Your IVF treatment process will be planned starting from the first day of your menstrual period. If you wake up menstruating in the morning, that day is considered the 1st day of your period; if your menstrual bleeding starts in the afternoon, the following day is considered the 1st day.

On the 2nd or 3rd day of menstruation, you should schedule an appointment and come to the clinic. During this examination, an ultrasound called “basal ultrasound” will be performed on your ovaries. Basal ultrasound checks the condition of the ovaries. If necessary and not done previously, blood will be drawn from you for some blood tests.

The ultrasound scan is performed with an ultrasound probe inserted into the vagina. Your bladder should be empty for your doctor to see your ovaries and the ovarian cells growing inside them as best as possible.

Your doctor will inform you about the plan for the IVF process, including when ovarian retrieval and embryo transfer into the uterus will occur, and the dates for these procedures.

The names and doses of the medications you will use during the treatment will be explained to you in detail by our nursing staff and provided to you in a list format.

Blood Tests and Imaging

We will inform you about when to start medication, when to have your first blood test, and when your first ultrasound will take place.

Based on the results of blood tests and ultrasound imaging, you will be thoroughly informed about approximately when the ovarian retrieval procedure will be performed once your ovarian cells have reached adequate size.

Your next steps will be planned and explained to you each day you have blood tests or ultrasounds done.

If you have any questions about medication use or the process, you can call +90530 542 77 24 for information.

If only one or two ovarian cells develop during your monitoring appointments or if hormone levels are found to be low in blood tests, it may be better to reconsider the treatment by using more medication or taking a break and trying again later. Similarly, sometimes ovaries may be paused in treatment because they are overly stimulated. Before making any decisions, we discuss options with you and strive to work collaboratively. While discontinuing treatment in such situations may be disappointing, it benefits us in planning future treatment schemes.

Ovarian Retrieval

After your ovaries have been grown with the IVF medications mentioned earlier, final maturation is achieved with an injection of the hormone hCG. The hCG injection is administered 36 hours before the planned ovarian retrieval procedure. We can tell you exactly when we will perform the ovarian retrieval procedure once we administer this injection.

We kindly ask you to come to the clinic 30 minutes before ovarian retrieval.

You will likely be at the clinic for 2-3 hours.

We recommend bringing someone to support you, such as your partner or a friend. If you wish, you can bring your favorite relaxing music to help calm you.

Do not eat anything for six hours and do not drink anything two hours before ovarian retrieval.

The medications used during ovarian retrieval may affect your ability to drive safely, so you should plan your transportation home accordingly.

We do not recommend engaging in activities that require attention for 24 hours after the ovarian retrieval procedure. Someone should take you home, and they should stay with you for 24 hours after the procedure.

You may experience vaginal bleeding after the ovarian retrieval procedure. If bleeding is heavy or lasts longer than one day, you must contact us. Mild cramping abdominal pain is frequently observed within the first 24 hours. In such cases, you can use the pain relievers we prescribe for you. If you experience severe abdominal pain, you should contact us.

Pain may be an indicator that something is wrong with your body. In case of severe bleeding and pain after the procedure, you should contact us.

One hour after giving a sperm sample is the optimal time when sperm quality is best. You can give the sample at home before the procedure and bring it with you or give it in the appropriate sperm collection rooms at the clinic.

We recommend refraining from sexual activity for three days to increase sperm count.

We do not recommend refraining from sexual activity for more than three days because of the accumulation of aged sperm.

We do not recommend using lubricants when giving a sperm sample, as even small amounts can be toxic to sperm.

Hormonal Support After the Procedure

After the ovarian retrieval procedure, your nurse will provide you with information about the medications your doctor recommends and their usage to thicken the lining of the uterus for embryo implantation.

These recommended medications contain progesterone hormone and come under the trade names Utrogestan or Crinone (progesterone in gel form, applied with a pre-filled applicator). There may be mild discharge when using Utrogestan or Crinone.

Sometimes, you may experience bleeding before a pregnancy test is performed, which does not necessarily mean you will not become pregnant.

Do not stop the gel or capsule without consulting your doctor until you have taken a pregnancy test and learned the result.

Embryo Transfer

Depending on the number and quality of embryos, embryo transfer can take place between the 2nd and 5th day after ovarian retrieval. You will be informed about how many embryos were created after the ovarian retrieval procedure.

You should be at the clinic half an hour before the planned embryo transfer.

You can continue your daily activities after embryo transfer – the embryos will not fall out, so do not worry!

During the embryo transfer procedure, an ultrasound is performed on the abdomen. To obtain a clearer image with the ultrasound, you should have drunk enough water and have a full bladder. Since we use ultrasound, especially to help with the insertion of the catheter containing embryos, having a full bladder makes the transfer easier.

Freezing of Embryos

Sometimes, instead of fresh embryo transfer, we may recommend freezing all embryos. If the uterine lining is not thick enough for embryo implantation or if there are other medical conditions, your embryos will be frozen and stored for transfer at a later time instead of being transferred immediately.

Pregnancy Test

Most people say that waiting to see if they are pregnant is the most stressful part of treatment. The pregnancy test is performed 15 days after embryo transfer. Your result will be communicated to you by us.”

What is Birth Control and Fertility?

Birth control means having as many children as a couple can care for. The most common misconception here is that birth control is a method used to decrease the population, which is entirely wrong. What matters is the right of a couple in a society to have as many children as they can care for (according to their social and economic circumstances).

Fertility health is crucial. Female fertility health spans from ages 15 to 40. The better a society can care for women in this age group, provide good preconception education, the better off it will be.

What are the most commonly used birth control methods in Turkey?

In Turkey, compared to the rest of the world, the most commonly used birth control methods are intrauterine devices (IUDs). For example, in Europe, birth control pills are more widely used in countries like the UK, while in the US and Canada. In Turkey, birth control pills are used around 3-4%, and similarly, IUDs are used around 15-20%. Apart from that, modern methods are unfortunately still less utilized in Turkey. Methods are divided into traditional and modern. The most commonly used modern methods are birth control pills, subdermal implants, hormonal or non-hormonal intrauterine devices (IUDs), and condoms.

The traditional methods include withdrawal and calendar-based methods, meaning refraining from intercourse on certain days of the month. In Turkey, 40 out of 100 women still use any modern method, and approximately half of the remaining women prefer traditional methods.

Which birth control method do I recommend the most? Why?

I recommend a method based on the patient’s condition, circumstances, and fertility expectations. This is very important. For example, for a couple who has never had children, if suitable, I recommend birth control pills or condoms. If they have experienced fertility, meaning they have had at least one child, then I list all options for the woman postpartum. What are these methods? Intrauterine devices, birth control pills, condoms, or subdermal implants. It’s essential to emphasize that there is no one-size-fits-all birth control method for everyone; it varies for each individual.

Which birth control method is the least risky? What is the most guaranteed method?

There is no answer to this question because there is no risk-free and guaranteed method found worldwide. Each method has its pros and cons. If we say the least risky, of course, these are the simplest and easiest methods passed down from fathers, such as withdrawal or calendar methods. Still, there is still a risk of around 15-20% of becoming pregnant. On the other hand, the most guaranteed birth control method currently in the world is tubal ligation, meaning tying and burning both tubes of the woman, or subdermal implants, or hormonal IUDs. These are currently the safest birth control methods. However, each has its pros and cons. In summary, there is still no birth control method that is suitable for every couple in the world without any risk or the most guaranteed.

What are the latest birth control methods in Turkey and the world?

The latest birth control methods include subdermal implants, which are available both in Turkey and worldwide. Hormonal IUDs are also available both in Turkey and worldwide. Apart from these, there are patch types of birth control pills (i.e., applied to the skin), which are not currently sold in Turkey but may be available soon. Also, there are vaginal rings, which are available worldwide but not used in our country.

What are the side effects of birth control methods?

The side effects of birth control methods vary. Frankly, the side effects of pills (birth control) are a bit more concerning to the public. These include nausea, vomiting, dizziness, and can cause depression. They can also lead to fungal infections. In addition, intrauterine devices have side effects such as bleeding and pain. The common feature of hormonal spirals or subdermal implants is irregular bleeding or no bleeding at all. There is a risk of condom breakage (i.e., the risk of being unreliable). As you can see, each method has its own side effects.

Emergency Contraceptive Pills

What are Emergency Contraceptive Pills?

