Interview of Eirini Lambrinoudaki with Melina Sidiropoulou (shape.gr)
Professor of Endocrinology at the Medical School of the National and Kapodistrian University of Athens and President of the Hellenic Society of Climacteric and Menopause, Eirini Lambrinoudaki, shows us the path we can follow for a smooth transition into the next chapter of our lives.
By Melina Sidiropoulou
We have seen our mothers, aunts, and older friends holding a fan and fanning themselves because they suddenly feel hot flashes, even in winter. We have seen them stay up late and sometimes change their mood without any obvious reason. Now we are beginning to recognize the first signs in our own bodies and minds as well.
Personally, I have started gaining weight very easily while following the same diet, with fat now accumulating for the first time around my abdomen. I experience more pain before my period, and my menstrual flow now lasts fewer days. My friends confide in me that they feel anger or even rage a day before their period—a sensation they had never experienced before—which frightens them. Others (like me) wake up at four in the morning and stare at the ceiling.
A common point, however, is that we are neither prepared nor properly informed for this major transition in our lives: the big M of Menopause. This is because we usually hear scattered information, experiences, and opinions, but we don’t make the effort to seek accurate information while we are still in our early 40s.
Perhaps because we think it is a process that will begin much later, or perhaps because we don’t want to think about it, falling into yet another trap set for women: the widespread belief until recently that menopause equals the decline of femininity and sensuality.
And yet, the best gift we can give ourselves is quite the opposite: to learn early about the menopause process, so that we can take care of ourselves and help our body transition as smoothly as possible into the next phase of our lives.
It was an older friend of mine—who suffers from severe headaches, has also gained weight without any change in her diet, and experiences many emotional fluctuations—who informed me that the Aretaieio Hospital has a specialized department dedicated to the education and care of women during menopause. This is the Climacteric and Menopause Department, which belongs to the Second Obstetrics and Gynecology Clinic of the University of Athens and has been operating since 1988.
We reached out to Eirini Lambrinoudaki, Professor of Endocrinology at the Medical School of the National and Kapodistrian University of Athens, President of the Hellenic Society of Climacteric and Menopause, Scientific Director of the European Menopause and Andropause Society (EMAS), and Editor-in-Chief of EMAS’s official journal, Maturitas, in order to address some of the key questions we all have.
What is the official definition of menopause?
Menopause is defined as the cessation of menstruation for one year after the age of 45. Otherwise, if a woman experiences even irregular periods, she is in the perimenopausal phase, which is the transition period from regular menstrual cycles to menopause.
There is a common belief that we should expect menopause based on when it occurred in our mother, rather than when we last had a period. Is this belief correct?
Yes, genetics is an important factor, but it is not definitive. Age at menarche does not influence menopause. Often, in women whose periods stop early (before the age of 45), we find cases of early menopause in their family history.
When would we usually say that a woman enters menopause?
We would say that the average age is between 50 and 52 years. However, a woman may experience symptoms even 4 or 5 years before her last period.
However, for a woman to have symptoms, menstrual cycle disturbances must have begun. In other words, as long as her periods are regular—occurring every month—symptoms usually do not appear. What a woman may notice before her cycle becomes irregular is a shortening of the cycle, for example, having periods every 22–23 days instead of every 28 days.
This change indicates that ovarian reserve has begun to decline, that the number of follicles is decreasing, and it is a sign of reduced fertility. We do not treat a woman who is still at this stage, but if she notices such changes and wishes to have children, we would advise her to accelerate the process.
What is the situation with hormone therapy, and why is there so much fear surrounding it?
For hormone therapy, we have two main categories of women: those over 45 years old and those under 45 years old. We use this age cutoff to guide our assessments and approach, and of course, it is individualized.
Before the age of 45, we refer to ‘early menopause,’ and early menopause is considered a medical condition, similar to hypothyroidism. In this case, the ovaries stop functioning much earlier than usual, and hormone therapy should be administered to restore menstrual cycles. The widespread fear concerns breast cancer, but nowadays the hormones used are natural. Therefore, a woman faces the same risk she would have if her periods had ceased naturally.
Is hormone therapy wrongly blamed?
Yes, provided that natural hormones are administered—identical to those produced by the ovaries—and not synthetic ones.
What has changed regarding hormone therapy today?
ormone therapy began to be used in the 1950s and has functioned like a pendulum. It started in the ’50s with spectacular results. By the early 2000s, approximately 70% of women in the US and Europe were using hormone therapy, but with synthetic preparations, which were easier to produce.
