Women's health • November 11, 2016

Everything has a transition – including menopause

Inger Øverlie, gynecologist Dr. Med.

Gynecologist, PhD

“You saved my life,” a patient once told me. The women who come to me experience typical symptoms of menopause. It usually starts with irregular periods and hot flashes, but they can also experience depression, mood swings and palpitations. We need to take these symptoms more seriously.

A full 25% of menopausal women have such severe symptoms that they affect their quality of life. The women I treat tell of waves of heat that hit them while they are giving a presentation at work, for example, and they find it absolutely terrible. They get sweaty and red in the face, lose concentration, and feel the need to undress and open the windows. Such experiences clearly affect their self-esteem.

Hot flashes can also make you wake up completely soaked at night, and it can be so bad that you have to get up and change your bed sheets. Some people also feel depressed and cry over the smallest things without fully understanding why. Some people complain of flu-like symptoms, lack energy and do not feel well. Hormone therapy quickly removes these symptoms.

Most positive aspects of hormone therapy

Many of the women who come to me want treatment and know that it is possible to get hormones. At the same time, many of them have heard that it can be dangerous, and that it can increase the risk of blood clots, breast cancer and cardiovascular disease. One woman told me that she doesn't tell her friends that she is getting treatment, because she is afraid they will say, "What, are you crazy, you could die from it!"

But countless studies show that the risk of such complications is very small if you start hormone therapy when you reach menopause, that is, when you are around 50. In fact, there are more positive aspects of hormone therapy than negative ones.

Simple treatment with plaster

The hormones can have a protective effect on the heart and blood vessels. In addition, women have an increased risk of osteoporosis after menopause, but estrogen reduces the risk and can have a long-term, positive effect on bone mass if you receive long-term treatment (more than five years). It is also not the case that short-term treatment (less than five years) increases the risk of breast cancer, as many believe - in fact, the risk of breast cancer decreases after stopping treatment.

I recommend that most of my patients who have major problems start with hormone therapy, preferably transdermal therapy. This means that they are given a patch that is attached to the skin so that the hormones enter the blood directly, without going through the liver and the gastrointestinal system. This way, other hormones in the body, such as testosterone, are not affected, and it reduces the risk of blood clots.

The symptoms disappear within days.

If you suffer from hot flashes, hormone replacement therapy is definitely the most effective. Once you start treatment, the hot flashes will disappear within days. It also helps with dry mucous membranes and reduces the risk of urinary tract infections, which can also occur during menopause.

Some women get depressed and I definitely recommend trying hormone supplements before other treatments. Many feel that they "become themselves again" shortly after starting supplements. Simply put, if your mood doesn't improve with this, you should consider whether there could be other causes for the depression than menopause.

In addition to hormone therapy, it will also help if you make simple changes to your daily life and lifestyle. Eating healthily and regularly, quitting smoking, and not least staying physically fit can reduce, for example, hot flashes.

For many women, menopause is not a problem, and many get through it without any major problems. In fact, most say afterwards that it wasn't as bad as they feared. Because menopause is just that – a transition. You "go back" to who you were. But like so many other transitions in life, you may need a little help to get through it.

Fact box: Women's menopause

Menopause often begins with irregular periods and subjective complaints such as hot flashes and depression. It can occur long before menopause.
Towards menopause, your ovaries will produce less and less of the hormones estrogen and progesterone, eventually so little that menstruation stops. When you have not had a period for 12 months, you have entered menopause.
Menopause usually begins after you turn 45, and the average age for menopause is 52 years.
Around 1% of Norwegian women enter menopause before they turn 40, so-called early menopause.

COMMENTS · 8

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Britt July 09, 2022

I am among the 1% who went through early menopause. It started right after giving birth when I was 30. Now I'm over 40. I wasn't believed by any doctors until I was approaching 40. Then tests were taken and osteoporosis was diagnosed, among other things. I've had a lot of rib fractures in connection with exercise, coughing, sneezing, etc. I'm now receiving treatment for osteoporosis. 2 doses of Aclasta with no effect, bone density decreased in all areas. Now I'm trying Prolia to see if it gives better results.
In addition, I was given hormone patches which were also supposed to help. But from week 2 I have been bleeding. I have now been using the patches for 9 weeks. Is there any hope of improvement? My GP tells me to contact the doctor who prescribed it, the doctor who prescribed it has not responded to my inquiries for over 4 weeks. I am so confused... What to do?

