Menopause: symptoms & treatment

During premenopause, the body slowly begins to reduce hormone production. This phase can start as early as age 30 and lasts on average around seven years. Progesterone levels fall particularly sharply during this time, often going hand in hand with the first changes in the woman’s cycle.

Symptoms during premenopause

• Mood swings and stronger PMS
• Sleep disorders and fatigue
• Hot flushes
• Headaches
• Changes in the breast: tenderness, sagging, cysts

Because symptoms can already occur in this early phase, treatment with hormone replacement products is often recommended during premenopause. Whether this is appropriate depends on the individual symptoms.

In early perimenopause, hormones become unbalanced for the first time: progesterone levels fall while oestrogen remains high. At this stage, many women experience fluctuations in their cycle, heavier periods or more pronounced PMS. Often the first clear signs of menopause set in.

Symptoms during perimenopause

• Longer or shorter cycles
• Heavier or lighter periods
• Hot flushes and sweating at night
• Migraines
• Feeling down
• Brain fog: difficulties concentrating, problems recalling words or the feeling of being mentally absent.
  

Menopause marks the final menstrual period. This milestone is only noted retrospectively, because menopause is only considered “official” when you’ve not had a period for 12 months. Before that, your periods may suddenly resume after months without bleeding.

Many people think they have already gone through menopause and then unexpectedly experience further periods. A full year without a period provides clarity and marks the final transition.

On average, menopause occurs at around 52 years of age. 

Postmenopause begins after the final menstrual period. The body still needs a few years to adjust entirely to the new, permanently lower, hormonal balance. From that point on, this “phase” lasts for the rest of a woman’s life – often a third of a person’s total lifespan.

Many symptoms experienced in the transition period subside noticeably during postmenopause. Mood swings, breast pain or severe cycle changes are then usually a thing of the past because the hormones no longer fluctuate constantly but remain at a stable level.

For many women, this phase also brings new freedoms: no more periods, no more worries about pregnancy, less physical restlessness. Postmenopause is therefore often calmer, clearer and less stressful than the years before.

Around one in two women experiences hot flushes – sudden sensations of heat spreading across the upper body, frequently accompanied by sweating, palpitations or shivering.

They are considered the only symptom that can be clearly attributed to hormonal changes. The extent to which they occur varies greatly from person to person.

For some women, hot flushes cause severe palpitations or dizziness. If these symptoms only occur together with the flushes, they are usually considered harmless.

If palpitations occur independently of this, medical advice should be sought.

Hormones influence our emotional state. “Oestrogen modulates neurotransmitter systems such as serotonin and dopamine, which play a central role in regulating our moods. When oestrogen levels drop, this can really affect your mood,” explains Professor Stute.

At the same time, partnerships, families or professional situations often change in this phase of life, which can increase irritability, sadness or worry. It is also important to note that not all depression in this phase of life is due to hormones.

“Psychological support should be sought if depressive moods last longer than two weeks, severely affect everyday life or lead to social withdrawal. Even if purely hormonal therapy is not enough, combining it with psychological support is often the most successful approach,” advises Professor Stute. 

Sleep problems are usually caused indirectly by hot flushes or night sweats. Heart palpitations, bladder weakness or worrying about getting older can also disrupt sleep.

Sleep disorders tend to become more common in old age anyway.

Incontinence or an irritable bladder are rarely directly related to hormones. However, the lack of oestrogen causes mucous membranes to become thinner and more susceptible to infections; the pelvic floor and connective tissue also lose firmness. This can promote the urge to urinate or exacerbate urine leakage.

Decreasing oestrogen makes the mucous membranes in the genital area thinner, drier and more sensitive. This can cause itching, burning or pain – also during sex. As a result, many women experience significant restrictions in everyday life for the first time.

With increasing age, energy expenditure decreases and the body stores fat, particularly on the stomach, waist and chest. Moderate weight gain can even alleviate symptoms, as adipose tissue produces oestrogen.

However, obesity increases the risk of diabetes, high blood pressure and cardiovascular disease.

Many women notice that their skin becomes drier and less firm. This is partly due to the decline in oestrogen and partly to the general ageing process.

Changes in hormone levels can also cause hair to become thinner in certain areas or to grow more strongly, for example on the face.

When hormone production decreases, interest in sex can wane or orgasms can be less intense. “But this isn’t necessarily the case,” explains Professor Stute.

In fact, biological changes only explain part of the sexual changes in this phase of life. “Menopause isn’t automatically associated with a decline in sexual activity.” The following factors play an equally important role:

• Partnership
• Stress levels
• How you experience the process of ageing
• Lack of sleep
  
• Your own body image
• Mood swings

Some women report a new sense of freedom and more serenity in their love life after menopause.

“There are some excellent treatment options today,” says Stute. These include:

• Local oestrogen therapies in the form of creams, suppositories or vaginal rings
• Systemic hormone therapy for severe symptoms

“Studies also show that hormone replacement therapy has a positive impact on the mind, skin and balance, and this naturally also has an effect on sexuality,” says Professor Stute. 

Decreasing oestrogen makes the mucous membranes in the genital area thinner, drier and more sensitive. This can cause pain during sex, burning or itching, symptoms that women often experience as particularly disturbing.

“Fortunately, it’s very easy to treat,” says Stute. Locally applied hormone-containing creams or suppositories are usually effective. Hormone-free moisturisers and lubricants can also provide quick relief.

Studies show that, for many women, non-hormonal products are as effective as hormonal preparations. Regular use is key. If symptoms persist, a gynaecological examination should be carried out, as there are often simple solutions.

Fertility decreases, but doesn’t stop abruptly. Pregnancy can also occur in the years before menopause, so couples should continue to use reliable methods of contraception until it is clear that menopause has been reached.

Suitable methods should be discussed with the gynaecologist. The pill partially alleviates symptoms, but contains artificial oestrogen and is associated with a higher risk of thrombosis, strokes and heart attacks than other hormone therapies.

Healthy women can continue to take their combined pill until around the age of 50. By that point at the latest, switching to a safer alternative is recommended.

It is also important to remember that if you’re not in a monogamous relationship you should continue to take precautions against sexually transmitted infections.