Dossier: Sexuality

Menopause: no more periods

Every woman is affected by the menopause at some point. But myths about this phase of life still abound. We take a look and tell you everything you need to know about the menopause. The change of life can also be liberating.

Text: Katharina Rilling; photo: iStock

One thing is certain: the menopause is a turning point in the life of every woman – and is far too often a taboo topic. Doubts, fears and symptoms are hidden and many women suffer alone: “An incredible number of women just grin and bear it. Many try to cover up symptoms such as anxiety, irritability, forgetfulness or even poor sleep,” says Petra Stute, head physician at the Maternité Women’s Clinic at Bern University Hospital. “I often wonder why women do this to themselves. Some patients don’t sleep properly for months. It doesn’t have to be that way; you can do something about almost any symptom.” 

The first and perhaps most difficult step is to admit that the menopause may be causing the changes. And to understand that the hormonal changes often happen much earlier than generally assumed. What many people don’t realise is that the menopause itself is one specific moment, while the change of life is a much longer phase that encompasses it: 

  • The premenopause refers to the entire fertile phase before the menopause.
  • Women usually feel the first signs of the menopause during the early perimenopause: their cycle can fluctuate and they may experience heavy bleeding and mood swings (PMS). This is caused by the fall in progesterone, while oestrogen levels remain high.
  • In the late perimenopause, oestrogen levels also fall, with production of this female sexual hormone ceasing entirely towards the end of this phase. Typical menopause symptoms such as hot flushes occur.
  • The menopause marks the final menstrual period. It is determined retroactively, because you can only be sure after 12 consecutive months without a period.
  • After the final menstrual period, the phase of postmenopause begins. The body still needs a few years to adjust entirely to the new hormonal balance.

At what age does the menopause start?

When your cycle shortens and your moods fluctuate, the question often arises: Is this the start of the menopause? It may be, but not necessarily. The female body isn’t an exact science. On average, the first symptoms of the menopause occur between the ages of 38 and 44. The second half of the perimenopause begins roughly around the age of 45. The last menstrual period, i.e. the menopause, usually occurs between the ages of 45 and 55. On average, women are 51 years old. 

And symptoms of the menopause? “Unfortunately, there’s no sure way of telling how long the symptoms will last,” says Petra Stute. But you can be sure that the hot flushes and hormone-related mood swings will stop at some point. However, changes in the genital area, such as vaginal dryness, don’t get better on their own. If you have irritating symptoms in this area, they have to be treated permanently. 

“Ageing takes place on multiple levels, it’s not just a question of hormone-producing ovaries. Women at this age are often just getting to or are at the peak of their emotional-social competence.”
Petra Stute, head physician at the Maternité Women’s Clinic at Bern University Hospital.

Frequent symptoms of the menopause 

The menopause isn’t an illness − it’s the body’s natural response to the change in hormones. Symptoms are very varied and depend on the phase you’re in. And not all women suffer from severe symptoms. A third of women experience light to moderate symptoms, while another third don’t feel any effects. In the perimenopause, symptoms are caused by strong hormonal fluctuations.

In this early phase, oestrogen levels are very high, which can lead to a feeling of tightness and pain in the breasts. At the same time, progesterone levels fall, which can also trigger symptoms. Shortly before and after the menopause, it’s the lack of oestrogen that makes its impact felt. But mood and energy levels are also affected by the general process of ageing and the change in life circumstances, for example when the kids leave home, your professional life changes or relationships break down. These symptoms could be a sign of the menopause: 

Mood swings and depression

Do all women experience mood swings before and after the menopause? “Thankfully not!” says Petra Stute. “But it’s true that women going through the menopause are twice as likely to suffer depression than younger women. The good news is that once women get through these phases, the risk of depression falls again.”

Generally speaking, women are particularly vulnerable during any periods of hormonal imbalance – not just during menopause, but also after childbirth, which sometimes leads to postpartum depression, or simply during their period as a symptom of premenstrual syndrome. 

Hot flushes

One symptom that is typical of the menopause: hot flushes. Women experience sudden outbreaks of sweating, a red face and even palpitations. “Some women experience cold shivers instead,” says Petra Stute. “But it is true that two-thirds of women suffer from hot flushes and sweats, with one-third suffering so severely that they have to go to the doctor, where they are often prescribed hormone replacement therapy.”

Patients with milder symptoms can try alternative therapies. Hot flushes are exacerbated by excess weight, high coffee consumption and smoking, among other things. 

Hair loss

As oestrogen levels fall during the menopause, male hormones gain the upper hand. Although these also decrease with age, the level of female hormones falls more sharply. That’s why the hair on our head usually becomes thinner and sparser.

Many women also feel that they lose more hair and that it doesn’t grow as long as it used too. At the same time, more hair tends to grow on the face. But women don’t start to grow hair all over their body like men. Hair follicles age independent of the hormonal changes – it’s completely normal to lose around 100 hairs a day. It’s only a sign of hair loss when you lose significantly more hair than this or areas of your head become more visible. 