Emergency Contraceptive Pills, or Morning-After Pills, come in two types worldwide. Morning-After Pills have been available in Turkey for about 1-1.5 years. They have been available worldwide for a long time.

We can talk about two types of pills here. The first is called the “Emergency Contraceptive Pill,” which contains both estrogen and progesterone. The other is called the “Morning-After Pill,” which contains only progesterone. Both are for emergency protection. If a couple has had intercourse without using any method or if the method they used failed, the most common example being condom breakage, emergency contraceptive pills help in such situations. They prevent pregnancy by about 80-85%. Currently, the most preferred worldwide are the Morning-After Pills containing progesterone. This method has fewer side effects compared to others and is more effective. In summary, their effectiveness is higher compared to emergency contraceptive pills (containing both estrogen and progesterone).

What is Abortion?

There are several types of abortions. Elective abortion occurs when a woman has an unwanted pregnancy due to the failure of contraception or because she did not use contraception. In such cases, the pregnancy is terminated, or sometimes for medical reasons (i.e., medical reasons), if the mother’s life is in danger or if there is a disability in the baby. These are all reasons for abortion.

Is Abortion a Birth Control Method?

Absolutely not. Abortion is not a birth control method. It should not be accepted as such. However, many women in Turkey still consider abortion as a birth control method. This is definitely a mistake. Abortion is a last resort.

For what reasons do women in our country undergo abortion?

The biggest reasons are ignorance and negligence. Why negligence? Because many intellectual women, including doctors, do not use contraception. They even rely on traditional methods.

As a result, these women become pregnant. I think the two biggest reasons in Turkey are negligence and ignorance of contraception.

What factors should be considered before abortion?

The most important factor to consider before abortion is how many weeks the baby is. Currently in Turkey, abortion is allowed up to 10 weeks, and abortion beyond 10 weeks is not legal. However, abortion can be performed for medical reasons, i.e., if there are reasons related to the mother and the baby. This should be approved by at least two specialists on the subject. Although there is generally no specific decision, abortions are performed in Turkey up to the 24th week.

In addition to these, it is essential not to perform abortion unless necessary. Just as we mentioned earlier, abortion is not a birth control method. But if it needs to be done, the physician performing the abortion must be experienced in this regard. Because despite abortion seeming simple, complications of abortion are still at the forefront of legal cases between doctors and patients today. Therefore, it is essential for the physician to be knowledgeable and experienced in this regard, and hygiene must be ensured at the place where the abortion is performed. At the same time, it is crucial that abortion be performed in hospital conditions, where intervention can be made in case of any problems, rather than in clinics or small offices.

How is abortion currently performed in our country?

All kinds of methods used worldwide are also applied in our country. Methods such as cervical dilation, followed by vacuum or curettage to empty the uterus, as well as various medical techniques to facilitate abortion both in the world and in Turkey. Honestly, we cannot say that Turkey has lagged behind in this regard in terms of global developments or methods.

What techniques were used in the past? What is the situation now?

In the past, some drugs related to abortion were used more. These drugs are not used today. Nowadays, more types of prostaglandins are used. The purpose of this method is to facilitate cervical dilation and make abortion easier. This is the most significant development. Other than that, surgical methods still continue as before. This is the same worldwide. One method used worldwide but not in Turkey is the use of progesterone antagonists.

What is the most suitable method for abortion?

It is difficult to give a definite answer to this question.

Because the method varies according to the individual. But the most commonly used method, as mentioned, is to give a medication before abortion to dilate the cervix, and then to perform vacuum aspiration, which is the removal of the embryo through vaginal means using medical instruments.

What are the risks of abortion?

Abortion carries many risks. The first is the risk of retained products of conception, and the second risk is bleeding. In addition to these, there is the risk of infection in the patient, and there are risks related to anesthesia.

Furthermore, if certain medical conditions or certain situations are not taken into account, complications due to these factors can also occur. For example, risks for a woman with heart disease… One of the most common complications we encounter as physicians is uterine perforation, tearing, or bleeding, retention of tissue in the uterus, and infection in the uterus.

What should be done after abortion?

Ideally, the woman should rest for at least two days. It is beneficial to use antibiotics after abortion (especially if hygiene is compromised or if the place where the abortion was performed is not very hygienic). Painkillers should also be used.

A woman who has had an abortion should refrain from sexual activity for at least two to three weeks, should not perform vaginal cleaning, and should take showers…

A woman who has had an abortion can become pregnant again. That is, there is no medical contraindication after the next menstrual period (if there were no complications during the abortion). However, psychological support is essential for her to become pregnant again. If the woman plans to have another abortion, it can create serious problems. Therefore, if a woman does not want to become pregnant again, she must use contraception. If she wants to become pregnant after abortion, she should do so when she feels ready. It is essential to be mentally prepared, not just physically.

What emotional states have you observed in women after abortion?

You observe various emotional states in women… In some women, you see distress, while in others, you observe relief and relaxation. Some women express sentiments like “I’m glad I did it, otherwise, I wouldn’t have been able to handle this pregnancy,” especially those who have issues in their marriage. Or if there are extramarital abortions, they may be seen as a relief. However, particularly if one of the couples really wants the baby and has had to terminate the pregnancy due to certain reasons, serious aggressive behaviors can be observed later on.

What recommendations do you have for women after the abortion procedure?

After abortion, we definitely inquire about contraception methods and when they want to become pregnant again, especially if the abortion was done at the woman’s request. We make recommendations accordingly. This is crucial to prevent future abortions.

In the meantime, if the abortion was not by the woman’s choice but was necessary, we try to address any issues before the next pregnancy… Then we facilitate her becoming pregnant.

Is psychological support necessary for women coming for abortion?

Providing psychological support is in the hands of the doctor. Instead of immediately saying, “Okay, let’s remove the fetus,” we ask why they felt the need for an abortion. And then we try to prevent it as much as possible… Sometimes, even if it’s a decision made jointly, we’re happy to see couples change their minds.

Sometimes, Turkish women may go to other doctors instead of their own, saying “Oh, I don’t want my doctor to see me like this.” In such cases, there’s nothing we can do.

To diagnose menopause, you must not have had a period for the past year, meaning you should not have had any bleeding, including spotting, for 12 consecutive months. The average age for menopause is in the 50s. Early menopause, on the other hand, refers to experiencing this entire process in your 20s or 30s, before the age of 40.

There are various terms used instead of early menopause (surgical menopause, premature ovarian insufficiency, menopause caused by radiation and chemotherapy, menopause due to genetic disorders, etc.). In this article, I will discuss the risk factors, causes, diagnostic tests, and treatments for early menopause.

Risk Factors for Early Menopause

It’s not always clear which women will experience early menopause, but certain conditions can negatively affect ovarian reserves and bring on menopause earlier. Those with predisposing conditions are at a higher risk of early menopause. Here’s a summary of factors that contribute to early menopause:

• Family history of early menopause
• Genetic conditions (such as Fragile X syndrome)
• Conditions that damage the ovaries (such as ovarian cysts, pelvic infections)
• Frequent ovarian surgeries
• Undergoing chemotherapy or radiotherapy that may harm the ovaries
• Taking medication that could damage the ovaries
• Smoking

Causes of Early Menopause

There are many known or unknown causes of early menopause. For example, you may have undergone surgery to remove your ovaries, there may be a family history of early menopause, or your ovaries may have been damaged due to chemotherapy or radiotherapy. In such cases, the cause is evident.

However, sometimes there is no identifiable cause, and you find yourself facing the process of early menopause. You may enter a period where you wonder, “Why me?”

In this section, I will discuss possible risk factors for early menopause.

The most common known causes of early ovarian insufficiency are as follows:

• Medical conditions such as post-surgery, post-radiotherapy, or post-chemotherapy
• Chromosomal and genetic abnormalities
• Autoimmune diseases (autoimmune conditions)
• Environmental factors (viruses, chemicals, etc.)
• Metabolic conditions (type 1 diabetes, galactosemia, etc.)
• Endometrioma (chocolate cyst)

Autoimmune Diseases

Autoimmune diseases occur when the body’s immune system attacks its own cells. In some autoimmune diseases, the body sees the ovaries as a threat and sends immune system cells to attack them, resulting in ovarian damage. The ovaries cannot produce hormones or eggs as they used to, leading to ovarian insufficiency.

Depending on the source, 5-30% of cases of primary ovarian insufficiency are believed to have an autoimmune cause.

