Menopause

Coming to us from Greek, ‘menopause’ literally means ‘end of monthly cycles’, but is generally used to describe the transition from routine menstruation to non-menstruation and beyond.
Menopause is a process of reduction in the production of female hormones (like estrogen) and of eggs by the ovaries, thereby reducing fertility.
Menopause usually affects women aged 45-50 years. However, the age to which women can maintain their fertility is variable and in rare cases women can enter menopause much earlier, for example after chemotherapy.

Many women aged around 40+ years begin to notice irregularities in their menstrual cycle that are indicative of hormonal imbalance. Known as ‘perimenopause’, the length of this transitional stage is variable, but can last several years. Once the production of estrogens and eggs by the ovary is exhausted a woman definitively enters into menopause.

Menopause brings with it the risk of long-term consequences for a woman’s health, including menopause osteoporosis (a bone disease that leads to increased risk of fractures), heart disease, blood clots, and Alzheimer’s disease.

During the perimenopause phase women may experience symptoms that will vary widely from one individual to another, but common symptoms are,

hot flushes,
night sweats and sleeplessness,
irritability and depression,
decreased libido,
degrees of urinary incontinence,
heart ‘palpitations’,
dry eyes, dry skin, and hair loss.

Some women do not suffer any of the symptoms listed above, but can still benefit from treatment to prevent the long-term health consequences of menopause, for example osteoporosis.

An annual gynecological check-up is recommended for all menopausal women and this should include an internal examination, ultrasound screening, Pap smear, and breast examination.
Further screening where indicated may include mammography, blood tests, electrocardiogram, and colonoscopy.

In consultation, Dr Naumann can discuss with you the benefits of annual screening for the health risks associated with menopause, along with the advantages and disadvantages of the various forms of preventative treatment available.
Preventative treatment with regard to menopause is very much based on personal needs and preferences and Dr Naumann is most sensitive to this fact.

Vulvo-vaginal atrophy

During their fertile years, women produce various hormones such as estrogen, progesterone and a small amount of testosterone. In particular, estrogen is responsible for the lubrication of the vaginal walls and promoting the balance of vaginal bacterial flora, while testosterone maintains the muscle tissue surrounding the vagina and pelvic floor. The consistency and elasticity of the vulva is also maintained. With the advent of menopause, the production of these hormones is significantly reduced and this modifies the tissue of the vulva and vagina. This results in vulvo-vaginal atrophy, which can also be caused by surgery or chemotherapy. There are various symptoms of vulvo-vaginal atrophy: dryness, itching, inflammation and pain during sexual intercourse. However, even non-sexually active women can find themselves faced with the problem wherein vaginal tissue loses its normal elasticity and becomes drier. As a result, it is easier for microtrauma and infections to occur; for example, a higher frequency of cystitis. Possible remedies are systemic hormone replacement therapy, local vaginal estrogen therapy or vaginal lubricants, such as hyaluronic acid. A new approach is the local administration of prasterone, a synthetic equivalent of dehydroepiandrosterone (DHEA) that is biochemically and biologically identical to human DHEA and metabolizes into estrogen and testosterone locally. The effectiveness of prasterone has been tested in two studies conducted in the United States and Canada on postmenopausal women aged between 40 and 80 years. After 12 weeks of treatment, improvement in excess of 40% was noted. Also noteworthy are the positive results related to libido, lubrication, pain and orgasm.