Interview with Elena Boulia (ow.gr)
Endocrinologist Eirini Lambrinoudaki, President of the Hellenic Society of Climacteric, and gynecologist Areti Avgoulea explain to OW what a woman can expect in order to best manage the challenging symptoms of menopause.
Menopause is the end of menstruation and occurs due to the cessation of ovarian function. The average age of menopause in European countries is 51 years. The timing of menopause can be influenced by childbirth, the length of the menstrual cycle, smoking, diet, and possibly heredity. Prior to menopause, there is usually a period of hormonal disturbances and irregular cycles known as the climacteric.
Because human life expectancy is continuously increasing due to improvements in living standards and advances in medical science, a woman today can expect to live on average beyond 82 years. For this reason, she should be aware of the effects of menopause on her physical and mental health, as well as the ways to prevent or manage them.
Symptoms Experienced by Women During Menopause
During the transition to menopause, women experience symptoms related to declining estrogen levels and normal aging. The main effects include hot flashes, night sweats, sleep disturbances, changes in sexual desire and function, emotional instability, atrophy of the urogenital system, skin atrophy, bone loss and osteoporosis, and an increased risk of cardiovascular disease. In European countries, 40% of menopausal women report symptoms of moderate to severe intensity.
The impact of vasomotor symptoms (hot flashes, night sweats) on women’s quality of life can be significant. Women with moderate to severe symptoms may experience sleep problems, fatigue, anxiety, and depression, which can affect work and daily activities. Additionally, many women report memory and concentration difficulties. Specifically, they often experience trouble recalling words, names, numbers, and similar information. These cognitive changes should not be confused with dementia, as its onset before age 64 is rare. Cognitive difficulties during menopause are associated with changes in estrogen levels, vasomotor symptoms, and disturbances in sleep and mood.
Menopause is a natural transitional period in a woman’s life cycle, coinciding with a range of life changes. For some women, these changes can lead to significant stress, emotional disturbances, mood loss, and even depression and anxiety disorders. Depression most often occurs in women who have previously experienced multiple negative life stressors, such as bereavement, or who have negative expectations about what they may experience during menopause.
One of the most significant changes in women after menopause is weight gain. This primarily occurs as an increase in total body fat, accumulation of central abdominal fat, and loss of muscle mass and strength. The result is the development of obesity, also due to reduced energy expenditure. The increase in abdominal obesity mainly appears during the early postmenopausal period, that is, within the first five years.
The Vital Importance of Exercise During Menopause
Exercise during menopause reduces overall mortality. Individuals who exercise have better metabolism, muscle strength, balance, cognition, and quality of life compared to those who do not. Additionally, they are observed to have lower rates of heart attacks, strokes, fractures, as well as breast and colorectal cancer. The ideal for this age period is approximately two hours of moderate exercise per week. Exercise plays a key regulatory role in daily life intensity, stress management, and the prevention or treatment of many diseases. People who exercise regularly experience better mood and increased energy.
Which Women Benefit from Hormone Therapy
The presence of menopausal symptoms can reduce a woman’s quality of life. In women with appropriate indications, hormone therapy can safely improve quality of life, as well as prevent osteoporosis and urogenital atrophy. Indications for hormone therapy include women experiencing hot flashes, night sweats, sleep disturbances, arthralgia, myalgia, feelings of depression, and vaginal dryness.
Recently, there has been discussion about bioidentical hormones, which are derived from plant-based raw materials chemically processed to resemble endogenous hormones. These formulations are prepared in pharmacies according to the prescribing physician’s instructions. However, since there is no scientific evidence supporting their use, bioidentical hormones cannot be recommended for hormone therapy—not only due to concerns about efficacy but, more importantly, because of potential risks.
In Which Cases Are Dietary Supplements Recommended
Dietary supplements are vitamins, minerals, herbs, amino acids, and other substances intended to improve nutritional status. In menopausal women, the most commonly used supplements include vitamin D, calcium, magnesium, B-complex vitamins, vitamin K, vitamin E, vitamin A, and omega-3 fatty acid supplements. Supplements should ideally be used only when a deficiency of a nutrient, mineral, or vitamin has been diagnosed, and not as a preventive measure. The use of dietary supplements is best done under the guidance of a physician or dietitian to avoid unnecessary and sometimes potentially harmful use.
Eirini Lambrinoudaki is Professor of Endocrinology at the Medical School of the National and Kapodistrian University of Athens, President of the Hellenic Society of Climacteric and Menopause, and Scientific Director of the European Menopause and Andropause Society (EMAS).
Areti Avgoulea is an Obstetrician-Gynecologist, PhD from the University of Athens, and Academic Fellow at the Climacteric and Menopause Department of the Second Obstetrics and Gynecology Clinic, Medical School, National and Kapodistrian University of Athens.