[alert-warning]Certain autoimmune diseases associated with excessive immune activity can cause early menopause by attacking the ovaries. Examples include Addison’s disease, Graves’ disease, among others.[/alert-warning]

Chromosomal Disorders

Some genes in the body play a role in egg formation and hormone secretion. Diseases associated with defects in these genes can lead to an earlier onset of menopause. Studies indicate that 10-12% of women diagnosed with early menopause have chromosomal abnormalities. This condition is more common in diseases associated with X chromosome abnormalities (94%).

Turner Syndrome (46,X0): It is characterized by the absence or abnormality of one of the two X chromosomes that women should have.

Fragile X Syndrome:

If you are a carrier of fragile X syndrome, you may carry fewer eggs in your ovaries, which can lead to early menopause.

It is one of the most common causes of familial mental retardation. The incidence is about 1/4000-1/6000 in women.

Infections

Some infections such as tuberculosis, malaria, measles, can damage ovarian tissue, disrupt ovarian hormone secretion, and damage ovarian tissue and eggs, leading to early menopause.

Surgical Interventions

Oophorectomy is the surgical removal of the ovaries.

Surgical menopause (also known as bilateral oophorectomy) occurs when both ovaries are surgically removed, leading the body into menopause. In other words, the ovaries do not stop functioning gradually, as in the natural process; instead, they are removed suddenly, and the body enters menopause.

In most cases, the procedure is minimally invasive, meaning a surgeon makes small incisions to access and remove the ovaries in the lower abdominal area.

Sometimes, your doctor may perform an oophorectomy during a hysterectomy (uterus removal surgery), meaning your ovaries may also be removed.

There are several reasons why your doctor may perform an oophorectomy that leads to menopause. These include:

Endometriosis (having chocolate cysts in your ovaries)

Non-cancerous ovarian tumors or cysts

Ovarian cancer

Ovarian torsion (twisting of the ovary around itself, disrupting blood flow)

Some women choose to undergo preventive surgery in cases of genetic disease to reduce the risk of ovarian or breast cancer.

Women with a family history of ovarian or breast cancer are at a higher risk of developing these cancers. Some genetic conditions predispose individuals to ovarian and breast cancer. Among these genes, BRCA is prominent. Some women undergo genetic testing to determine if they have mutations in the BRCA1 and BRCA2 genes.

[alert-warning]Approximately 60% of ovarian cancer patients with a genetic predisposition are associated with BRCA1 mutations and 30% with BRCA2 gene mutations.[/alert-warning]

Surgical menopause has a significant difference in that the patient enters menopause immediately after surgery, without experiencing the perimenopausal period.

According to the American National Cancer Institute, mutations in the BRCA1 and BRCA2 genes account for 15% of all ovarian cancers. These gene mutations also account for 20 to 25% of hereditary breast cancers. Women with these genes are at a higher risk of developing cancer at an earlier age. In such cases, removing the ovaries can reduce a woman’s risk of developing the disease. If your BRCA test result is positive, meaning you have this gene, talk to your doctor and seek genetic counseling.

Radiation Therapy and/or Chemotherapy

Chemotherapy drugs or radiation given for treatment can damage not only cancer cells but also rapidly dividing cells such as hair follicles, bone marrow, and eggs, leading to conditions such as hair loss, suppression of the immune system, and early menopause. In some cases, temporary menopause may occur due to low-dose short-term treatment. After treatment, the ovaries may stop functioning for several months but may eventually recover. If the egg reserve is damaged during this process, infertility may occur even if periods return.

Other Conditions Causing Menopause-Like Symptoms

Thyroid Disorders: The thyroid gland is an organ located in the neck. It regulates many functions in the body through the hormones it secretes. Deficiency or excess can lead to serious conditions and complaints. It can mimic early menopausal symptoms by causing amenorrhea (lack of menstruation).

Hyperprolactinemia: Prolactin hormone is known as the milk hormone. Its main function is to stimulate milk production from breast tissue after childbirth. The normal value in the blood is 10-25 ng/ml. When prolactin hormone is secreted inappropriately due to various reasons, it can cause irregular menstruation and even amenorrhea (lack of menstruation), mimicking this symptom of early menopause.

Polycystic Ovary Syndrome (PCOS): In a normal menstrual cycle, the ovary produces one egg each month, but in polycystic ovary syndrome (PCOS), there are numerous small sacs (follicles) containing unruptured eggs in the ovaries. Hormones secreted from these unruptured follicles can affect your overall hormone balance, causing amenorrhea (lack of menstruation) and mimicking early menopause. Other symptoms seen in PCOS include irregular menstruation, infertility, increased hair growth, hair loss, acne, increased risk of uterine and possibly breast cancer, increased risk of cardiovascular disease, increased risk of diabetes due to increased insulin hormone, depression, and anxiety.

While no causal relationship has been proven between smoking and early menopause, there is an association between smoking and early menopause. Therefore, women predisposed to POI should be advised to quit smoking.

• Pituitary gland disorders,
• Imbalance in body fat mass,
• Excessive stress,
• Excessive exercise,

Oral contraceptives, certain other medications, and systemic diseases can also cause irregular menstruation, mimicking early menopause.

Early Menopause Symptoms

During early menopause, there are changes in the body due to decreased estrogen hormone levels. These are often the symptoms that prompt you to see a doctor.

Let’s take a closer look at these symptoms you’re experiencing.

When a patient presents with complaints of amenorrhea, the doctor will first request blood tests to investigate thyroid hormones, prolactin, and some female hormones to rule out diseases that mimic early menopause.

Hot Flashes

Do you ever feel a sudden sensation of heat on your face while sitting quietly watching TV? Hot flashes are the most common symptoms of menopause. They can occur in 3 out of 4 women. Some patients may experience hot flashes even while continuing to menstruate during the perimenopausal period.

A hot flash is a sudden sensation of heat felt in the upper part of the body. Your face and neck may become flushed. Tiny red dots may appear on your chest, back, and arms. You may even experience sudden chills or sweating after hot flashes.

This condition is very common a year before and after the cessation of menstruation. Recent scientific studies have shown that hot flashes can last up to 14 years after menopause.

Vaginal Dryness and Infection

Problems such as vaginal dryness and infection may begin or worsen during the menopausal period. As mentioned earlier, low levels of estrogen hormone during menopause cause the vaginal tissue to become drier and weaker. This can lead to itching, burning, or pain during intercourse.

You may develop small tears in the vagina during sexual intercourse. Vaginal tears put you at higher risk for sexually transmitted infections (STIs or STDs). Therefore, although you have no risk of pregnancy after menopause, you should still practice safe sex to prevent sexually transmitted diseases.

Irregular Periods

You might be thinking, “I’m already in menopause, why do I need periods?” However, due to hormonal fluctuations in your blood during the perimenopausal period, it is very likely that you will experience irregular menstrual bleeding and spotting. Your periods may become more frequent or less frequent. They may last longer or shorter. Missing a few periods without any symptoms does not mean you are in perimenopause or transitioning to menopause.

Sleep Problems

Many women experience difficulty sleeping throughout menopause. You may have difficulty falling asleep and your sleep quality may be affected due to the decrease in progesterone hormone in your body. In addition, decreased estrogen hormone levels in your blood can cause hot flashes during sleep. This is sometimes called night sweats. Many menopausal women experience symptoms related to urination. If frequent urination is added during sleep, you may feel tired throughout the day.

Depression and Anxiety

During menopause, your risk of depression and anxiety is higher. A new process can raise questions and concerns in your mind. You may experience sadness or depression due to the loss of fertility or changes in your body. If you have symptoms of depression or anxiety, you should definitely talk to your doctor. Your doctor may recommend therapy or medication or both for depression or anxiety treatment.

Mood Swings

You may feel irritated or have sudden crying spells out of nowhere. Just as you experienced mood swings before or during your menstrual periods, it is more likely that you will experience emotional changes during menopause as well. Also, even if you have never experienced these complaints before menstruation or after childbirth, you may experience them during menopause. These emotional fluctuations may also be due to stress, changes in family dynamics, and feeling tired. These emotional fluctuations do not necessarily mean depression.

Skin

Due to the lack of estrogen after menopause, changes such as dryness, loss of elasticity, and decreased blood flow occur in the skin, resulting in thinning and wrinkling. These changes can also result in poor wound healing, hair loss, and pigmented spots (pigment changes) on the skin. The good news is that all of these can be delayed with estrogen therapy. Wrinkles, smoking, and sun exposure exacerbate these symptoms. You should avoid smoking and sun exposure.