In the early 2000s, large studies were published showing an increased incidence of breast cancer and thrombosis in women receiving hormone therapy. As a result, by 2010–2015, almost no women were using hormone therapy. Today, however, based on more recent data, we know that if we select women who truly need hormone therapy and administer natural hormones, it can be given safely.
What applies to women over 45 years old?
In this group of women, hormone therapy is administered only to those who suffer from symptoms; not all women in menopause require hormone therapy.
Common symptoms of menopause include hot flashes, poor sleep, depression, memory disturbances, bone pain, myalgias, and vaginal dryness—symptoms that can all affect a woman’s quality of life.
In these women, we do not perform full hormone replacement, but administer lower doses than those the body would naturally produce. And, of course, we always use natural hormones. In other words, we provide partial replacement to alleviate the symptoms.
So, are we giving the body time to adjust to the changes?
Yes, that’s correct; that is what happens.
Which diseases are directly associated with menopause?
With menopause, the risk of osteoporosis increases sharply, especially during the first 5–6 years, which are the most critical for bone density loss.
These include cardiovascular problems, diabetes, high cholesterol, high blood pressure, increased abdominal fat (what we call ‘male-pattern fat distribution’), as well as cognitive disorders. Dementia, for example, may occur earlier if menopause begins at an earlier age.
What can a woman do to protect her health during the menopausal stage?
First of all, she should pay close attention to her weight, as weight tends to increase due to changes in metabolism, which are related to the decline in estrogen and muscle mass.
We should keep in mind that basal metabolism decreases by approximately 500 calories per day. Thus, if lifestyle habits are not adjusted, weight increases. On average, a woman will gain 10–15 kilograms between the ages of 40 and 60.
Would you advise women to follow a special diet?
I would suggest that they watch their portions and increase energy expenditure. It is not necessary to go to the gym, but they should do anything that engages the muscular system and can be incorporated into their routine. Typically, this would mean 30 minutes of brisk walking every day or 1 hour of dynamic exercise three times a week.
Should they undergo any special annual screenings for their health as a preventive measure?
Regarding osteoporosis, it is advisable to have a bone density test during the menopausal transition phase and, depending on the results and other risk factors assessed by her doctor, to repeat the test every 1–5 years, depending on each woman’s individual profile.
Regarding heart health, blood pressure should be checked once a month, as the first five years after menopause are the most critical for developing hypertension. It is also advisable to have an annual blood test to monitor blood sugar, lipid levels, kidney function, and liver function.
Finally, it would be advisable for a woman to have a preventive cardiology check-up (including an electrocardiogram and an echocardiogram), which does not necessarily need to be repeated every year (her doctor will provide individualized guidance).
Are general practitioners adequately informed to properly guide a woman who is in the menopausal phase?
Not particularly. General practitioners and internists follow guidelines for the general population and do not tailor their care to the specific needs of women during the menopausal transition.
Is there a gap regarding this specific group in the National Health System?
Yes, I believe there is a gap in this area. We aim to address this gap through the events organized by the Hellenic Society of Climacteric and Menopause.
Our Society regularly organizes conferences to inform doctors of all specialties involved in women’s health. Recently, our Society published a menopause guide aimed at the public, so that women can receive accurate information and consult specialists when necessary.
Does a woman need to have undergone any tests beforehand to visit the Menopause Unit at Aretaieio Hospital?
Even if the tests have not been done, they can be prescribed by our department. In any case, the tests that are conducted are also posted on the website of the Hellenic Society of Climacteric and Menopause, emmino.gr.
In your opinion, why does menopause remain a taboo topic for discussion?
In the public consciousness, menopause is associated with aging. Women often feel uncomfortable sharing an experience that is perceived as marking the end of ‘femininity,’ a notion that is clearly not true.
At times, women feel vulnerable and guilty, especially if menopause begins early. They may think that their lifestyle was inadequate and that their early menopause resulted from their own mistakes.
Additionally, because they are usually at the peak of their careers at these ages, they do not want to show signs of weakness in their professional environment.
And psychologically, how can menopause affect a woman?
With panic attacks and anxiety, depression, and mood swings. These symptoms are very common, and it should be emphasized that they improve significantly with hormone therapy.
According to your experience, do women receive support from their partners?
It depends on the case. However, I am fortunate to say that couples often come to the clinic seeking a solution together.