctor if abnormalities are detected. 

Since menopause is a natural part of ageing, it cannot be prevented. Following lifestyle advice and considering HRT may help manage symptoms effectively. 

Farmacotherapeutisch kompas. (2019). Oestrogeen met oestrogeenreceptormodulator. Geraadpleegd van https://www.farmacotherapeutischkompas.nl/bladeren/groepsteksten/oestrogeen_met_oestrogeenreceptormodulator

Nederlands Huisartsen Genootschap. (2019). NHG-Standaard De overgang. Geraadpleegd van https://www.nhg.org/standaarden/volledig/nhg-standaard-de-overgang

Nederlands Huisartsen Genootschap. (2018, 1 maart). Ik ben in de overgang. Geraadpleegd van https://www.thuisarts.nl/overgang/ik-ben-in-overgang

Raboud UMC. (2019). Overgang. Geraadpleegd van https://www.radboudumc.nl/patientenzorg/aandoeningen/overgang/wat-is-de-overgang