In our modern day life with the internet and television, reality shows and being bombarded with loads of information from every angle, we tend to think that there are no more taboo topics, that any topic is allowed because it is widely discussed. Years ago, menopause was taboo, but nowadays it is more and more talked about. Dr. Krasimir Nedyalkov – obstetrician-gynecologist, head of department of the First General Hospital “Saint Sofia” answers the most frequently asked questions related to this delicate period in the life of every woman. – Dr. Nedyalkov, is menopause a disease? What should every lady and the man next to her know about menopause? Menopause or climacteric is a natural period of every woman’s life, but it is very often associated with physical and emotional complaints. During menopause, the amount of estrogens and progestogens, responsible for the monthly cycle, gradually decreases. The reason is the weakened function of the ovaries. In the brain, more precisely in the pituitary gland, the production of hormones increases, which should stimulate the ovaries to secrete more estrogens and progestogens to reach normal levels. Due to a reduced supply of follicles, the ovaries are unable to normalize the amounts of estrogens and progestogens, the pituitary gland tries to balance the process and continues to increase the release of ovarian stimulating hormones. However, the latter affect other centers in the brain and this leads to the typical symptoms of menopause. – Who are they? Hot flashes, sleep disturbances and mood swings. But sometimes it is not so easy to recognize even the usual symptoms of menopause. However, there are several signs that help to identify it more easily. – Does menopause occur in the same way for all women? Of course not. Every woman is unique and just as her monthly cycle and pregnancy are different, menopause is an individual experience. It is typical of all symptoms, both physical and mental, that because of the specific changes in the production of different hormones, each one of them manifests itself with different strength, at different times. Other symptoms are also observed. The most common are: Weight gain; Hair thinning, hair loss; Pain during period, profuse bleeding; Spontaneous sweating, dizziness; Chest pain and/or tightness; Vaginal dryness, vaginal atrophy; Inability to control the urge to urinate, cystitis; Skin relaxation. But again, this is an individual process for each lady. – Are there ladies who go through menopause without even realizing that they are in this period of life? Yes. In 20% of women, complaints may be absent and they go through menopause extremely easily without any complications or unpleasant symptoms. – Should women have certain tests? In about 66% of women, the clinical picture is typical and it is clear that menopause is about to occur. In such cases, laboratory tests are usually not necessary.If menstrual irregularities begin well before the age of 50, or if there are unclear symptoms, tests are needed to determine the cause of the irregularities. To confirm menopause or perimenopause, blood tests are done to measure the levels of estrogen and follicle-stimulating hormone – FSH. – Is it true that menopause occurs earlier and earlier? In general, menopause occurs on average around age 51. Early menopause is when menstruation ends before the age of 40. The exact reason for this is not always clear. However, the genetic link in early menopause is known. For example, in women whose mothers had an early menopause, the same can be expected. Some studies also prove a link with smoking. Menopause occurs 1 to 2 years earlier in women who smoke. – And how long does it last? For each lady, this is an individual experience of different duration. Conventionally, menopause can be divided into several periods – premenopausal, menopausal and postmenopausal. The term climacteric unites the time from the beginning of the first to the onset of the last period. Premenopause has the longest duration. This is the time when menstrual cycles are still regular, but gradually begin to become more abundant or less frequent, and after reaching the age of 40 and irregular. Menopause covers the period of complete cessation of menstruation. For its confirmation, the absence of menstruation 12 months ago is considered. It may last about 10 years. With the disappearance of the unpleasant symptoms of menopause comes its end. – Why does it also affect the libido? The decrease in hormones automatically has an impact on libido, that is, sexual desire. Although many studies deny this. Obviously, everything is individual. Often during menopause, drying of the vaginal mucosa is observed, resulting in painful penetration, which may be a factor in decreased desire. – What advice would you give women to go through this period more easily? There are several steps that can greatly help them improve comfort. Despite complaints and ailments, they should maintain a positive attitude. Movement at this time is recommended because it is the best medicine. It helps with numerous diseases and is an independent factor for the general condition of any organism. Ladies should be persistent and not overload themselves. 20-30 minutes a day of physical activity is quite enough, no matter if they run, walk, swim or ride a bike. Overcoming stress is the next step. Many of us hope that someday our daily lives will not be so stressful. But they are mistaken. In general, with age, commitments increase, and with them, stress – both in the professional and personal terms, it increases the unpleasant manifestations of the menopause.NEWS_MORE_BOX Ladies should take more time for themselves and have a love life. Many women wonder what happens to sex during menopause and after. Very simple: it continues as before. Studies on the subject show that menopause can unlock an even greater interest in erotica: the insecurities of youth give way to liberated passion and enjoyment of sex – a chance not to be missed. – And what therapy should they choose – hormonal or alternative to it? This is decided by the woman’s treating gynecologist, depending on the intensity of the complaints and each woman’s own medical history. More and more women have a modern attitude to menopause, whether the symptoms are mild or not, they are looking for a way to maintain their standard of living in an effective way that does not carry any risk. Remifemin is a medicinal product that has been on the Bulgarian market for 20 years. The product has over 50 years of experience in the field of effective and safe treatment of menopausal symptoms. The special “iCR” extract contained in the preparation Remifemin® is patented and all the properties of the drug are due to it. I guarantee it is hormone-free, including phytohormones. Grapewort owes its soothing and balancing effect to the substances in its rhizome, which do not contain phytoestrogens. An extract is obtained from the dried rhizome using the most modern pharmaceutical technology, the so-called isopropanol extract. It guarantees a successful and harmless therapy without phytohormones, including phytoestrogens, without affecting the endometrium and breast tissue. For women who generally do not wish to take hormones or because of previous illnesses should not do so, Remifemin is a good alternative to affect the symptoms of menopause. It should be noted, however, that phytotherapy can only be considered truly safe if the product does not contain phytoestrogens. The intake of hormones should be only and only for symptoms of the highest intensity in the lowest possible doses and for the shortest possible time! – To which women would you recommend Remifemin? To women who do not wish to take hormones; For women with contraindications for hormone replacement therapy (HRT); To women with risk factors for HRT; To women with forced menopause; To women with hormone-dependent tumors; To those who have undergone long-term use of HRT. – What are the advantages of the drug? 1. It is extremely effective because it does not contain hormones or so-called phytoestrogens. Hormones should be taken strictly controlled and short-term. Phytoestrogens are dangerous for bone density and the liver, often with questionable efficacy. 2. It has good tolerance. Remifemin® is well tolerated. To date, no side effects and adverse reactions have been observed. 3. It is a clinically tested herbal medicinal product. Efficacy, tolerability and safety have been well studied in many studies. 4.Its safety has been repeatedly proven: There are no specific side effects It does not damage the liver It has a safe profile in relation to mammary gland and endometrial tissues, even with long-term use.