Hair

Unwanted changes in hair and hair include hirsutism (unwanted facial hair) or alopecia (hair loss). Hair loss is the most common. Hair loss has also been reported on the lower legs, genital area, and armpits. Oral Hormone Replacement Therapy (HRT) may help control increased facial hair growth in some women.

Hair removal creams, epilation, and waxing can be effective treatments for increased hair growth. Hair loss can be treated with locally applied minoxidil, but you should always consult your doctor before using any medication.

Teeth

Menopause can be blamed for a variety of dental and oral problems, including dry mouth and gum inflammation.

HRT can be beneficial as a result of its role in preserving bone and preventing tooth loss and eliminating the need for prosthetics. The effects of HRT include reduced gum bleeding, decreased bone loss, and improved saliva flow.

Investigative Tests for Early Menopause

So, you’ve noticed some symptoms and are wondering, “Could I be experiencing early menopause?” What happens now? How can you determine whether it’s early menopause or another condition causing these symptoms? The only way to be sure is to consult your doctor.

Shall we take a brief look at the tests that need to be done?

Hormone Tests

Follicle Stimulating Hormone (FSH)

This hormone is the most helpful in diagnosing menopause in patients under 45 years old. Let’s take a somewhat technical approach to FSH. What does FSH do? Why does it increase in early menopause? Let’s take a closer look.

FSH is a hormone secreted by the pituitary gland in the brain. The pituitary gland produces FSH and releases it into the bloodstream. This hormone (yes, it’s quite a journey) travels through the blood to the ovaries, where it stimulates the follicles, or egg cells, present in the ovarian tissue, allowing you to ovulate and become pregnant each menstrual cycle. If the ovaries respond less to FSH (during early menopause when the ovaries are not functioning properly), the body releases more FSH to obtain the same number of eggs. More FSH stimulates the ovaries to ovulate as before. Therefore, an increase in FSH levels is an indirect indicator that the ovaries no longer function as they used to.

Interpreting Your FSH Result

On the 3rd day of the menstrual cycle, the normal FSH value is expected to be 3-10 mIU/ml. Results between 10-12 mIU/ml indicate that your ovaries are starting to slow down. In other words, you may be in the perimenopausal period (the period when you start to feel physical symptoms but have not yet experienced a year of amenorrhea).

Higher FSH values – 30 and above – are considered indicative of menopause. Even if your FSH levels are high, you may still be menstruating.

It should be noted that normal laboratory values may vary depending on the laboratory where the test is conducted.

Hormone levels can fluctuate, and blood values can fluctuate, so remember that a single independent FSH test may not mean much on its own!

Some women may have a high FSH value once and return to normal levels the next month. Here, what’s important is the increased FSH levels in blood samples taken 4-6 weeks apart.

Estrogen (Estradiol) Hormone

Estradiol is the most active form of estrogen hormone and is found in high levels in the blood during the reproductive years. It is secreted by the ovaries. As the ovaries begin to function more slowly with the onset of menopause, the estradiol level in the blood begins to decrease. The main cause of symptoms such as vasomotor symptoms, hot flashes, vaginal dryness, urinary tract complaints, depression, and diseases such as cardiovascular disease and osteoporosis during menopause is the decrease in estradiol hormone.

Interpreting Your Estradiol Result

The normal 3rd-day estradiol value is 25-75 pg/ml (these levels may vary from laboratory to laboratory). Generally, estradiol levels of about 30 or below are considered indicative of menopause, correlated with high FSH levels. If your estradiol level is less than 50 picograms per milliliter, you may still be menstruating, but you may also experience hot flashes, vaginal dryness, and difficulty sleeping.

In general, it is recommended to increase estradiol levels to at least 40 to 50 pg/mL to prevent bone loss, with the ideal being a value of 60 pg/mL or higher.

Antimüllerian Hormone (AMH)

Since AMH is secreted by cells called granulosa that surround egg cells, it is an indicator of how many eggs you have in your ovaries.

AMH levels are significantly lower in women with POF than in healthy women. AMH measurement also gives your doctor an idea of how you will respond to the drugs used in your treatment for childbearing desires. Studies have shown that patients with very low AMH values are more likely to experience amenorrhea (no longer menstruating), while patients with high AMH values are more likely to continue menstruating.

AMH can also be used to assess ovarian reserve before treatment in patients who will undergo chemotherapy or radiotherapy or who will undergo early menopause for medical reasons, also known as iatrogenic, after medication or surgery.

Other Tests

We have discussed the causes of early menopause and conditions that can mimic early menopause. While your doctor may request some tests to diagnose early menopause, they may also request other tests, in addition to those mentioned above, to investigate other possible causes and the effects of this process on your body.

Additional Tests That May Be Requested:

• Prolactin, TSH, Cortisol, ACTH, DHEA-S in blood samples
• Chromosome Analysis
• Pelvic Ultrasound and Breast Ultrasound
• Bone Density Measurement

Health Issues Caused by Early Menopause

Infertility

One of the most devastating consequences of early menopause is loss of fertility. Currently, there is no effective way to stop egg loss or reactivate the ovaries. If there are no eggs left, there is little that can be done. Some women may appear to have eggs on ultrasound, but there is a possibility of not responding to normal hormonal signals and being unable to conceive with medical treatments. About 5-10% of women with early menopause will begin ovulating and become pregnant naturally. However, a large portion will not regain lost ovarian function and menstrual cycles. Unfortunately, hormone replacement therapy does not increase the number of eggs or the chance of pregnancy.

Don’t despair immediately. First, the remaining egg count should be evaluated. If your egg count is low, there are two options. If you don’t have a partner planning for a child, freezing your eggs is the best option. If you have a partner considering having children, you can plan for pregnancy naturally or through IVF treatment according to your doctor’s recommendation.

Bone Loss (Osteoporosis)

Early menopause can affect a woman’s calcium levels in the bones. In women, estrogen helps the body effectively absorb calcium. As a woman’s estrogen levels begin to decrease during menopause, there is a faster loss of calcium from the body. Osteoporosis, or as we commonly know it, bone loss, resulting from decreased bone density, is a major cause of disability, especially with advancing age, leading to fractures of the hip, wrist, and spine. Women with premature menopause are at even higher risk of osteoporosis. A healthy diet, regular exercise, and, if necessary, medication supplementation will be important for prevention. Regular monitoring of bone density in this situation is strongly recommended. The use of estrogen therapy will replace lost estrogen and slow bone loss, even leading to significant reduction in fracture risk in women.

Heart Diseases

Estrogen is a hormone that has a protective effect on vascular health and other heart diseases. After menopause, the protective effect of estrogen on heart and vascular health disappears, and women are more likely to develop heart and vascular diseases. Many studies have shown that women who experience early menopause are at increased risk of coronary heart disease compared to their peers.

Standard coronary risk factors such as serum cholesterol, blood pressure, and obesity increase during menopause, which is associated with an increase in coronary heart disease observed after early menopause.

Women in this situation are recommended lifestyle changes (such as quitting smoking, regular exercise).

Treatment Options for Early Menopause

After receiving a diagnosis of early menopause, the main condition to be determined is whether you want to have children. Your doctor will determine the treatment flow accordingly.

If you desire to have children, you should research egg freezing and IVF treatments. Additionally, hormone replacement therapy is necessary to prevent health problems due to decreased protective estrogen effects in the body.

Infertility Treatment

For many young women, fertility is only a possibility in the future, so making decisions to preserve fertility, especially after a diagnosis of early menopause, can be very difficult. Some women decide to remain childless. Others may try IVF or medications to increase decreased ovarian function.

Another situation is the need for surgical treatment or preservation of fertility before chemotherapy/radiotherapy. In such cases, it is urgent to start the egg/embryo freezing process focusing on the patient’s health. The most effective and established way to preserve fertility in young women is to freeze oocytes or embryos before starting treatment.

Factors to consider in such situations include whether the patient has passed adolescence, whether there is a period of 2-3 weeks before starting chemotherapy/radiation therapy, and whether the cancer is hormone-sensitive.

In patients undergoing radiation therapy (radiotherapy), it may be considered to move the ovaries (oophoropexy) to an area outside the radiation field.

The decision to become pregnant when a woman is diagnosed with cancer or a serious medical condition is one that she should consider after consulting with her treating physician.

