Menopause: symptoms, duration and treatment

Menopause: symptoms, duration and treatment

Women between 45 and 60 are typically close to, amid, or just after menopause. Around two-thirds of women have menopausal symptoms during this time, which can range from sweating and weight gain to joint pain, numbness or tingling in the body. Every third woman going through menopause suffers so severely that she can hardly cope with everyday life without treatment. Below, we present typical symptoms of menopause and their causes. We also explain when menopause usually begins, how long the symptoms last, and what helps fight them.

Menopause: definition and phases

Menopause, also called the climacteric in medical terms, describes a period in which women undergo an age-related hormonal change. This change is accompanied by the gradual end of the monthly period and a beginning loss of fertility.

The menopause is divided into three individual phases, all of which relate to the menopause, i.e. the time of the last menstrual period. Distinctions are made:

  • Premenopause, i.e. the time before menopause, in which the hormone balance is already changing.
  • The perimenopause, which lasts for several years. During this time, the ovaries stop working.
  • Postmenopause, in which the hormonal balance levels off again and which heralds the end of the menopause.


Premenopause: when does menopause start?

Premenopause – the time before menopause – marks the beginning of menopause. It mainly affects women between 40 and 50 – women are, on average, 47.5 years old. This phase lasts about four years on average.

During premenopause, the release of follicle-stimulating hormone (FSH) increases slightly. The production of the corpus luteum hormone progesterone, on the other hand, decreases. This can lead to the periods between two bleedings becoming shorter. However, the period still occurs. Because estrogen levels are often elevated, individual bleeding can be more intense and last longer. Headaches and chest pains are common during this phase, but hot flashes and heavy sweating can also occur.

Perimenopause: when does menopause start?

The “peak” of menopause is perimenopause. It lasts six to seven years on average. This usually leads to significant irregularities in the cycle up to the absence of menstrual bleeding. On average, women are 52 years old when they have their last menstrual period and thus the onset of menopause.

The formation of progestins decreases more quickly than that of estrogens, so the concentration ratio between Progesterone and estrogens fluctuates wildly. Those affected may experience symptoms such as hot flashes, tachycardia, mood swings or increased nervousness. Many women find this phase of menopause to be the worst.


Postmenopause: when is menopause over?

Postmenopause begins a year after your last period and lasts until hormone levels have reached a new stable level. The menopausal symptoms subside. Nevertheless, problems such as a dry vagina or dry skin and urinary incontinence often still occur.

The end of postmenopause and, thus, menopause varies from woman to woman. It depends not only on the hormonal changes but also on the subjective experience of the symptoms.

How long does menopause last?

The duration of menopause varies from person to person, as does the age at which menopause occurs. The exact time of the menopause can only be defined retrospectively if there has been no further menstrual bleeding for a year. Overall, menopause can last about 10 to 15 years.

Premature menopause

For some women, menopause occurs particularly early. One speaks of premature menopause (climacteric praecox), when the ovaries stop functioning before age 40. Possible reasons for an early onset of menopause include genetic causes, autoimmune diseases, malnutrition, being underweight or smoking. When the ovaries are removed – for example, due to cysts or tumours – menopause occurs immediately.


Symptoms in the climacteric

About a third of women have no or hardly any symptoms during menopause, and another third have moderate symptoms. However, in one-third of all women, the hormone levels drop so quickly that they experience this as physical and mental stress. When the first signs appear, you should seek gynaecological advice. You will receive help adjusting to this new phase of life and, if necessary, the appropriate treatment.

Common complaints during menopause

How often the different menopausal symptoms occur is listed in the following table:

In addition, with advancing age, the lack of hormones can lead to the following symptoms, among others:

  • Regression of the mucous membranes in the vagina (atrophy) with vaginal dryness (characterized by itching and burning) and pain during sexual intercourse and an increased susceptibility to urinary tract infections
  • Skin slackening, as it loses elasticity, becomes thinner and drier, which can manifest itself as redness and itching, as well as a tendency to pigment and age spots.
  • circulatory problems
  • Weakening of the pelvic floor muscles and associated incontinence
  • Decreasing hair growth and hair loss, sometimes “masculinization” (more facial and body hair) due to a relative excess of testosterone (compared to the other hormones)
  • Intermenstrual bleeding (spotting)

Medical causes of the complaints

Menopause is an age-related physical change process. The fluctuations in estrogen levels often manifest as irregularities in temperature regulation in the form of hot flashes, sweating or blushing.

In addition, vegetative changes can occur, i.e. changes in the area of ​​the nervous system, which is not controlled voluntarily and regulates vital functions such as heartbeat, breathing, digestion, and metabolism . Progesterone and estrogen have opposite effects on the autonomic nervous system. For many women, the constantly changing concentration of hormones is accompanied by palpitations, increased nervousness, sleep disorders (especially problems sleeping through the night), listlessness, irritability or mood swings. Abnormal sensations such as numbness or tingling and burning in the arms and legs or the whole body (paresthesia) are usually related to the nervous system.

The real estrogen deficiency symptoms only appear in the postmenopause. They affect the female sex organs and can show up as dry vagina, bladder weakness and altered sexuality.

In addition, many women also experience non-medical changes during this phase of life, which can also trigger mood swings and other symptoms, such as problems getting back to work or when children start to unhook and move out of the house.


