Dr. Olga Sambolska*

Menopause typically occurs between ages 45 and 55, but the timing varies depending on race, ethnicity, country and health behaviours. The average age of menopause is 51.

Many women begin to experience menopause symptoms during the perimenopausal transition, often without realising the cause.

Menopause is caused by the natural aging process and ovarian failure, but in some cases can be caused by surgically removed ovaries or radiation or chemotherapy exposure to ovaries.

Understanding menopause symptoms

Menopausal symptoms can be divided into a few main groups: vasomotor symptoms, psychological symptoms, physical and metabolic changes and genitourinary syndrome.

• Vasomotor symptoms are well known as hot or cold flashes and excessive sweating.
• Psychological symptoms include mood swings, irritability, anxiety, lack of motivation and depression. Additionally could be noticeable memory problems, foggy brain and difficulty concentrating. Sleep problems often make these symptoms worse. Some women may mistakenly worry about dementia due to mild cognitive symptoms, but these are typically temporary and hormone-related.
• Physical and metabolic symptoms can involve heart palpitations, unexplainable fatigue, joint, muscle pain and increased risk of cardio-vascular diseases, arthritis and osteoporosis. Skin dryness, thinning, hair loss, gum diseases and tooth loss are also common for menopause. Weight gain and changes in body shape due to slowing metabolism are common and can contribute to other serious complications such as obesity, diabetes, high cholesterol and cardio-vascular diseases.
• Genito-urinary syndrome of menopause is a separated condition that includes specific symptoms like: increasing urination frequency and urgency, stress urine incontinence and increased risk of UTI (urinary tract infections), vaginal dryness and painful sex.  

Fatigue, joint pain, and body changes are common physical symptoms of menopause. — Photo canva.com

The cause of menopause symptoms

The primary cause of menopause symptoms is deficiency of estrogens, mainly estradiol. This hormone is involved in around 30 physiological processes in the female body. As estrogen levels decline, regulation of many body systems is disrupted, leading to the wide range of symptoms during menopause.

Diagnosis of menopause

Diagnosis is mostly clinical, based on classic symptoms and absence of period for 12 months. Hormonal blood test used commonly to check FSH, LH (pituitary hormones that regulate ovarian function), estradiol and AMH (ovarian hormones that significantly low in menopause).

Treatment options for menopause 

Lifestyle modification 

This is crucial for menopause symptoms reduction. This includes not only avoiding smoking and alcohol, but also reducing caffeine and salt intake, maintaining a healthy diet with calcium, vitamin D and natural probiotics. Regular moderate exercise helps stabilise weight, preserve muscle, support heart health, and reduce stress and anxiety. Practices like yoga, tai chi, and meditation also help with mental symptoms and sleep quality. 

Hormone replacement therapy (HRT) 

HRT remains the most effective treatment for moderate to severe menopause symptoms. There are few forms of hormonal medicines: pills, gel, patches, pellets. Although HRT does not significantly increase risk of blood clots (venous thrombosis), stroke, uterine and breast cancer dose, duration of HRT should always be under gynecologist control. Each patient should be individually assessed for the benefit and risks, with regular monitoring of side effects and treatment effectiveness through annual checkups.

Routine monitoring

It is recommended to have regular blood tests to check lipid profile, glucose levels, blood coagulation, liver and thyroid function. A pelvic exam along with pelvic ultrasound, breast ultrasound, and mammography should be performed annually. Bone density testing may also be advised based on personal or family history of osteopenia or osteoporosis.

Non-hormonal and herbal options

Non-hormonal therapies are suitable for women with mild menopause symptoms or those who cannot use HRT. Some herbs contain substances that act like estrogens and may help relieve vasomotor symptoms. These include black cohosh, red clover, evening primrose oil, soy isoflavones, contain. However, herbal products can interact with various medications such as antidepressants, anticoagulants, and hormone therapies. Since quality and dosage can vary widely between brands, their use should always be guided by healthcare providers. 

Please do not wait for menopause symptoms to disappear on their own or become more severe. Talk to your gynecologist to assess your symptoms, evaluate risk factors and find the right support to improve your quality of life. 

Menopause is not the end – it’s a new chapter in a woman's life, one that can be fulfilling, and full of new experiences, emotions and encounters. — Family Medical Practice

Dr. Olga Sambolska. — Photo courtesy of Family Medical Practice

*Dr. Olga Sambolska graduated from Lviv National Medical University in 1996 and commenced her medical career at the Volyn Regional Maternity Hospital in Ukraine. Since 1998 she has been a registered obstetrics and gynecology doctor, providing healthcare to women in relation to pregnancy, birth control, menopausal issues, contraception, menstrual cycle diseases and sexually transmitted diseases. She is fluent in English, Ukrainian, Polish and Russian.

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