Hormone Replacement Therapy

Young women with early menopause may choose estrogen therapy to alleviate symptoms of estrogen deficiency, and often higher doses may be required compared to older women. The decision to use HT/HRT should be made after discussion with their doctor, as the presence of some diseases or cancers may preclude the use of estrogen therapy.

After breast or endometrial cancer, most women are advised to avoid estrogen-containing medications. In such cases, non-hormonal treatments for hot flashes or vaginal dryness may be beneficial.

When using HT/HRT, the current approach is to continue treatment until age 50-51, which is the average age of natural menopause. After this age, the decision to continue is similar to the decision for normal age menopause.

Options include estrogen tablets, estrogen patches, or gels. If a woman has undergone a hysterectomy (uterus removal surgery), estrogen alone can be used.

Additionally, regular vaginal estrogen can be used in patients experiencing problems during sexual activity.

Combined oral contraceptive pills (some birth control pills) can be used until age 50 if there are no significant risk factors for the woman (such as a tendency to clot, a history of clotting disease, or smoking). The decision to use combined oral contraceptive pills should be made after discussion with their doctor, as the presence of some diseases or cancers may preclude the use of estrogen therapy.

If contraception (birth control) is necessary and a woman does not desire pregnancy at the same time as treatment, hormonal options include combined oral contraceptive pills or an estrogen-containing intrauterine device (usually in the form of a patch or gel). Non-hormonal contraceptive options include the copper intrauterine device or barrier methods such as condoms.

Prevention of Osteoporosis

Osteoporosis, or bone loss due to estrogen deficiency, is common in women with early menopause. Smoking, inadequate calcium intake, and lack of exercise, as well as situations such as chemotherapy, also contribute to bone loss.

Especially if you are not using Hormone Replacement Therapy, estrogen hormone can no longer protect your bones.

Measuring bone density is very important. Depending on the basic bone density in your body, bone mineral density should be checked every one to two years.

A healthy lifestyle is important for maintaining bone health. Women with early menopause should not smoke, engage in regular weight-bearing exercise, and ensure adequate calcium and vitamin D intake.

If a woman has experienced a fracture due to osteoporosis at least once, there are many treatment options available to reduce the risk of possible recurring fractures.

Prevention of Heart and Vascular Diseases

Early menopause is closely associated with increased risk and cardiovascular disease, heart failure, and high cholesterol. If there are no obstacles to the use of Hormone Replacement Therapy, it is recommended to use it until the age of natural menopause. If you have risk factors for heart health, these risk factors (such as hypertension, weight, smoking, diabetes, cholesterol) should be screened appropriately. Lifestyle changes such as healthy eating, exercise, weight loss, and smoking cessation are as important as medication therapy during this process.

Cognitive Function

Chemotherapy-related memory impairment, one of the causes of early menopause, is well recognized. However, the long-term impact of estrogen deficiency on cognitive function is currently uncertain. Women who undergo early menopause due to surgical reasons have an increased risk of Parkinson’s disease and Alzheimer’s disease. Estrogen therapy until natural menopause age in women is believed to have a beneficial effect on cognitive/neurological conditions.

Lifestyle changes (exercise, quitting smoking, maintaining a healthy weight, safe alcohol intake) also play a significant role in improving these symptoms.

Menopause is the permanent cessation of menstruation. Menopause is a normal part of a woman’s life cycle. Sometimes referred to as “the change of life,” we’ll discuss everything about menopause in this section, from definitions to the transition to menopause, the physical and mental effects of menopause on your health, in short, everything about menopause.

What is Menopause?

Menopause is the period when menstruation permanently ceases, and pregnancy is no longer possible. For it to be called menopause, at least one year must have passed since your last period. After menopause, your ovaries produce estrogen and progesterone hormones at very low levels. These low hormone levels can increase your risk for certain health issues.

What is Perimenopause or Transition to Menopause?

Perimenopause, or menopause transition, is the time leading up to your last period. The transition period before and after menopause is referred to as “perimenopause.” As your body transitions to menopause, your hormone levels fluctuate randomly, leading to unexpected menopause symptoms. During this transition, your ovaries produce more estrogen and progesterone hormones than usual. You may experience irregular periods because you may not ovulate every month. Your periods may be longer or shorter than normal, or you may experience unusually heavy or light menstrual bleeding.

Many women experience hot flashes and other menopause symptoms during this transition.

When Does Menopause Transition Typically Begin?

Perimenopause, the transition to menopause, typically begins in a woman’s late 40s.

How Do I Know if I’m Transitioning to Menopause?

Sometimes, it can be difficult for you and your doctor to determine if you are in perimenopause. You need to provide information about the symptoms you experience during this process.

Symptoms: Hot flashes, sleep disturbances

Irregular periods: Keep track of your periods. Irregular periods may be the first sign of menopause.

Hormone levels: If your periods stop before the age of 40, your doctor may test your hormone levels. Doctors usually do not recommend this test unless there is no medical reason. This is because hormone levels fluctuate unpredictably up and down during the transition to menopause. Therefore, it is difficult to decide whether you are going through menopause based on this blood test alone.

How Does Menopause Affect Me?

Menopause symptoms can start suddenly and may initially be very mild. Some women notice many changes in various aspects. Some menopausal symptoms, such as mood swings, are similar to premenstrual syndrome (PMS) symptoms. Others may be new to you. For example:

• Your periods may not be as regular as before, and they may last longer or be shorter. Your periods may stop for a few months and then start again.
• Your periods may be more or less intense than before.
• You may experience hot flashes and sleep problems.
• Your mood may change, or you may feel irritable.
• You may experience vaginal dryness. Sexual intercourse may be uncomfortable or painful.
• You may be less interested in sex.

Other possible changes may not be noticeable. For example, you may begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that weakens bones and makes them more likely to break. Changes in estrogen levels can also increase cholesterol levels and your risk of heart disease and stroke.

How Long Does the Menopause Transition Last?

Perimenopause, the transition to menopause, can last from two to eight years without permanent cessation of your periods. For most women, the transition to menopause lasts about four years. You will know you have reached menopause only after you have gone a year without any bleeding after your last period. This means that there has been no bleeding, including spotting, for 12 consecutive months.

Should I Continue to Use Birth Control During the Transition to Menopause?

Yes. During perimenopause, even if you don’t have a period for one or several months, you can still get pregnant during the transition to menopause. During perimenopause, you may still ovulate some months, but it is impossible to know exactly when you will ovulate. If you do not want to get pregnant, you should continue to use birth control for one more year after your last period. You can learn more about different birth control methods from your doctor.

After menopause, you cannot get pregnant, but anyone with an active sex life can contract sexually transmitted infections (STIs). After menopause, if you do not use condoms, you may be more likely to contract STIs. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sexual intercourse, exposing you to STIs.

When Does Menopause Occur?

Menopause occurs when there have been 12 consecutive months without menstruation. The average age for menopause in women is generally between 45 and 55. One way to understand when you might enter menopause is to consider the age at which your mother experienced it. Menopause may occur earlier due to:

Never having children: Pregnancy, especially multiple pregnancies, can delay menopause.

Smoking: Studies suggest that smoking can lead to entering menopause about two years earlier than non-smokers.

Some health issues may also lead to early menopause.

Menopause usually happens on its own. However, if you undergo chemotherapy or surgery to remove both ovaries, you may enter menopause.

What Happens After Menopause?

After menopause, you will no longer be able to become pregnant, and you will no longer have periods. If you experience any vaginal bleeding after menopause, you should see a doctor as soon as possible. Post-menopausal vaginal bleeding is not normal and may indicate a serious health issue.

After menopause, you may experience:

• Low hormone levels: With menopause, your ovaries produce very little estrogen and progesterone hormones. Due to changing hormone levels, you may develop health risks such as osteoporosis, heart disease, and stroke.
• Menopause symptoms: After menopause, you may experience symptoms such as hot flashes due to changes in estrogen levels.
• Vaginal dryness: Vaginal dryness can occur after menopause.

Menopause Symptoms

During the transition to menopause, fluctuating hormone levels can affect menstrual patterns and lead to symptoms such as hot flashes and sleep problems. As you approach menopause, you may also experience other symptoms such as pain during intercourse, urinary problems, and irregular periods. Medications and other treatments can help alleviate your symptoms.

Hot Flashes

Hot flashes are the most common menopausal symptom. Three out of four women experience hot flashes.