Menopause: postmenopausal health implications

Postmenopausal – i.e. after a woman’s menstrual period has ended – the risk of some diseases increases:

  • Osteoporosis: Estrogens promote the formation of bone substances by stimulating bone metabolism. If there are fewer estrogens after menopause, bone fractures are more common.
  • Heart and vascular diseases: Estrogens protect the vessels because they increase the proportion of “good” HDL cholesterol (high-density lipoprotein), which prevents arteriosclerosis and heart attacks . Presumably as a result of the lack of estrogen after menopause, the risk of cardiovascular diseases increases.
  • Weight gain and diabetes: The altered lipid metabolism also affects body weight. The calorie requirement falls due to decreasing muscle mass, and more abdominal fat is stored due to the hormone composition. If affected women do not change their eating habits or increase energy expenditure by exercising more, they will gain weight. This also increases the risk of diabetes mellitus or cardiovascular diseases.
  • Breast Cancer: The risk of developing breast cancer increases in women as they age. Hormone therapy to treat menopausal symptoms can increase the risk of breast cancer. Other factors that favour the development are a family history, obesity, alcohol consumption and smoking.
  • Nutrient deficiency: A magnesium deficiency is not uncommon during menopause. The reasons are increased loss through heavy sweating and reduced intake due to hormonal changes. A potassium deficiency is also possible as a result of excessive sweating.

Treatment: What helps against the symptoms of menopause?

Menopause is a natural process. Symptoms that occur are, therefore, not symptoms of an illness but can often be treated with medication or natural remedies.

The most well-known method is hormone replacement therapy, but there are other ways to alleviate the symptoms. For example, other medications are also used, such as anticholinergics (active ingredients: such as bornaprine or methanthelinium bromide) or particular antidepressants to relieve sweating. In addition, women can take some measures themselves to alleviate the symptoms.

Hormone replacement therapy in menopause

In hormone therapy or hormone replacement therapy (HRT or HRT), the natural hormone deficiency is compensated for by the administration of synthetic hormones. This is intended to alleviate the symptoms that arise from the hormonal imbalance.

Combination preparations with estrogen and progestin are mainly used. Pure estrogen preparations (monotherapy) are now usually only prescribed for local use or for women whose uterus has been surgically removed. The drugs are usually administered as tablets, patches or gels.

Hormone replacement therapy is considered to be particularly effective but is also associated with side effects. For example, the risk of thrombosis, heart attack or breast cancer increases. Water retention, weight gain, nausea or high blood pressure can also occur.

So-called bioidentical hormones are made from plant substances such as soy or yam root and are considered semi-synthetic. They are sometimes referred to as “natural alternatives” but can also cause side effects.

In both cases, a thorough medical consultation is recommended to weigh the advantages and disadvantages of the respective therapy forms and choose the right time to start therapy. If the menopause occurs prematurely, hormone therapy is usually unavoidable. 

Here, you will find detailed information about hormone therapy during menopause.


Herbal and naturopathic remedies

Herbal medicine (phytotherapy) uses monk’s pepper, pomegranate extract or St. John’s wort (Hyperici herba) for menopausal symptoms. The so-called phytoestrogens (estrogen-like plant substances) from soy, yarrow, red clover or black cohosh (Cimicifuga racemosa) are also used as food supplements. These drugs’ effects and side effects have yet to be sufficiently investigated. However, initial studies indicate, for example, positive effects of soy-based chaste trees and phytoestrogens. A doctor’s consultation can help better assess these methods’ benefits and risks.

Homeopathic remedies, most commonly Acidum sulfuricum, Aristolochia, Cimicifuga, Lachesis or Sepia, are also used to treat menopausal symptoms. In Bach flower therapy, the flowers are selected depending on the state of mind of those affected, regardless of the physical symptoms. Traditional Chinese Medicine (TCM) offers acupuncture, a popular method of relieving menopausal symptoms.

Home remedies for the ailments

The following tips can also help alleviate the symptoms of menopause:

  • Sage tea inhibits perspiration and can be used against unpleasant hot flashes.
  • Lady’s Mantle tea is an herbal progesterone that works against mood swings and hot flashes.
  • Alternating foot baths help against circulatory problems, insomnia or high blood pressure: the feet are alternately held in warm water for five minutes and cold water for 30 seconds. Then dab your feet and put on warm wool socks.

More tips to deal with symptoms during menopause

The so-called non-drug measures are an integral part of the treatment of symptoms during menopause:

  • It is advisable to switch to a healthy, balanced diet with little caffeine, alcohol, and nicotine but plenty of vitamins, minerals, trace elements, and sufficient liquids.
  • Exercise: Just swimming or cycling for 30 minutes two to three times a week can relieve hot flashes and sweats, strengthen the immune system and improve sleep. Sport can tighten the muscles and connective tissue, stimulate bone metabolism and prevent obesity. Sufficient exercise can slow down the degradation processes in the organism.
  • Stress avoidance and conscious relaxation, such as yoga, Pilates or acupuncture, relieve nervousness and irritability.

These measures not only alleviate menopausal symptoms but also help to prevent osteoporosis or heart and vascular diseases. A healthy lifestyle can even help delay the onset of menopause.


See menopause as an opportunity.

In general, it is crucial how women evaluate the menopause themselves. For many, this phase means the chance to change and to start a new phase in life, in which they see themselves as independent personalities again and not just as nest preparers for the family. Many women are also happy about the change, as it means the end of menstrual cramps or the need to use birth control. It is, therefore, often a question of attitude as to how women experience the menopause.


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