1 answer SVAR
- Find Tysland Johnsen Dec 16, 2022
  
  Hey!
  
  Sorry for the late reply. In premature ovarian failure, it is important to receive treatment with estrogen, to replace the estrogen that you do not produce yourself, and to prevent osteoporosis, among other things. There are many different ways to take estrogen, but usually transdermal (via the skin) treatment is preferable, either in the form of a patch, gel or spray. When giving pure estrogen in this way, it is important to also administer progestin to protect the lining of the uterine cavity (the endometrium). This can be done in various ways, either via tablets daily (Utrogestan) or cyclically (Provera 14 days every 3 months), or by inserting a hormonal coil (Mirena) into the uterus. If you use estrogen patches alone, without the addition of progestin, you will over time build up a uterine lining that can then lead to bleeding problems, and in very rare cases, cell changes in the uterine cavity. Women who have had their uterus removed do not need additional progestin, but it is assumed that you have your uterus intact.
  
  SVAR
Anna Dec 31, 2021

Hi, I am slim and healthy and had my period until I was 57/58 years old. I have not had any problems with menopause, but was diagnosed with osteopenia. I therefore started taking estradot 50 mg 6 weeks ago at the age of 60 1/2. I do not notice a difference, but I am thinking about possible negative consequences (thrombosis, cancer...). Is it right to use this medication in my case only for osteopenia? Does it help when I first start 2/3 years after my last period? Otherwise I use calcium + vit.D3 .2 tablets daily.

1 answer SVAR
- Find Tysland Johnsen Jan 23, 2022
  
  Hey!
  
  As far as I know, osteopenia alone is not an indication for starting Estradot. The main indication for starting estrogen preparations should be menopausal symptoms. Furthermore, there is something to consider that is not stated. If you still have your uterus intact, you should not use Estradot alone – as this over time stimulates the endometrium, with the chance of developing cell changes in the uterine cavity. You should therefore also have the addition of progestogen to counteract this. If you have had your uterus removed, you can stay on Estradot alone.
  
  Regards
  Finn
  
  SVAR
Anita April 25, 2021

I am a 57 year old woman and have started taking Livial! It works well for sex and dry mucous membranes, but I have had a lot of joint and muscle pain! Will this subside over time? I have been using it for about 3 weeks.

1 answer SVAR
- Terje Sordal Jun 30, 2021
  
  Hello Anita
  
  Cannot rule out that it is due to Livial, it is registered as a side effect with unknown frequency.
  If you can use estrogen, then Estalis patch 50 micrograms may be an alternative.
  
  SVAR
Godny Jan 10, 2019

Hi, I'm wondering how long I can take hormones? I've been taking Livial since I was 52, I'm now 67, I stopped taking Livial 2 years ago but I'm so bothered by hot flashes, it's really affecting my quality of life, can I start taking Livial again?

1 answer SVAR
- Terje Sordal February 14, 2019
  
  Hi, Gudny! You can take hormones as long as you need them due to reduced quality of life. It's almost a shame that you stopped, but if you don't have risk factors for blood clots or heart/vascular disease, the benefits will probably outweigh the risks of starting again.
  
  1 answer SVAR
  - Terje Sordal October 07, 2018
    
    Hello,
    The chance of getting pregnant as a 44-year-old woman is unfortunately low, anyway, but it would be worse if you had also had an elevated FSH value. Even if the egg reserve is low (AMH), there may still be some genetically normal eggs left. It is not certain that the chance would be much higher with IVF than by trying naturally, if all other conditions are normal, such as sperm quality and fallopian tube function.
    
    SVAR

Everything has a transition – including menopause

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