Menopause is one of life's stages that every woman goes through sooner or later. Although health-related topics are being discussed more and more, the period of transition still remains somewhat taboo. And precisely due to a lack of sufficient information, women going through perimenopause often feel alone and barely recognize their own bodies.
That's why we asked physician and nutritionist MUDr. Kateřina Fialová, who specializes in women's hormonal health in her practice, not only during perimenopause.
In today's interview, you will find out how the body prepares for menopause and everything it entails, when it might be time to seek advice from experts, and also the pros and cons of hormone replacement therapy.
What are perimenopause and menopause, and how do these conditions manifest?
Perimenopause and menopause are two completely different states, unfortunately often confused.
Menopause is the last bleeding in a woman's life, thus it has a precise chronological date. It can only be identified retrospectively - 12 months after the last bleeding, or if a woman tracks her cycle using STM and knows that ovulation has not occurred for a year (in connection with age). In our conditions, it occurs between the ages of 49 and 52, but there are women who still bleed at 58, and conversely, younger women who no longer bleed. Postmenopause follows menopause.
Perimenopause, on the other hand, is a period (not a single date) that is not precisely time-bound, when the body prepares for menopause and can be accompanied by many negatively perceived symptoms – sleep disorders, psychological problems, hot flashes, irregular cycles, heavy bleeding. This period can last 2 to 10 (12) years, so it can start as early as 35/40 years old.
What happens in the body during perimenopause and which hormones play the biggest role in it?
Unlike what many women may have heard, estrogen levels do not decline after the age of 40. If they did, this period would be much more pleasant. Perimenopause is a time when estrogen does the worst it can – its levels are like a rollercoaster, often several times higher than before, and then they drop sharply again. Conversely, the hormone progesterone, which for years has been estrogen's sparring partner and balanced its effects, begins to gradually decline. Most of the symptoms accompanying this period arise precisely from this hormonal storm, sometimes described as a second puberty. After menopause, most symptoms tend to normalize, and some women even feel much better (especially psychologically).
In your opinion, why should women be informed about perimenopause?
Just to understand what is happening in their bodies and that they are not inferior, "written off," or sick, which unfortunately happens very often. Perimenopause is a completely natural physiological process; it is an adaptation to allow us to live longer lives even after the end of our reproductive age, to have the energy to care for our offspring and our offspring's offspring. And furthermore, of course, to understand how to better manage this period and what not to underestimate.
In some cases, premature menopause occurs; how can this happen and can it be prevented?
Premature menopause is menopause that occurs before a woman's 40th birthday and affects 1 in 100 women. Unfortunately, in most cases, the cause is unknown. Genetics, autoimmune diseases, extreme stress, past oncological treatment, endometriosis, etc., play a role, but these are risk factors that can contribute to the development of this condition, not definitively and solely cause it.
In cases of premature menopause, the symptomatology is very pronounced, and women often need at least some form of hormone therapy. Since the cause is unclear, it is not yet possible to say with certainty that if you do/don't do this or that, you will prevent its onset. However, it is true that unhealthy cycles and an unhealthy lifestyle are among the risk factors, so a lot can certainly be done in terms of primary prevention by a woman taking care of herself and her cycles.
What can worsen the course of menopause? Are there any common mistakes women make in your experience?
The course of menopause, or more precisely postmenopause, is definitely worsened by the fact that women don't know what is happening to their bodies during perimenopause – which is absolutely crucial for how their life and health will be after their reproductive age ends – and they don't respect it. I wouldn't say these are mistakes; it's more ignorance and a sadly small amount of information about this period. I feel that it's most often about "doing everything even more, pushing harder, trying harder..." – going on radical diets, exercising, working at the same time, building a career, taking care of family and home, all without time for oneself. At 25, our bodies forgive a lot, but that certainly doesn't work after the age of 35/40.
Menopause often comes with many (often unpleasant) accompanying symptoms. What does a normal course of menopause look like, and what, on the other hand, is not normal and should be actively addressed, perhaps with functional medicine doctors?
The perception of accompanying symptoms of peri- and menopause can vary – both in terms of duration and intensity of symptoms. And it's probably up to each woman to assess how much it affects her life and its quality. It is stated that women who experience hot flashes early in the perimenopausal period generally have a worse course and need some form of help.
Another reality associated with the transition – and especially with the gradual loss of estrogen's protective shield – is a higher risk of developing insulin resistance and certain diseases such as diabetes, dementia, atherosclerosis, high blood pressure, cancer… In this case, I think it is wise to actively address the situation with doctors.
Hormone replacement therapy or medications are often recommended for menopause. What is your view on this? Are there any pros and cons?
Hormone replacement therapy is a very broad topic and certainly has its pros and cons, just like any other form of therapy. What I would simply mention is that not all hormone therapy is the same, and that there are also so-called natural or bioidentical treatment methods, and that it is always absolutely essential to respect which phase of peri- or menopause a woman is in and what her own hormone production is like. So, again, personalized and in the context of other circumstances.
Would you recommend any basic supplements to alleviate menopausal symptoms? Can certain herbs, such as ginseng or alfalfa, help?
I would be very careful with herbs during perimenopause, as many of the recommended herbs (such as lady's mantle, red clover, etc.) have an estrogenic effect and could actually worsen a woman's symptoms. The situation is different in postmenopause.
Among the basic supplements (which can generally help every woman), I would definitely mention magnesium, B vitamins, vitamin C, astaxanthin as one of the strongest antioxidants, evening primrose oil, and royal jelly.
The Menopause Botanical Complex has, in my opinion, an amazing composition. In one capsule, you'll find ingredients essential for most women during menopause. Chinese Angelica (dong quai) is a herb prescribed for centuries in China, playing a nourishing role in maintaining natural hormonal balance and women's mental and physical well-being. Ashwagandha, or Indian ginseng, helps reduce stress and improves concentration - all things women deal with during this period. It has antioxidant, antiviral, and anti-inflammatory effects and slows down cell aging. And magnesium, every woman and every cell needs it!!!
Is there anything you would like to tell women who are currently going through hormonal changes?
Educate yourself about how the female body works, the changes it goes through, and don't give up on finding answers to your questions. Solutions to get through the hormonal storm as best as possible do exist!
Was the article helpful for you? Share it with your friends and spread the information further so that as many women as possible going through menopause know what is happening to them and never have to fight with their bodies again.
Femvie products that can help you
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Frequently Asked Questions
At what age does menopause begin?
Menopause occurs on average at age 51, but the transitional period (perimenopause) can start as early as after age 40. It definitively occurs after 12 months without menstruation.
What are the most common symptoms of menopause?
Hot flashes, night sweats, sleep disturbances, mood swings, vaginal dryness, and fatigue are among the most common symptoms. In total, up to 34 different symptoms of menopause have been described.
How to naturally manage menopause?
Natural support includes regular exercise, a diet rich in phytoestrogens, supplements such as magnesium or botanical complexes, and stress management techniques.
Is natural support for menopause effective?
For many women, yes - natural supplements and lifestyle changes can significantly alleviate symptoms. For more severe problems, it is advisable to consult a doctor about hormone therapy.
