Menopause - climacteric

The menopause occurs in the woman usually between the 45th and 60th year of life. During this time, the body's own production of sex hormones diminishes and the ability to reproduce returns. At the same time, but even four to five years earlier, more or less pronounced symptoms such as hot flashes, sweats and mental changes can cause problems.

    How come the typical complaints?

    Climacteric and menopausal complaints arise because the ovaries initially restrict their function and then adjust them gradually. The sex hormones they produce (estrogens and progestins) have a variety of physiological tasks that go far beyond reproduction. Conversely, this not only makes a pregnancy impossible, but in addition, other impairments are possible, for. On the uterus, the vagina, on the mammary gland and also on non-sex specific organs such as the bones, the liver and the circulatory system.

    What are the typical menopausal symptoms?

    • Hot flashes (70%),
    • Sweats (55%)
    • Dizziness (45%)

    These symptoms first appear as a result of the hormone deficiency and last about 3 to 5 years. The extent to which the symptoms are pronounced varies considerably from woman to woman and depends strongly on the individual vegetative and psychological constitution. After 10 to 15 years, further complaints may occur. For example: Arteriosclerosis, a uterine depression, bladder dysfunction such. As severe urination, recurrent infections and dehydration of the vagina or osteoporosis.

    Phases of menopause

    The menopause runs over several years in different phases.

    • The premenopause denotes the time in which the change is announced. About the age of 40 first symptoms may occur. It can then lead to bleeding irregularities and various complaints.
    • The term menopause refers to the very last menstrual period. To be really sure if it is the menopause, it will take another year to wait. If you are unsure, you should contact the doctor.
    • Postmenopause is the decade after the menopause. In the ovaries, lower and lower levels of estrogen and progestogen are formed until production is finally stopped.

    Treatment of menopausal symptoms

    An integral part of a treatment of the complaints are the so-called non-drug measures:

    • Change to a healthy diet with low caffeine, alcohol and nicotine
    • Stress avoidance and more exercise
    • Conscious relaxation z. With yoga, acupuncture etc.

    These measures also serve to maintain good health and well-being for a long time.

    Hormone therapy

    If the declining hormone production during the menopause is primarily responsible for the physical and mental discomfort, it seems reasonable and logical to replace these missing hormones, so as to combat annoying symptoms by the hormone administration. Compound preparations with an estrogen and a gestagen component are predominantly used. Pure estrogen supplements are now generally prescribed only in women who have had their uterus surgically removed. In order to individualize the therapy, it should first be taken into account in which phase of the menopause the woman is. Study results from the US and the discussion about the relationship between the benefits and risks of hormone replacement therapy, which has been sparked in the media, has prompted the Federal Institute for Drugs and Medical Devices (BfArM) to investigate the following areas of use and conditions for hormone replacement therapy with estrogen-progestagen combinations to publish:

    1. in menopausal complaints:

    • only with pronounced individual suffering
    • only after exclusion of risk factors (cardiovascular diseases, venous thromboembolic complications, cancer) and after informing the patients about the possible risks
    • Duration of use as short as possible (eg 1 to 2 years and possibly exhaust attempts)
    • choose the estrogen dose as low as possible

    2. for the prevention of osteoporosis (bone loss):

    • To prevent osteoporosis, estrogen-progestin combinations should no longer be used in post-menopausal women
    • in women at increased risk of osteoporosis, other available options should be considered as an alternative.

    3. in case of reversion to the urinary and genital organs:

    • Consider topical (skin) drugs such as patches or gels.

    Regarding the protective function of the cardiovascular system, the BfArM notes that the prevention of cardiovascular diseases is not one of the approved fields of application of the estrogen-progestagen combinations commonly used in Germany. Based on the current data, the treatment for the purpose of prevention is not justified.

    possible side effects

    • Thrombosis, weight gain, high blood pressure
    • Increased risk of uterine or breast cancer (only with estrogen alone in women whose uterus is still present)
    • Skin reactions, breast tensions
    • Headache, dizziness
    • Gastrointestinal complaints, liver dysfunction

    Contraindications for hormone therapy

    Important contraindications for hormone replacement therapy are:

    • severe liver disease
    • increased risk of thrombosis, previous or existing thromboses or embolisms
    • estrogen-dependent tumors
    • endometriosis
    • Diabetes mellitus with manifest vascular damage
    • difficult to set high blood pressure

    Herbal medicines

    Today, herbal medicines are also available for the treatment of menopausal symptoms. Phytotherapy is particularly suitable for the treatment of immediate reactions after elimination of estrogen production such as sweating, hot flashes and dizziness.

    Black cohosh

    However, herbal medicines are also important for women who are not allowed to or do not want to take hormone supplements. As women with a tendency to vascular occlusion or certain liver diseases. Cimicifuga racemosa (black cohosh) has the greatest importance in the treatment of climacteric complaints. The menopausal symptoms usually improve after a period of use of 4 to 6 weeks. Incidentally, medicines containing the active ingredient of black cohosh can also be taken together with hormone preparations, since no corresponding interactions or contraindications are known.

    St. John's wort against depressive moods

    In addition to Cimicifuga, St. John's wort (Hyperici herba) plays an important role in the treatment of mental symptoms. It fixes anxiety and tension as well as depressive moods. The effect begins only after about one to two weeks. When taking St. John's wort, especially in fair-skinned persons intensive sun exposure due to a possible photosensitizing effect should be avoided.

    homeopathic remedies

    Also homeopathic remedies are used successfully in the treatment of climacteric complaints, most commonly Acidum sulfuricum, Aristolochia, Cimicifuga, Lachesis or Sepia. An initial aggravation of the symptoms does not have to occur, but on the other hand is a good sign for the therapy and means that the appropriate remedy has been found for the patient.

    Bach Flower Therapy

    The Bach flower therapy causes a psychological harmonization between the core of the patient and his daily behavior on the personality level. The selection of the flowers takes place depending on the state of mind of the patient. By contrast, physical symptoms are irrelevant.

    Summary

    There are a variety of ways to influence menopausal symptoms, in which just the combination of different therapy directions can provide increased efficacy and even more individualized therapy. The individual situation is decisive and the wishes of the patient regarding the direction of therapy should be considered.

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