Menopause is one of the stages of life that every woman will go through sooner or later. Although health topics are becoming more open, the transition period still remains a bit taboo. And it is precisely because of the lack of information that women going through perimenopause often feel alone and hardly recognize their bodies.
That's why we asked doctor and nutritionist Kateřina Fialová , who specializes in women's hormonal health, not only during perimenopause.
In today's interview, you will find out how the body prepares for menopause and what it entails, in which case it may be time to seek advice from experts, but also what the pros and cons of hormone replacement therapy are.
What are perimenopause and menopause and how do these conditions manifest themselves?
Perimenopause and menopause are two completely different conditions, but unfortunately they are often confused.
Menopause is the last bleeding in a woman's life, so it has a precise time. It can only be identified retrospectively - up to 12 months after the last bleeding, or if the woman monitors 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. Menopause is followed by postmenopause.
Perimenopause, on the other hand, is a period (not a single date) that is not even precisely time-bound, when the body prepares for menopause and can be accompanied by many negatively perceived symptoms - sleep disorders, psychological problems, hot flashes, cycle irregularities, heavy bleeding. This period can last 2 to 10(12) years, so it can start as early as 35/40 years.
What happens in the body during perimenopause and what hormones play the biggest role in it?
Contrary to 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 period when estrogen does its worst – its levels are like a roller coaster , often several times higher than before, and then drop sharply again. On the contrary, the hormone progesterone , which for years was estrogen's sparring partner and balanced its effects, begins to gradually decline . Most of the symptoms that accompany this period arise from this hormonal storm, which is sometimes described as a second puberty. After menopause, on the other hand, most of the symptoms tend to improve, and there are even women who feel much better (especially psychologically).
Why do you think women should learn about perimenopause?
If only 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 be able to live a longer life even after the end of reproductive age, to have the energy to take care of our descendants and the descendants of our descendants. And then, 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, enormous stress, cancer treatment, endometriosis, etc. play a role, but these are risk factors that can contribute to the development of this condition, but not cause it with certainty and as the only cause.
In the case of premature menopause, the symptoms are often very pronounced and women often need at least some form of hormonal treatment. 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 it. In any case, unhealthy cycles and an unhealthy lifestyle are one of the risk factors , so a lot can certainly be done as part of primary prevention by a woman taking care of herself and her cycles.
What can worsen the course of menopause? In your experience, are there any common mistakes that women make?
The course of menopause, or rather postmenopause, is certainly made worse by the fact that women do not know what is happening to their bodies during perimenopause – which is absolutely crucial for how their life and health will look like after the end of reproductive age – and they do not respect it. I would not say that these are mistakes, it is more ignorance and a sadly low level of information about this period. I perceive that most often it is about "doing everything even more, more with all your might, trying harder..." - following radical diets, exercising, working at the same time, building a career, taking care of family and household, without any time for yourself. At 25, our bodies forgive us a lot, but it definitely does not work that way after 35/40 years of life.
Menopause comes with many (often) unpleasant accompanying symptoms. What does the normal course of menopause look like and what is not okay, and should it be actively addressed, for example, with functional doctors?
The perception of the accompanying symptoms of peri- and menopause can vary – both in terms of duration and intensity of symptoms. And it is probably up to each woman to assess how much it affects her life and its quality. It is reported that women who suffer from hot flashes early in the perimenopausal period generally have a worse course and need some form of help.
Another fact related to the transition - and especially to how the protective shield of estrogen gradually disappears - is a higher risk of developing insulin resistance and certain diseases such as diabetes, dementia, atherosclerosis, high blood pressure, oncological diseases... In this case, I think it is wise to actively address the situation with doctors.
Hormone replacement therapy or medication is often recommended during menopause. What are your thoughts 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 just like to mention in a simple way is that there is no hormone therapy as hormone therapy and that there are also so-called natural or bioidentical methods of treatment and that it is always absolutely necessary to respect the stage of peri- or menopause a woman is in and how she is doing with her own hormone production. So again, personalized and in the context of other contexts.
Would you recommend any basic supplements to alleviate the symptoms of menopause? Can certain herbs like ginseng or alfalfa help?
I would be very careful with herbs during perimenopause, because many of the recommended herbs (such as black cohosh, red clover, etc.) have an estrogenic effect and can 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 Complex has an amazing composition for me. In one capsule you will find the ingredients necessary for most women during menopause. Chinese angelica (dong quai) has been prescribed for centuries in China, which plays a nourishing role in maintaining the natural hormonal balance and mental and physical well-being of women. Ashwagandha , or Indian ginseng, helps reduce stress and improves concentration - everything that 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 one of our cells needs it!!!
Is there anything you would like to say to women who are currently going through hormonal changes?
Learn about how the female body works, the changes it goes through, and don't give up on finding answers to your questions. There are solutions to get through the hormonal storm in the best way possible!
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