Menopause and perimenopause

Symptoms

The most frequent are hot flushes and night sweats, sleep disturbance, mood changes, vaginal dryness, pain during intercourse and frequent urination. There is often difficulty concentrating. Intensity varies greatly from one woman to another. Symptoms can be confused with thyroid problems or anemia, so the doctor may request tests.

Long-term consequences of lower estrogen

Estrogen protects the bones and blood vessels. After menopause bone loss accelerates, so the risk of osteoporosis rises, and cardiovascular risk becomes more evident; blood pressure (hypertension) and lipids are checked regularly. Urogenital changes are progressive and usually do not go away without treatment.

Practical management of symptoms with or without hormone therapy

Hot flushes and night sweats arise from a change in thermoregulation in the hypothalamus when estrogen falls, and often improve with simple changes. Dressing in layers, a cool bedroom at night, avoiding individual triggers (alcohol, spicy foods, caffeine, smoking) and weight loss in women with overweight can lower their frequency. Regular exercise and cognitive behavioral therapy have proven benefit for sleep and mood. If non-hormonal medicines are used, they are chosen and dosed by the doctor.

Vaginal dryness and urinary symptoms (the genitourinary syndrome of menopause) do not improve by themselves and often worsen. Vaginal moisturizers and lubricants give partial relief; low-dose vaginal estrogen is the most effective treatment and is little absorbed into the circulation, so it is usually suitable even for women who are not on systemic hormone therapy, after discussion with the doctor. Regular sexual activity and pelvic floor exercises help tissue health. Disturbed sleep is addressed with sleep hygiene: a regular schedule, low light in the evening and limited screens.

Bones, heart and recommended checks after menopause

After menopause bone loss accelerates in the first years, so checking risk factors is sensible: history of fractures, smoking, excessive alcohol, very low weight, corticosteroid use and relatives with hip fracture. Assessment of bone density (densitometry) is performed at another center and we interpret the result. Bone protection rests on dietary calcium (about 1000–1200 mg a day in total), vitamin D according to measurement, weight-bearing exercise (brisk walking, strength) and fall prevention; anti-osteoporosis drugs are reserved for high-risk cases.

Cardiovascular risk, which before menopause is lower than in men, gradually approaches it afterwards. So blood pressure, cholesterol, glucose and weight are checked at least yearly or at the interval the doctor recommends, and smoking is addressed. Breast screening (ultrasound and mammography according to age and risk) and cervical screening continue. Seek assessment for any vaginal bleeding, new pelvic pain or a new change in the breast. At the visit bring a description of symptoms, the date of the last period, the list of medicines and the family history of cancer, thrombosis and osteoporosis.

Treatment, including hormone therapy

Lifestyle changes (activity, sleep, avoiding hot flush triggers) help. Hormone replacement therapy is the most effective treatment for vasomotor symptoms and can be chosen when benefit outweighs risk. Risks depend on the type, route, dose and duration as well as on the woman’s age and diseases (breast cancer, thrombosis, heart disease). Local vaginal estrogen treats dryness with low systemic exposure. There are also non-hormonal alternatives. The decision is individual and reviewed periodically.

Care at Tirana Polyclinic: we offer gynecology consultation, breast ultrasound as indicated and interpretation of tests and of bone density scans performed outside the clinic. Reviews are every 6 months to a year, or sooner when the doctor considers it reasonable.