Menopause- A Beginners' Guide

Menopause? Really now?

The menopause is a natural process that every woman goes through. During this phase of life, our bodies experience numerous hormonal changes. These can cause a variety of symptoms, ranging from mild discomfort to serious health problems. Googling can quickly lead to therapies, some of which can sound a little intimidating. Here we want to give you an overview of which therapies work against which symptoms, what their advantages and disadvantages are and for whom they are generally not suitable. In any case, you should talk to your doctor in detail and give each therapy time to work and not change drug therapies too quickly without consulting your doctor. 

But let's dive into the maze of therapies and get an overview of what can help with which symptoms.

#1 Hormone therapy (HRT)

Hormone replacement therapy (HRT) can be administered in various forms, including orally (in tablet form), transdermally (patches, gels), and vaginally (creams, suppositories). When taking HRT orally, you usually take 1 pill per day, depending on the dosage and the specific preparation. There are both combined HRT (with oestrogen and progesterone) and oestrogen-only preparations; your doctor will explain the details to you.

Advantages of oral HRT:

• Easy to take: The pill can be easily integrated into everyday life.
• Effectiveness: It effectively relieves common symptoms of the menopause such as hot flushes, night sweats, sleep disorders and vaginal dryness.
• Protection against osteoporosis: Taking HRT can slow down bone loss and thus reduce the risk of osteoporosis.
• Many years of experience: Oral HRT is one of the most commonly prescribed forms of hormone replacement therapy and has a long history of clinical use.

Disadvantages of oral HRT:

• Increased risk of blood clots: Oral HRT may slightly increase the risk of thrombosis, stroke and pulmonary embolism -especially in women who smoke, are overweight or have a history of clot formation.
• Liver stress: As the oestrogen passes through the liver, it can affect the production of clotting factors and other substances. This makes it less suitable for women with certain liver diseases.
• Increased risk of breast cancerProlonged use of combined HRT (oestrogen and progesterone) may increase the risk of breast cancer, especially after more than 5 years of use.
• Side effects: Possible side effects include headaches, nausea, breast tenderness and mood swings.

Alternatives to oral intake:

• Lifestyle adjustments 
• Transdermal therapy (patch, gel): Often preferred as it reduces the risk of blood clots and liver exposure as it does not pass through the digestive tract.
• Vaginal preparations: Local HRT (creams or suppositories) is particularly suitable for women who primarily suffer from vaginal dryness and discomfort during sexual intercourse.
• The decision for a specific form of HRT should always be made in consultation with the doctor, based on individual health factors and preferences.

Who is HRT not suitable for?

It is important to discuss these contraindications with a doctor in order to find the safest treatment option during the menopause. You now know what they mean and can address these points at your doctor's appointment.

#2 Non-hormonal medications

Non-hormonal medications offer an alternative to HRT and are often used to treat menopausal symptoms such as hot flushes and mood swings. These mainly include SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), which are also used to treat depression and anxiety.

Advantages of non-hormonal medication:

• No hormonal intervention: These drugs offer an alternative for women who cannot or do not want to take HRT for medical reasons.
• Relief from hot flushes and night sweats: SSRIs and SNRIs have been shown to be effective in reducing hot flushes.
• Improve mental health: They can alleviate mood swings and depressive symptoms that occur during the menopause.

Disadvantages of non-hormonal medication:

• Side effects: Common side effects include nausea, headaches, insomnia and reduced sexual desire.
• Slow effect: It can take several weeks for the full effect to take effect.
• Not sufficient for severe symptoms: These medications may not be as effective for severe physical symptoms of menopause such as vaginal dryness.

Who are they not suitable for?

If you have one or more of these risk factors:

• Untreated depression: SSRIs/SNRIs should be monitored by a doctor, especially when used to treat mood swings and depression.
• High blood pressure: Some medications should not be used without medical supervision in women with high blood pressure. Talk to your doctor about what would be best for you.
  
  

#3 Supplements for bone health: calcium, bisphosphonates, vitamin D

During and after the menopause, oestrogen levels fall, which increases the risk of osteoporosis and bone fractures. Calcium, vitamin D and bisphosphonates are essential components for supporting and maintaining bone density during this phase of life.

Benefits of calcium, bisphosphonates and vitamin D:

• Calcium: Important for maintaining bone health and preventing bone loss (osteoporosis).
• Vitamin D: Promotes calcium absorption in the body and strengthens the bones.
• Bisphosphonates: drugs that slow down the breakdown of bone and reduce the risk of fractures by improving bone density.

Disadvantages of calcium, bisphosphonates and vitamin D:

• Calcium: Excessive intake can increase the risk of kidney stones and heart disease.
• Bisphosphonates: Long-term use can lead to rare but serious side effects such as necrosis of the jaw and atypical femur fractures.
• Vitamin D: Too much vitamin D can cause hypercalcemia, which can damage the kidneys and lead to other health problems.

