Menopause Clinic:

Menopause: Last menstruation which is followed by an amenorrheal period of minimum 12 months or which is recorded before the surgical removal or destruction of both ovaries.

  • Perimenopause: Transition period immediately before the start of natural menopause, in which changes appear, and which covers 1 year after menopause.
  • Artificial menopause: Menopause caused artificially by medical treatments or surgical interventions which eliminate, or lead to serious damages in, ovaries.
  • Premature (Early) Menopause: Menopause in women at 40’s or earlier.
  • Postmenopause: Years after menopause.

Physiology of Menopause

Loss of ovarian follicles leads to reduction in ovarian hormone production, which results in cessation of menstruation and loss of fertility.

FSH (follicle-stimulating hormone) level increases.

Body changes such as weight gains, dermal and hair changes, vaginal dryness and bone loss are reported.

Purpose of Menopause Treatment:

Disease or Circumstances:

Used for treatment of menopause-related complaints (hot flush, perspiration, tachycardia, sleep disorders, distractibility, sexual anorexia);

  • Vasomotor symptoms in postmenopausal women (hot flushes), and vaginal atrophy, and for prevention or treatment of osteoporosis.

Interventions and Important Practices:

  • Individualization of treatment according to profit / loss profile of woman, and:
  • Hormone therapy (HT) formulas;
  • Ways of administration;
  • Treatment timing.
  • Periods of use of estrogen treatment (ET) and estrogen – progesterone treatment (EPT):
  • ET in women with vulvar and vaginal dryness
  • HT in women with premature menopause

Advantages of administration of transdermal (adhesive patches placed on skin) and low-dose oral estrogen.

Major Recommendations:

Results and Recommendations:

Individualization of treatment in hormone therapy (HT) bears a critical importance. Treatment should be individualized in the light of woman’s health and life priorities and quality, and according to such personal risks as venous thrombosis, coronary artery disease (CAD), stroke and breast cancer.

Period recommended for treatment varies depending on combined estrogen – progesterone treatment (EPT) and estrogen treatment (ET). While period of use of EPT is limited by the increased breast cancer risk and the increased breast cancer mortality as a result of use for 5 years, ET has a more advantageous profit/loss profile in an average period of use of 7 years and in the follow-up process of 4 years, and this in turn paves the way for a more flexibility in the period of use of ET.

ET is the most efficient treatment of vulvar and vaginal dryness symptoms. Low-dose local vaginal ET is recommended in case of only vaginal complaints.

Women who enter premature or early menopause and are fit for HT may continue to use HT until at least their average natural menopause age (51). A longer period of use may also be considered for management of complaints.

Summary:

Many new information is collated within the initial 10 years following the printing of first results of WHI and EPT studies. There are many evidences demonstrating that different HT formulations, different ways of administration and different administration times lead to different effects. To prepare an individual profit / loss profile is a must for every woman considering to use any HT formulation. Wish of a woman to use HT will vary according to her personal situation and particularly, severity of her menopausal complaints and the effects of these complaints on her life quality. Absolute risks of use of HT by a healthy woman in young menopause between 50 and 59 years of age are low. On the other hand, long-term use of HT and initiation of HT treatment at advanced age are associated with larger risks.

Periods of use recommended for ET and EPT are different. As ET has a more advantageous safety profile, in absence of side effects and risk factors, it may be considered for long-term use. Women in premature menopause are under increased osteoporosis and probably cardiovascular risks, and generally, such women report stronger complaints that women who enter menopause at average ages. Therefore, in these young women, HT treatment is recommended to be continue until average menopause age and to be reassessed at that age.

Postmenopausal Bleeding:

Uterine cancer (endometrial cancer) is particularly seen in old and postmenopausal women. Consulting to a doctor due to a vaginal bleeding or maculation after menopause may ensure detection of cancer at early stage. 70% of cases are between 45 and 74 years of age. As it shows early symptoms, 75% of all cases are diagnosed at initial stages. 5-years survival chance is around 84% in average for all stages, and this rate is even higher when the disease is detected earlier.

Risk Factors:

  • Above 60 years of age;
  • Obesity;
  • Long-term use of hormone drugs not containing progesterone and containing only estrogen;
  • Menstrual bleeding starting at young ages, and entering into menopause at advanced ages;
  • No labor history or infertility history;
  • History of colon cancer or endometrial cancer of herself or her family;
  • History of breast or ovarian cancer;
  • Ovarian diseases;
  • Use of tamoxifen (a hormone drug used in breast cancer treatment);
  • Diabetes Mellitus;
  • Nutrition rich in animal fats;
  • Hypertension and Menstrual irregularities.
  • Estrogen Replacement Treatment
  • Early symptoms are seen in many women suffering from endometrial cancer.

These symptoms are:

Abnormal vaginal bleeding, maculation or flow:They are important especially in women at menopause period. It is in the form of irregular menstrual bleedings in women who are still menstruating. All women who are suffering from postmenopausal bleeding or have increased post-40’s vaginal bleeding complaint must consult to a doctor against the probability of uterine cancer. Furthermore, during periodic gynecological examinations, measurement of endometrium (inner mucous membrane of uterus) thickness by transvaginal ultrasonography may also give an idea about uterine cancer. In case of an endometrium thickened in postmenopausal years, it should be checked for cancer. Non-bleeding vaginal flow may also be a finding, as 10% of flows associated with endometrial cancer are non-bleeding.

Burning sensation in urination, pain during sexual intercourse,

Pain or mass at pelvic area.

In case of presence of any one of the aforementioned symptoms, a gynecologist should be consulted.