A hot flash is a sudden sensation of heat in the upper part of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. You may even experience cold chills after hot flashes or sweats.

Recent studies suggest that hot flashes can last up to 14 years after menopause. Doctors and researchers do not fully understand why hot flashes are so common during menopause. The good news is that there are medications available that can prevent hot flashes.

What Can You Do?

You can consider hormone therapy. If you are still menstruating, talk to your doctor about low-dose hormone therapy. Hormone therapy helps relieve hot flashes and night sweats in menopausal women. There are some risks associated with hormone therapy. If you decide to undergo hormone therapy, take the lowest effective dose that helps with your symptoms and for the shortest duration possible.

Consider other medications. If hormone therapies are not an option for you, consult your doctor about prescription drugs used for other health problems. Even if you don’t have specific health issues, some antidepressants, epilepsy drugs, and blood pressure medications can help with hot flashes.

Monitor your hot flashes. Write down what triggers your hot flashes and try to avoid them. Possible triggers include spicy foods, alcohol, caffeine, stress, or being in a hot environment.

Drink cold water. When you feel a hot flash coming on, try drinking ice-cold water.

Dress in layers and remove a layer as needed.

Take deep breaths. When a hot flash starts, try taking slow, deep breaths. Slow, deep breaths signal to your body that it’s time to relax and calm down. This may help shorten the duration of the hot flash.

Lose weight. Hot flashes may be worse in women who are overweight. A recent study found that losing weight may help alleviate hot flashes.

Vaginal Problems and Infections

Vaginal problems such as vaginal dryness may begin or worsen during the menopausal period. Low estrogen levels can cause the vaginal tissue to become drier and weaker. This can lead to itching, burning, pain, or discomfort. It can also cause pain during sexual intercourse and may result in small cuts or tears in the vagina during intercourse, putting you at a higher risk for sexually transmitted infections.

What Can You Do?

Vaginal moisturizer. A vaginal moisturizer can help lubricate your vagina.

Vaginal lubricant. A water-based vaginal lubricant can make sexual intercourse more comfortable.

Prescription medication. You can also discuss other ways to treat vaginal dryness with your doctor, such as hormone therapy, estrogen cream, gel, or a vaginal ring.

Irregular Periods or Bleeding

Your periods will become either more frequent or less frequent. Regular periods will cease. There will be days when you ask yourself, “Where did this bleeding come from?” or “Why haven’t I had my period yet?”

What Can You Do?

Always see your doctor first to ensure that there is no other reason for your lack of menstruation, such as pregnancy or a health problem.

If you haven’t had a period for a year and then begin bleeding or spotting, be sure to see your doctor. In menopausal women, spotting or light bleeding may indicate cancer or another serious health issue, which may require taking a sample from the uterine lining.

Sleep Problems

Many women going through menopause find it difficult to sleep at night. Low progesterone hormone levels can make it difficult to fall asleep and stay asleep. Low estrogen levels can also cause hot flashes, which lead to night sweats. This is sometimes referred to as nocturnal sweating. As a result, you may feel more tired than usual during the day.

What Can You Do?

One of the best ways to get a good night’s sleep is to engage in regular physical activity. Doing too much activity close to bedtime can make you more awake. Even if you haven’t exercised regularly in the past, starting to exercise during menopause can help you feel better. Studies have shown that certain exercises, such as yoga and stretching, can help reduce hot flashes.

• Avoid eating, smoking, and drinking alcohol before bedtime. Avoid caffeine in the afternoon.
• Drink hot beverages. Try drinking something warm before bedtime, such as decaffeinated tea or warm milk.
• Limit the use of TV, phone, or computer screens in your bedroom according to bedtime. The bright light from screens tells your brain to wake up instead of sleep.
• Develop good sleep habits. Keep your bedroom dark, quiet, and cool.
• Try to go to bed and wake up at the same times every day.

Memory Problems

You may be forgetful or have difficulty concentrating. Two-thirds of women going through perimenopause report experiencing memory or concentration problems.

What Can You Do?

Adequate sleep and physical activity are important, as well as eating healthily and quitting smoking. This can improve memory.

Stay socially active. Social interaction can delay memory loss and help prevent diseases such as dementia and Alzheimer’s.

Stay mentally active. You can strengthen your memory and focus by engaging in mental activities such as crossword puzzles.

If forgetfulness or other mental issues are affecting your daily life, talk to your doctor.

Urinary Problems

Many women develop bladder or urinary problems during menopause. Lower estrogen levels than before can weaken your urinary tract. You may experience urine leakage when sneezing, coughing, or laughing. Post-menopausal urinary problems are not a normal part of aging and can be treated.

What Can You Do?

The treatment for urinary leakage depends on the cause and may include limiting or preventing caffeine, medication use, using special medical devices, physical therapy, or surgery.

Talk to your doctor about what you can do at home to treat urinary leakage. These include special exercises for pelvic floor muscles called Kegel exercises. Your doctor may also recommend losing weight, as extra weight puts more pressure on your bladder and nearby muscles.

Mood Swings

You may feel tense. If you experienced postpartum depression or sadness, you are more likely to experience mood swings.

What Can You Do?

• Try to get seven to eight hours of sleep.
• Find ways to be active to help you feel your best. Find ways to be active.
• Look for ways to relieve your stress.

Talk to your doctor about menopausal hormone therapy, which may help with mild mood swings. All medications have risks, including menopausal hormone therapy. Mood changes during menopause are usually not the same as depression, which is a different, serious condition that often requires treatment.

Depression and Anxiety

Your risk of depression and anxiety is higher during menopause. You may experience sadness or depression due to fertility loss or changes in your body. If you have symptoms of depression or anxiety, talk to your doctor. Your doctor may recommend therapy or medication or both for depression or anxiety treatment.

What Can You Do?

• Try to get enough sleep. Most adults need seven to eight hours of sleep each night. Lack of sleep is associated with depression.
• Be physically active for at least 30 minutes most days of the week.
• Limit alcohol consumption.
• Lower your stress levels. Try relaxation techniques, such as reading, spending quiet time outdoors, or trying other healthy ways to relax.

Changes in Sexual Feelings

Some women feel more comfortable with their sexuality after menopause. Some may have difficulty becoming aroused. If it’s uncomfortable or painful, you may be less interested in sexual intercourse.

What Can You Do?

If you’re bothered by vaginal dryness, there are treatments available to improve vaginal lubrication. Learn more about menopause and your sexuality.

Some women are less interested in sex during menopause due to other menopausal symptoms such as depression, anxiety, or lack of sleep. If your menopausal symptoms bother you, talk to your doctor about possible treatments.

Menopause Treatment

Many women may not need treatment for menopausal symptoms. You may find that your symptoms improve on their own. If you’re bothered by your symptoms, talk to your doctor about ways to find relief. You can work together to find a treatment that’s right for you. Some women may find that changing their eating habits and engaging in more physical activity can help reduce menopausal symptoms, while others may need medication to alleviate their symptoms.

Which Medications Treat Menopausal Symptoms?

If your menopausal symptoms are bothering you, talk to your doctor. Your doctor may recommend medications to help with your symptoms. All medications have risks, and your doctor can help you find out which ones are best for you.

Low-dose hormone therapy can help reduce these symptoms. They help stop or reduce hot flashes, vaginal dryness, and mood swings. They also treat heavy or irregular periods. If you smoke, you should not use hormone therapy. Hormone therapy, especially methods containing combined hormones like birth control pills and vaginal ring or patch, can increase your risk of blood clots and high blood pressure, and the risk is higher in women who smoke.

Water-based vaginal lubricants can make sexual intercourse more comfortable. A vaginal moisturizer can help retain the moisture needed in vaginal tissues.

Some prescription medications can help with vaginal discomfort, dryness, or pain if lubricants don’t work. These include estrogen creams, tablets, or rings applied to the vagina (see information about topical hormone therapy).

If you have severe vaginal dryness, hormone replacement therapies may be effective.

What is Hormone Replacement Therapy?

Hormone replacement therapy is prescription medication that helps relieve menopausal symptoms such as hot flashes and vaginal dryness that affect your quality of life.

During menopause, your ovaries produce very little estrogen and progesterone hormones. Hormone replacement therapy aims to replace the hormones that are no longer produced by your ovaries with artificial estrogen and progesterone.