Vaginal dryness

Oestrogen deficiency causes the mucous membranes in the genital area to recede and become thinner and drier. This leads to tears and minor injuries, causing itching, a burning sensation and increased vaginal discharge. And some women experience pain during sex. There is also a greater risk of urinary tract infections, because as the mucous membranes of the bladder and urethra also recede, more bacteria can colonise the vaginal flora.

Trouble sleeping

Regardless of whether you have problems falling asleep, sleeping through the night or even suffer from insomnia, bad sleep impacts on your quality of life. This is a problem that a good half of menopausal women are all too familiar with. As the mood-lifting hormone oestrogen dwindles or disappears completely, women experience mood swings, which can also affect their quality of sleep or the ability to fall asleep.

The lack of oestrogen also promotes night sweats, which also does little to ensure a good night’s sleep. And as the progesterone levels fall, so, too, does its calming and sleep-promoting effects. 

Joint pain

Joint pain is not only caused by the natural process of ageing. Oestrogen supplies the structures around the joints with fluid and promotes blood circulation. As this hormone decreases, joints become stiffer and less flexible. And as you get older, there is a greater risk of osteoporosis, osteoarthritis or arthritis – the (lack of) hormones is also partly to blame here.

But not every woman going through the menopause suffers from joint pain. A balanced diet, exercise and a healthy lifestyle can reduce the pain or prevent it from occurring in the first place. 

Menopause affects weight gain 

Your trousers suddenly start to feel a bit tight even though you’re eating the same as you’ve always done. Many women are frightened of putting on weight during the menopause. "On average, women gain half a kilo a year. But it’s not a gradual weight gain so woman can get used to it and adjust”, says Petra Stute. Most women experience sudden weight gain of five to six kilograms within a few months. The reason for this is that the metabolism and hormone balance change, while women don’t really adjust their eating habits and exercise routines. 

However, the weight gain doesn’t usually get out of hand. Eventually, things settle down. But you should take action to maintain a weight you’re happy with. Excess weight increases the risk of diabetes, cardiovascular disease and dementia – especially when oestrogen levels fall. And it can be a challenge to lose weight during the menopause. “It’s incredibly difficult to suddenly eat fewer calories, change long-held habits and to exercise more. All the more so when symptoms such as joint pain or depressive moods start happening at the same time,” explains Petra Stute. Nevertheless, it is worth changing your diet and making sure you get enough exercise. And to take a look at hidden fatteners such as alcohol or sweet drinks. 

Sexuality during the menopause

It’s true that women can experience a lack of sex drive as the female hormones fall during the menopause. Hormonal changes can reduce the libido, sexual arousal and the intensity of orgasms. But it’s not written in stone. “Menopause isn’t automatically associated with a decline in sexual activity. There are many influencing factors in play, such as the quality of the partnership or stress levels. But also the question of how a woman feels about getting older,” explains Petra Stute.

If women find themselves unattractive as they get older or experience anything from low moods to depression, this also reduces the desire for physical closeness with a partner. One irritating physical symptom can be vaginal dryness. Fortunately, this can be easily treated with creams or suppositories containing hormones. Lubricants and hormone-free, moisturising vaginal creams can also help. In fact, one study shows that these even have the same effect as hormone preparations. 

It’s fair to say that the menopause does influence sexuality, but the impact doesn’t have to be negative. “Some women experience the menopause as a time of liberation as it means no more periods and no risk of falling pregnant. This can have a positive effect on their love life,” says Petra Stute. 

Contraception during the menopause

Although it’s much more unlikely that a woman will fall pregnant the closer she gets to the menopause, it’s not totally impossible. So couples still have to take precautions. It’s best to talk to your gynaecologist about the best methods of contraception and when you no longer need to use it. Does the pill also help prevent symptoms of the menopause? “Yes and no,” says Petra Stute. “Although the combined pill does contain artificial oestrogen which helps against symptoms of the menopause, the classic contraceptive pill is associated with a higher risk of stroke, thrombosis and heart attack than HRT. Therefore, only healthy women are recommended to continue taking their usual combined pill until the age of 50. Then, at the latest, it’s essential to change.”

“Patient anxiety about HRT is understandable, but it really pays to talk to your gynaecologist.”
Petra Stute, head physician at the Maternité Women’s Clinic at Bern University Hospital.

Is HRT dangerous?

“I estimate that in Switzerland around one in 15 women undergo hormone replacement therapy,” says Petra Stute. Medication can help balance the loss of hormones that occur during the menopause. The aim of HRT is not to restore hormone levels to the level they were at before the change. It’s more about reducing severe menopause symptoms. Stute explains: “There are many benefits to hormone replacement. It not only reduces the symptoms of menopause, but also lowers the risk of osteoporosis, dementia, heart attack, diabetes and colon cancer. It also offers benefits for the skin, hair, figure and weight.” However, the specialist points out that taking oestrogen orally increases the risk of thrombosis and stroke. This isn’t the case with hormone patches or gels, which is why they are a better option. 

