Dealing with Menopause - “Forever young” or “Forever woman”?

Prim. Univ.-Prof. Dr. Christian Kainz

Medical fields:
Gynecology and obstetrics

Medical Director of Döbling Private Hospital and the Döbling Outpatient Clinic in Vienna

Prof. Kainz, how frequently do these complaints occur?

With the onset of menopause, many things change in a woman's life, as the hormone-producing function of the ovaries gradually slows down and eventually stops. This can cause a range of unpleasant symptoms including hot flashes, difficulty sleeping, mood swings, sweating and weight gain. These changes can have a significant impact on everyday life and reduce the quality of life. However, the symptoms vary greatly from woman to woman, both in type and intensity.

About 75-80% of women experience symptoms such as hot flashes, sleep problems, mood swings and sweats during menopause. The intensity and duration of these symptoms can vary greatly. Approximately 20-25% of women experience severe symptoms that can significantly impact their quality of life, while other women experience only mild or no symptoms.

There are various approaches to easing symptoms, including lifestyle changes, hormone replacement therapies, and alternative treatments.

What other hormonal diseases can reduced estrogen production cause?

In addition to the typical menopausal symptoms, the reduced estrogen production during menopause can also increase the risk of various diseases, including: osteoporosis, cardiovascular diseases, urogenital problems (vaginal dryness, urinary tract infections, incontinence), as well as mood swings and depression. These diseases and risks underline the importance of preventive measures and individual medical care during and after menopause.

Hormone therapy is one way to ease menopause symptoms - but is it suitable for all women?

Hormone therapy (HRT) can be an effective way to relieve menopausal symptoms such as hot flashes, sleep problems, vaginal dryness, and mood swings. However, it is not suitable for all women. Whether hormone therapy makes sense depends on various factors, including the individual's health profile, the type and severity of symptoms, and the risk of certain diseases. Here are some important considerations regarding the suitability of hormone therapy:

Suitable candidates for hormone therapy:

• Women with severe menopause symptoms and severe impairment of quality of life
• Women without serious risk factors who are not at increased risk of developing certain diseases such as breast cancer, cardiovascular disease or thrombosis
• Younger women in early menopause appear to benefit more from hormone therapy and have a lower risk of complications.

Hormone therapy may not be suitable for:

• Women at increased risk of breast cancer, i.e. with a personal or family history of hormone-dependent cancer (such as breast cancer)
• Women at increased risk of cardiovascular disease: women who have already had heart disease, stroke or deep vein thrombosis or pulmonary embolism,
• Women with liver disease
• Women with uncontrolled high blood pressure

The decision for or against hormone therapy should always be made in consultation with a doctor, who can weigh up the individual risks and benefits and make a personalized recommendation.

Hormone replacement therapy has fallen somewhat into disrepute after various studies have found it to be risky. Some women were unsure and refused hormone therapy. What can women use as a guide?

Hormone replacement therapy (HRT) has indeed become controversial in recent years, particularly following the publication of the Women's Health Initiative (WHI) study in the early 2000s. This study reported increased risks of breast cancer, heart attack, stroke and thrombosis in women who received hormone therapy. These results led to great uncertainty among women and professionals and to a significant decrease in the prescription of hormone therapy.  

However, subsequent analyzes and studies have shown that the risks of HRT vary depending on the type of hormones, the dose, the method of administration (tablet, patch, gel), the age of the women and when therapy is started. Today's view of HRT is more differentiated and allows a more individual approach, i.e. an individual weighing up of benefits and risks.

For women with very severe menopause symptoms, the relief may outweigh the potential risks. Individual risk factors such as a family history of breast cancer, cardiovascular diseases or thrombosis should always be taken into account and the dosage and duration of therapy should be tailored to the woman individually.

Women who choose hormone therapy should do so in consultation with their doctor and be regularly monitored by a doctor in order to adjust therapy if necessary and minimize risks.

Does hormone therapy increase the risk of developing breast cancer?

Yes, hormone replacement therapy (HRT) can increase the risk of breast cancer in women, especially when a combination therapy of estrogen and progestin is taken for a long time. However, the exact increase in risk depends on various factors, such as the type of hormones, the duration of use, the woman's age and her individual health profile.

While HRT may increase the risk of breast cancer, it also offers significant benefits for women who experience severe menopausal symptoms or are at high risk of osteoporosis. The decision to take HRT should therefore be based on an individual risk-benefit assessment that takes into account the woman's specific needs and risks.

In any case, and in particular women who are taking hormone therapy should have regular breast cancer screening examinations (e.g. mammography) in order to detect changes at an early stage.

Are there effective alternatives to hormone therapy?

Yes, there are several effective alternatives to hormone therapy (HRT) for women who experience menopause symptoms but want to avoid the risks of hormone therapy or for whom hormone therapy is not suitable. These alternatives aim to relieve menopause symptoms such as hot flashes, sleep problems, vaginal dryness and mood swings.

Through lifestyle changes - balanced diet, reduction of alcohol, caffeine, a healthy body weight, regular physical activity, stress management and relaxation techniques - as well as non-hormonal medications and herbal supplements, many women can achieve significant symptom relief.

There are many effective alternatives to hormone therapy. Choosing the best option depends on the specific symptoms, general health, personal preferences and individual risk factors. It is important to seek advice from a doctor or specialist to develop the best strategy for managing menopause symptoms.

What does “healthy aging” mean for women? Can a healthy lifestyle and healthy philosophy of life help women?

Healthy aging for women means managing the natural aging process to promote physical, mental and emotional health in order to live a long, active and fulfilling life. Healthy aging encompasses various aspects of well-being, including a healthy lifestyle, preventive health measures, social connections, mental fitness and a positive philosophy of life.

Can a healthy lifestyle and philosophy help women age healthily?

Yes, a healthy lifestyle and a positive philosophy of life can significantly help women age healthily. Studies show that women who practice health-promoting habits, such as regular exercise, a healthy diet, not smoking and moderate alcohol consumption, have a lower risk of chronic disease and live longer. Additionally, a positive attitude and social connectedness contribute to better emotional and mental health and can mitigate the effects of stress and age-related challenges.

Is preventive care just as important for older women as it is for younger women?

Yes, prevention is just as important, even more important for older women than it is for younger women. With increasing age, the risk of chronic diseases such as heart disease, high blood pressure, diabetes, osteoporosis and certain types of cancer (e.g. breast, colon and uterine cancer) increases. Regular checkups help detect these diseases early, when they are most treatable, and can significantly improve the prognosis.

Ongoing health care can help maintain quality of life, extend life expectancy, and preserve the ability to remain active and independent. Vaccinations - e.g. against influenza, pneumococcus and herpes zoster - are also crucial in protecting older women from infectious diseases that can pose a higher risk as they age.

What services are offered to older women at the Döbling Private Hospital and the attached Outpatient Clinic?

The Döbling Private Hospital in Vienna is a renowned medical facility that offers a variety of services for women of all ages, and in particular for older women. The hospital and the attached outpatient clinic offer comprehensive medical care, diagnostics and modern therapy options that are tailored to the special needs of older patients.

By combining modern medical facilities, individual care and specialized expertise, the hospital ensures that older women receive the best possible care to maintain or improve their health and quality of life. Women seeking specialized and comprehensive medical care benefit from the hospitals wide range of services, top specialists and the patient-oriented philosophy.