Overview
The menopause transition (climacteric) is the natural phase of hormonal change in a woman's life, usually occurring between the ages of 45 and 55. During this time the body gradually reduces its production of the sex hormones oestrogen and progesterone until menstrual periods stop permanently (menopause). Many women experience complaints such as hot flushes, night sweats, sleep problems or mood swings during this phase; for a considerable proportion, the symptoms are severe enough to noticeably affect everyday life, work and quality of life. Menopausal symptoms are very treatable. Based on a medical assessment, hormone replacement therapy (HRT) may be an option; non-hormonal and herbal approaches as well as lifestyle measures are also available. In a video consultation, doctors can assess your symptoms, discuss the benefits and risks of hormone therapy with you and, where medically justifiable, issue follow-up prescriptions for an existing, well-adjusted therapy. Billing is carried out as a private service according to the German GOÄ fee schedule; patients with statutory insurance can use the service on a self-pay basis.
Common causes
Menopausal symptoms are caused by the declining hormone production of the ovaries. Falling oestrogen levels affect, among other things, temperature regulation in the brain, the sleep-wake rhythm, the mucous membranes, bone metabolism and mood. The transition does not proceed evenly: during perimenopause, the years before the final menstrual period, hormone levels fluctuate strongly, which explains irregular cycles and symptoms that vary in intensity. How strongly symptoms are experienced depends on genetic predisposition, lifestyle, body weight, stress levels and accompanying illnesses. Smoking and premature loss of ovarian function, for example after surgery or certain cancer treatments, can bring the onset of menopause forward and intensify complaints. Other conditions, such as thyroid disorders or depression, can cause similar symptoms and should be taken into account in the medical assessment.
When to see a doctor
Seek medical advice if hot flushes, sleep problems or mood swings noticeably impair your quality of life, if you would like to start, adjust or continue hormone replacement therapy, or if you are unsure whether your complaints are actually explained by the menopause. Certain warning signs require prompt in-person assessment: any bleeding that recurs after more than twelve months without a menstrual period, unusually heavy or persistent bleeding, newly palpable lumps in the breast, and unexplained weight loss. If you are on hormone therapy, you should also watch for signs of thrombosis, for example a calf that is swollen, painful or warm on one side. In case of sudden shortness of breath, severe chest pain, signs of paralysis, speech disturbances or sudden loss of vision, call the emergency number 112 immediately – these signs may indicate a pulmonary embolism or a stroke.