However, hormone replacement therapies have a bad reputation for a completely different reason, as Stute explains. “The risk of breast cancer is increased after five and a half years of combination therapy with oestrogens and luteal hormones. What this means: Without hormone treatment, 14 out of 1,000 women between the age of 50 and 59 are diagnosed with breast cancer within five years. After five and a half years of combination therapy, this figure rises to around 18 out of 1,000 women in the same age group. Three to four women are thus additionally diagnosed with breast cancer within this period.” Understandably, many women are therefore unsure whether they should start hormone replacement therapy. However, realistically, the risk increases only minimally, and quality of life can be significantly improved. “Patient anxiety regarding HRT is understandable, but it really pays to talk to your gynaecologist.” 

How herbal remedies work

HRT is not always the answer. There are many herbal remedies that can help with the symptoms of the menopause. For example, valerian, St. John's wort, monk’s pepper and lemon balm are effective for sleep disorders. St. John’s wort also helps with mood swings, monk’s pepper with PMS and cycle fluctuations. Other well-known naturopathic preparations for the menopause are yam root and evening primrose oil. The latter also moisturises the skin from the inside out and thus counteracts the dryness that is typical during this time.

For hot flushes and outbreaks of sweating, Petra Stute recommends herbal preparations made from black cohosh, rhubarb, sage, soy or red clover. “They can reduce symptoms by around 30%. Acupuncture is also said to reduce symptoms by between 30 to 40%.” Another home remedy against hot flushes is alternating cold/warm foot baths. 

But according to Petra Stute, there is a catch. “Herbal preparations have the disadvantage that they are symptom-oriented, which means you have to take one plant, such as St. John’s wort, for psychological well-being, valerian drops for sleep disorders, and black cohosh, soy or red clover to control hot flushes. But in this case you have no protection against the long-term effects of oestrogen deficiency on bones, heart and the brain.”

The best way to ensure a healthy transition to the next phase of life with as few complaints as possible is to choose a therapy tailored to your symptoms. “You don’t have to put all your eggs in one basket – you can switch from one form of therapy to the next or combine them without having to explain why. It’s your life, your choice.”

“Many women use this hormonally enforced period of reflection to focus on themselves for the first time in years and think about what they want.”
Petra Stute, head physician at the Maternité Women’s Clinic at Bern University Hospital.

Do men experience the menopause, too?

Men between the age of 45 and 65 do feel the passage of time as the level of the male sexual hormone testosterone decreases with age, thus affecting muscle build-up, hair growth, the voice and sexuality.

However, it would be wrong to say that men go through the menopause the same way as women. Unlike female sexual hormones, male testosterone levels don’t fall rapidly. They decrease gradually from the age of 40 by around one percent a year. And male hormone production never ceases entirely, which is why men remain fertile into old age. The male body therefore has time to adjust to the hormonal changes.

In addition, around a quarter of older men retain a similar testosterone level to young men. Only around 20 percent of men develop partial androgen deficiency, where the concentration of testosterone is too low. 

But even if, strictly speaking, men don’t go through the menopause, the ageing process does bring symptoms associated with a reduced testosterone level:

  • Physical changes, such as losing muscle mass or gaining stomach fat
  • Impact on sexuality, such as lack of libido and erectile dysfunction
  • Mood disorders such as listlessness and irritability
  • Loss of memory, difficulty concentrating
  • Hot flushes and heavy sweating 

To keep the hormone balance on an even keel, it’s often enough to simply adjust your lifestyle: exercise regularly, eat a balanced diet, lose any extra weight, drink only moderate amounts of alcohol, smoke less, get plenty of sleep and avoid stress. Having sex can also get your testosterone levels back on track. To rule out underlying illnesses, you should see a doctor about your symptoms. And remember: it’s generally wrong to talk about men going through the menopause, because menopause literally means “end of menstrual periods”. 

Menopause as a period of positive change

The menopause does signal an acceleration in the ageing process. If a woman doesn’t take hormones, she does age a little faster. Oestrogen protects against many ageing effects when it comes to skin, hair, blood vessels and bones. Some women now see more wrinkles when they look in the mirror or suffer from joint pain, swelling or back pain as a result of ageing. Some feel like everything suddenly hurts. But it’s not true to say that life is all downhill from here.

Although the hormonal adjustment does pose a challenge for most women, it can also be beneficial. Many women use this hormonally enforced period of reflection to focus on themselves for the first time in years and think about what they want, sort out their relationships, get rid of negative influences, stand up for themselves more and demand more from the people around them.

The menopause can also mark a time of positive change and new experiences for women. People around them may initially find this process irritating and exhausting, but it can really do them good. What’s more: ageing takes place on multiple levels, it’s not just a question of hormone-producing ovaries. Women at this age are often just getting to or at the peak of their emotional-social competence.”