These treatments are usually taken as a pill every day. You can also use estrogen or estrogen plus progesterone hormone therapy as skin patches. Like all medications, hormone replacement therapy has risks. It is recommended that if you decide to use medications, you use the lowest dose for the shortest time needed. Other menopausal hormone therapies called topical hormone therapy do not treat hot flashes but can help with vaginal dryness.

What is Topical Hormone Therapy?

Topical hormone therapy is creams containing low doses of estrogen applied directly to the vagina. It helps relieve vaginal dryness but does not help with menopausal symptoms like hot flashes. There are also vaginal ring and gel forms. The risks of topical cream are different from the risks of menopausal hormone replacement therapy.

Is Hormone Therapy Safe During Menopause?

Menopausal hormone therapy (sometimes called hormone replacement therapy) may be safe for some women, but it also carries some risks.

Research shows:

• Menopausal hormone therapy may be an option for women up to age 59, but it’s usually recommended only within the first 10 years of menopause. Younger women and those closer to their last menstrual period are less likely to experience harmful side effects of menopausal hormone therapy.
• Menopausal hormone therapy reduces symptoms such as hot flashes, sleep problems, mood changes, and vaginal dryness.
• Hot flashes usually require higher doses of estrogen therapy that affect the entire body.
• Women experiencing vaginal dryness or discomfort during intercourse may find relief with low-dose vaginal estrogen creams.
• Estrogen alone and estrogen combined with progesterone medications increase the risk of stroke and blood clotting in the legs and lungs. The risks are rare in women under 50.

Who Should Not Take Menopausal Hormone Therapy?

• Menopausal hormone therapy may not be safe for some women.
• You should talk to your doctor if you have the following risks:
• A history of risk factors such as heart disease or high cholesterol
• A family or personal history of breast cancer
• High blood cholesterol levels
• A family history of gallbladder disease
• Liver disease
• A history of stroke or blood clotting disorder

How Long Does Menopausal Hormone Therapy Last?

This process varies from person to person and depends on the symptoms experienced, but it is not recommended to last more than 10 years.

Talk to your doctor to learn about the risks and benefits of menopausal hormone therapy based on your symptoms, age, and risk factors.

Menopause and Sexuality

You may experience changes in your sex life during menopause. Some women say they have more sexual intercourse due to the relief of not having children during this period and social circumstances, while others express less frequent thoughts of sexual intercourse or less enjoyment.

What Effects Will Menopause Have on My Sex Life?

Menopause can cause changes in your sex life.

• Some possible changes include:
• Due to low hormone levels, vaginal tissues become drier and thinner. This condition, called vaginal atrophy, can cause discomfort or pain during sexual intercourse.
• Low hormone levels can reduce your sexual desire.
• Night sweats can make you more tired by disrupting your sleep quality.

If changes in your sexual condition bother you, talk to your doctor.

What Can I Do to Improve My Sexual Health Before and After Menopause?

You can take some steps to improve your sexual health during the transition to menopause and after menopause:

• Be active: Physical activity can increase your energy levels, elevate your mood, and make you feel better about yourself. All of these can help increase your interest in sex.
• Don’t smoke: Smoking can decrease blood flow to the vagina and reduce the effects of estrogen.
• Avoid alcohol: It can slow down your body’s response to sexuality.
• Have sex more often: If you choose to have sex, you can increase blood flow to your vagina and keep tissues healthy.
• Give yourself time during sex: Prolonged foreplay increases blood flow to the vagina and vulva, leading to moistening. Moisture preserves tissues, allowing for more comfortable sex.
• Do pelvic floor exercises: These exercises can increase blood flow to the vagina and strengthen the muscles involved in orgasm. Learn more about pelvic floor exercises.
• Avoid products that irritate the vagina: Foam baths and some soaps can cause irritation. If you have vaginal itching or irritation, consult your doctor as it may be a sign of infection.

Treatment for Postmenopausal Vaginal Dryness

For mild discomfort during sex caused by vaginal dryness, you can use over-the-counter, water-based vaginal lubricants. For more severe vaginal dryness, your doctor may prescribe certain medications that you can insert into the vagina.

These medications include:

• Vaginal estrogen creams
• Estrogen tablets or rings for insertion into the vagina
• Ospemifene (a non-hormonal medication)

Discuss your symptoms and personal health concerns with your doctor to determine if one or more treatment options are right for you.

How Can I Talk to My Partner About Menopause and Sexuality?

Talking to your partner about your concerns can strengthen your relationship. You can ask them the following questions:

• What makes you feel good about yourself?
• When do you feel more comfortable?
• In which positions do you feel more comfortable and happy?
• What do you think about changes in my appearance?

If changes in your sexual life bother you, consider seeing a therapist for individual or couples therapy.

Do I Still Need Protection During Sex After Menopause?

Yes, if you are not in a monogamous relationship, you still need to use condoms after menopause to prevent sexually transmitted diseases. In a monogamous relationship, you and your partner should only have intercourse with each other and no one else.

Condoms are the best way to prevent STDs when you have sexual intercourse.

Menopause and Your Health

Changes in your body during menopause can increase your risk of certain health problems. Low estrogen levels and other age-related changes (such as weight gain) can increase your risk of heart disease, stroke, and osteoporosis.

How Does Menopause Affect My Health?

After menopause, your ovaries produce very little estrogen. Women going through menopause have very low estrogen levels. Low levels of estrogen and progesterone after menopause increase your risk of certain health problems. Other health problems may naturally occur as you age.

Common health problems that occur in the years after menopause include:

• Heart disease: Before age 55, women have a lower risk of heart disease than men. Estrogen helps keep blood vessels open and maintains a healthy balance of cholesterol in the body. Without estrogen, cholesterol can build up in the walls of blood vessels leading to blockages.
• Stroke: Your risk of stroke doubles every ten years after age 55. Low estrogen levels in your body can contribute to cholesterol buildup in blood vessel walls leading to stroke.
• Osteoporosis: Due to decreased estrogen after menopause, there is a faster loss of bone mass. Osteoporosis is a condition where your bones become fragile and weak, making them more likely to break. A large study in recent years showed that women who experienced severe hot flashes and night sweats during menopause generally had more osteoporosis.
• Urinary incontinence: About half of women after menopause have difficulty holding urine. Lower estrogen levels can weaken the urethra, a tube that extends from the bladder. If the urethra weakens, you may have difficulty holding urine. Learn about treatment options for urinary incontinence.
• Oral health: Dry mouth and the risk of cavities increase with menopause.

Does Hormone Therapy During Menopause Prevent These Health Problems?

No. Menopausal hormone therapy helps alleviate menopausal symptoms such as hot flashes and vaginal dryness. Menopausal hormone therapy can increase your risk of blood clots, stroke, and some cancers and does not prevent heart disease or dementia (memory loss).

What Routine Screenings Do I Need After Menopause?

All women need regular check-ups and screening tests throughout their lives. Some routine tests to be done:

• Regular mammograms from age 50 to 75 (X-ray imaging of breast tissue)
• Regular Pap smear tests after menopause, every five years, both Pap test and HPV test
• Bone density measurement, measurements to detect bone loss
• Other tests to screen for diabetes and heart disease
• Blood pressure, cholesterol, and other tests recommended by your doctor
• Consult your doctor about flu shots and other vaccines. In addition to the flu vaccine, vaccines are available for pneumonia, shingles, and other diseases.

Your doctor may recommend other tests based on your health condition. For example, you may need to see a specialist for certain specific problems such as urinary incontinence.

How to Stay Healthy During and After Menopause

There are several important steps you can take to improve your health during menopause.

• Quit smoking: Quitting smoking is one of the most important steps you can take to become healthier. Smoking harms your bones, increases the risk of heart disease, and contributes to 12 different types of cancer, among other health risks.
• Stay active: Engaging in at least 30 minutes of physical activity on most days of the week is one of the best ways to stay healthy. Physical activity can benefit your bones, heart, and mood. Your exercise routine doesn’t have to be complicated. Brisk walking and regular household chores are good for your health. Ask your doctor which activities are suitable for you.
• Goal: Aim for at least 2 hours and 30 minutes of moderate-intensity physical activity (such as brisk walking) or 1 hour and 15 minutes of high-intensity activity (such as running or playing tennis) per week.
• Eat well: Consuming vitamins, minerals, fiber, and other essential nutrients is crucial. Learn how many calories you need each day based on your age, height, weight, and activity level. Consult your doctor about dietary supplements.