Alternatives to supplementation:

• Lifestyle measures such as strength training: In addition to supplementation, regular weight-bearing exercises such as walking, jogging and strength training are important to strengthen bones and prevent bone loss.
• HRT (hormone replacement therapy): In cases of severe osteoporosis, HRT can also slow down bone loss by stabilizing hormone levels.

Who are they not suitable for?

If you have one or more of these risk factors:

• Kidney problems: Women with kidney problems should have their intake of calcium and vitamin D carefully monitored, as an imbalance of the minerals could damage the kidneys.
• Gastrointestinal disorders: Bisphosphonates can cause gastrointestinal complaints, so they should only be used under medical supervision in women with a sensitive stomach or heartburn.

#4 Natural lifestyle interventions with blood glucose management (Hello Inside program)

Metabolism changes significantly during menopause, which can increase the risk of insulin resistance, weight gain, dementia and type 2 diabetes. Programs for more optimal habits like ours, which includes nutrition, exercise, stress management and sleep hygiene, are critical for wellness and symptom management during this stage of life. The Hello Inside program offers women a comprehensive approach that provides personalized recommendations based on real-time blood glucose data.

Benefits of lifestyle interventions:

• Weight control: An adapted diet and regular physical activity help to maintain a stable weight, which is often difficult during the menopause.
• Blood glucose management: The Hello Inside program uses continuous glucose monitoring (CGM) to track blood glucose fluctuations in real time, allowing you to adapt your diet and exercise to your body's new needs and see your progress immediately.
• Stress management and sleep improvement: Stress reduction and sleep hygiene strategies can help to manage hormone-related sleep disorders and stress during the menopause.
• The therapy also addresses the more serious health risks that occur more frequently after the menopause and has a lasting positive effect on quality of life.
• The therapy can be optimally combined with all other therapies.
• The therapy has no side effects, except that you will know more quickly how your body responds to which changes and what has an effect on you.

Disadvantages of lifestyle interventions:

• Requires discipline and commitment: Lifestyle interventions require long-term discipline and consistent implementation.
• Slower results: Unlike medication, changes in diet, exercise and stress management take time to have their full effect on symptoms.

Who are they not suitable for?

• Irregular lifestyle: Women with very unpredictable daily schedules or high stress levels can find it difficult to build the structure and discipline needed for successful lifestyle interventions.
• Severe insulin resistance or diabetes: Women with advanced insulin resistance or diagnosed diabetes may need additional medical support alongside lifestyle interventions.
  
  

There is no right and wrong with therapies as long as you consult your doctor

The menopause is a phase of life that every woman experiences slightly differently. As soon as you know for sure that the symptoms are due to your menopause, there are various therapies that can provide relief from the symptoms, one after the other or in parallel. The optimal therapy is individual to each woman. Natural lifestyle therapies are always a good starting point due to their gentleness and the coaching sessions also help you to identify more self-determined solutions for yourself during your menopause.

Importance of natural therapies through lifestyle programs such as Hello Inside summarized:

• Effective lifestyle adjustments are always a medically medically sensible complementary measure to all other forms of therapy. forms of therapy.
• Lifestyle interventions such as Hello Inside are the only form of therapythat addresses the menopause symptoms of weight gain and developing insulin resistance.
• Natural lifestyle interventions are an efficient, yet gentle first form of therapy to which you can also combine hormone or non-hormone therapy and supplements over time to improve the effect.
• Discuss your symptoms with your doctor firstif you are unsure whether you are in the menopause.

At a glance: Menopause symptoms and possible forms of therapy:

Sources

Dormire, Sharon L et al: Menopausal Hot Flash Frequency Changes in Response to Experimental Manipulation of Blood Glucose. Nursing Research 52(5):p 338-343, September 2003.

Jull, Janet et al: Lifestyle Interventions Targeting Body Weight Changes during the Menopause Transition: A Systematic Review, Journal of Obesity, 26 May 2014

Lumsden MA, Davies M, Sarri G, for the Guideline Development Group for Menopause: Diagnosis and Management (NICE Clinical Guideline No. 23). Diagnosis and Management of Menopause: The National Institute of Health and Care Excellence (NICE) Guideline., JAMA Intern Med. 2016;176(8):1205–1206.

National health System UK (NHS), Alternatives to hormone replacement therapy (HRT), NHS online database

Støer, N.C. et al: Menopausal hormone therapy and breast cancer risk: a population-based cohort study of 1.3 million women in Norway. British Journal of Cancer 131, 126-137 (2024)

Wu O.: Postmenopausal hormone replacement therapy and venous thromboembolism, Gender Medicine 2005;2 Suppl A:S18-27

Xu L, et al: The Hepatoprotective and Hepatotoxic Roles of Sex and Sex-Related Hormones, Frontiers in Immunology 2022 Jul 4;13:939631