After menopause, calcium is needed to maintain bone health. Doctors recommend that women aged 51 and older consume 1,200 milligrams of calcium per day. Vitamin D is also important for bone health. If you need calcium supplementation or more vitamin D, ask your doctor.

Practice safe sex: You cannot become pregnant after menopause. However, you can still contract a sexually transmitted infection. Condoms are the best way to prevent STIs during sexual intercourse. After menopause, the vagina may become drier and thinner, leading to small cuts or tears during sexual intercourse. Vaginal cuts or tears put you at a higher risk for STIs. Learn ways to prevent STIs.

Will I Gain Weight After Menopause?

Yes, it’s possible. Many women gain an average of 5 kilograms after menopause. The decrease in estrogen levels may play a role in weight gain after menopause.

Weight gain can increase your risk of high blood pressure, high cholesterol, diabetes, heart attack, and stroke. If you are overweight, inactive, or have an unhealthy diet, the risk is even higher. Learn about the effects of excess weight and obesity on heart health.

The best way to lose weight (if you are overweight or obese) is to consume fewer calories each day. Eating healthily and engaging in at least 30 minutes of exercise per day are the best ways to maintain a healthy weight.

Premenstrual Syndrome (PMS), also known as premenstrual tension, refers to the physical and emotional complaints that affect your daily life during the two weeks before your menstrual period.

[alert-success]PMS affects about 3 out of every 100 women, causing symptoms severe enough to interfere with their daily lives.[/alert-success]

The exact cause of premenstrual syndrome (PMS) is unknown. All reproductive system-related hormones fluctuate at certain times of the month, with some women being more sensitive to these hormonal changes. It is believed to be associated with fluctuations in hormone levels.

Symptoms caused by premenstrual syndrome improve with the onset of menstruation and disappear after menstruation.

Common emotional and physical complaints associated with premenstrual syndrome vary from person to person, but often include:

• Mood swings
• Feeling depressed
• Feeling irritable and tense
• Fatigue and sleep problems
• Headaches
• Decreased or increased appetite
• Swelling in the hands and abdomen
• Breast tenderness

Some medical conditions can cause symptoms similar to premenstrual syndrome. Some medical conditions that can mimic PMS include depression, chronic fatigue, hypothyroidism, and irritable bowel syndrome (IBS).

The most important point in distinguishing this condition from other illnesses is that symptoms associated with PMS develop in the two weeks before menstruation and improve in the following two weeks.

When other possible diseases are suspected, blood or other tests should be ordered to rule out these conditions.

Treatment options for premenstrual syndrome include both medical and alternative treatment methods.

There are a variety of options available to help you cope with your symptoms and continue your daily life in a healthy way.

Regardless of the option you choose, keeping track of your symptoms can help you determine whether a particular treatment is effective or not.

For patients experiencing premenstrual syndrome, recommendations should include exercise, regular nutrition, and stress management techniques (such as yoga, meditation, etc.).

It is known that psychological support and therapy can help improve premenstrual symptoms.

Calcium and vitamin D supplements may be helpful in treatment. Evening primrose oil can reduce breast tenderness.

In medical treatment, antidepressants, diuretics, and birth control pills are beneficial.

“Dysmenorrhea” in medical terminology refers to painful menstruation.

Dysmenorrhea is one of the most common complaints encountered during menstruation. In more than half of menstruating women, there is a complaint of pain for 1-2 days every month.

There are two types of dysmenorrhea:

• Primary (or primary) dysmenorrhea
• Secondary (or secondary) dysmenorrhea

Primary dysmenorrhea is pain felt in the lower abdomen caused by uterine contractions during menstruation, known as “menstrual cramps.” Certain substances secreted from the uterus during menstruation cause uterine cramps.

In this case, the pain usually occurs with or just before the onset of menstruation. The pain is severe on the days of menstruation and typically lasts for 1-2 days. It often begins at the onset of menstruation and becomes less painful as age advances. Improvement in pain may be seen after childbirth.

In the case of secondary dysmenorrhea, menstrual pains are caused by a condition related to the female reproductive organs. Unlike primary dysmenorrhea, the pain tends to worsen rather than improve over time.

The pain associated with menstrual cramps lasts longer than menstrual cramps and may even persist after the end of menstruation.

The main causes of secondary dysmenorrhea include:

• Endometriosis: Endometriosis is a condition where the tissue lining the inside of the uterus, called the endometrium, is found outside the uterus. Painful menstrual periods and pelvic pain are common symptoms of endometriosis.
• Adenomyosis: Similar to endometriosis, adenomyosis is the presence of endometrial tissue, which lines the inside of the uterus, within the muscular wall of the uterus. Pain during menstruation and increased menstrual bleeding are common symptoms of adenomyosis.
• Fibroids: Fibroids are benign (non-cancerous) tumors that develop in the uterus and originate from the uterine myometrium. They can cause painful menstrual periods.

If You Have Pain During Menstruation:

Your symptoms and medical history should be carefully reviewed, and a gynecological examination should be performed first.

In cases where a gynecological examination and ultrasound imaging are not sufficient, laparoscopy (looking into the abdomen with cameras) may be planned for diagnostic purposes.

The preferred medications for the treatment of painful menstrual periods are pain relievers and birth control pills. Additionally, lifestyle changes, exercise, and healthy eating may contribute to the improvement of your pain.

In cases where medication is not effective, treatment should be directed at the underlying cause, and surgery may be necessary in some cases.

What Are Ovarian Cysts?

Ovarian cysts are sacs filled with fluid or tissue that develop in a woman’s ovaries. Ovarian cysts are very common. They can occur at any age from childhood to postmenopause. Most of them are benign and regress without treatment. However, sometimes these cysts can be malignant and turn into cancer.

What Are the Different Types of Cysts?

• Functional Cyst: This is the most common type of ovarian cyst we encounter. It usually does not cause any symptoms. Functional cysts often disappear within 6-8 weeks without treatment.
• Teratoma: This type of cyst contains different types of tissues that make up the body, such as bone, teeth, hair, etc. These cysts may be present from birth, but they can also develop later. In very rare cases, some teratomas can turn into cancer.
• Cystadenoma: These cysts form on the outer surface of the ovary. Although they can grow very large, they are usually benign.
• Endometrioma (Chocolate Cyst): This cyst results from endometriosis. For more detailed information, you can refer to the Endometriosis section.

What Symptoms Do Ovarian Cysts Cause?

Ovarian cysts usually do not cause any complaints. They are often detected during routine examinations. Some cysts may cause abdominal pain or pressure sensation. If the cyst is large, it can twist around itself, causing a disruption in blood flow to the ovary. This condition is called ovarian torsion. Severe, twisting, and sudden onset abdominal pain, nausea, and vomiting may occur in this situation. Emergency surgery is required in this case. Sometimes, cysts can rupture or bleed into themselves, resulting in severe pain. It is necessary to monitor the amount of bleeding; sometimes surgical intervention may be required.

How Are Ovarian Cysts Diagnosed?

Imaging and blood tests are performed.

• Imaging tests: The most common type is ultrasound. This test relies on the use of sound waves to create images of your uterus and ovaries. Ultrasound provides information about the location, size, and structure of the cyst. Your doctor may also request an MRI or CT scan.
• Blood tests: The value of a substance called CA 125, which is expected to increase in ovarian cancer, is measured in the blood. Since this substance can also increase in conditions other than ovarian cancer (e.g., endometriosis), HE4 blood test has also been examined in recent years. The evaluation of HE4 and CA125 together has a high success rate in indicating the risk of ovarian cancer.

CA 125, HE4, along with specific findings from ultrasound and physical examinations, particularly after menopause, provide an indication of the risk of ovarian cancer in a woman.

How Are Ovarian Cysts Treated?

Treatment is selected by evaluating the cause, appearance, size, blood values, and growth rate of the cyst together.

Possible treatments include:

WATCHFUL WAITING The cyst is monitored with repeated ultrasound checks. Your cysts may remain the same size, shrink, or even disappear. In such cases, no additional treatment is necessary. Most cysts disappear spontaneously after one or two menstrual cycles.

SURGICAL Some cases may require surgery to remove the cyst or the entire ovary. Surgery is necessary if the cyst is large, causing symptoms, or if there is suspicion of cancer.

How Is Surgery Performed?

If your cyst is considered benign, laparoscopic surgery is often preferred. Sometimes, this may not be suitable (if the cyst is very large or suspected of cancer), and surgery is performed through an abdominal incision.