What is Menopause?
Menopause is a physiological process characterized by a permanent decrease in the production of female ovarian hormones such as estrogen and progesterone. It is defined by the cessation of ovulation and the cessation of menstrual cycles for at least 12 months, resulting from the depletion of ovarian follicles. Menopause therefore symbolizes the transition between an individual’s fertile period and the pre-senility period, and is usually expressed as the cessation of menstrual cycles.
At What Age Does Menopause Begin?
Although the age of menopause varies depending on genetic, ethnic, environmental and lifestyle factors, the average age worldwide is around 51. This age may be brought forward by a few years in those with a family history of early menopause, in women who smoke, or in those who have had ovarian surgery. On the other hand, factors such as long-term use of contraceptive hormones or a high body mass index may delay the onset of menopause by a few years.
What are the symptoms of menopause?
Many women who enter menopause experience vasomotor symptoms such as hot flashes, night sweats, and sleep disturbances. Urogenital complaints such as vaginal dryness, painful intercourse, and urinary incontinence may develop due to decreased estrogen. Mood swings, irritability, poor memory, and difficulty concentrating are among the common psychological effects. In addition, decreased bone mineral density, decreased skin elasticity, and weight gain along with a decrease in metabolic rate are physical changes that make menopause more evident.
What is Perimenopause and Postmenopause?
Perimenopause describes the transition period before menopause and begins with irregular menstrual cycles, followed by vasomotor symptoms and hormonal fluctuations, which last approximately two to five years. During this period, estrogen and progesterone levels fluctuate, and cyclical anovulation and frequent missed periods may occur. Postmenopause is the phase of life that begins 12 months after the last menstrual period. During this phase, hormone levels stabilize and remain low, and vasomotor symptoms usually decrease in severity; however, monitoring of bone and cardiovascular health is critical.
How Is Menopause Diagnosed?
Menopause diagnosis is primarily based on patient history and the duration of irregular menstrual periods. The most reliable finding indicating menopause is complete cessation of menstrual bleeding for 12 months. To support this clinical finding, blood tests show elevated FSH (Follicle Stimulating Hormone) and low estradiol levels. FSH levels above 30–40 IU/L in particular strengthen the diagnosis of menopause; however, symptoms and laboratory findings are evaluated together, not alone, to ensure certainty.
What Tests Are Performed During Menopause?
In women suspected of menopause, FSH and estradiol tests are primarily performed. Dual energy X-ray absorptiometry (DEXA) scan to assess bone mineral density, lipid panel and blood sugar measurements for cardiovascular risk profile, and TSH test to review thyroid function are frequently used tests. Pelvic ultrasonography or urodynamics may also be needed to monitor vaginal atrophy and bladder symptoms. In addition, transvaginal ultrasound to assess endometrial thickness and endometrial biopsy if necessary is performed if there is postmenopausal bleeding.
How Do Hormone Levels Change During Menopause?
During perimenopause, estrogen and progesterone levels fluctuate, with FSH and LH levels beginning to rise. After menopause, estrogen is nearly undetectable, while FSH levels remain persistently high (usually above 40 IU/L). Progesterone declines dramatically as ovulation ceases. This persistent low estrogen environment accelerates bone resorption, reverses cardiovascular protective effects, and leads to atrophy of vaginal tissue, so symptom management and long-term health maintenance strategies are tailored to hormonal changes.
Changes in the Body Caused by Menopause
The permanent decrease in estrogen and progesterone levels with menopause leads to significant changes in many systems of the body. As vascular tone is disrupted, sudden hot flashes, night sweats and sleep disorders occur. The vaginal mucosa becomes thin and dry, and the risk of pain and urinary incontinence during sexual intercourse increases. Bone metabolism accelerates; the increase in osteoclastic activity decreases bone density and increases the risk of osteoporosis. The decrease in metabolic rate creates a tendency for weight gain and fat accumulation, especially in the abdominal area. The skin collagen structure weakens, elasticity is lost and fine wrinkles become more pronounced. While mood swings, anxiety and depressive complaints are common during perimenopause; memory loss and concentration problems may occur in the later stages. Since the protective effect of estrogen on the cardiovascular system disappears, the risk of high LDL-cholesterol, arteriosclerosis and heart disease increases.
What are the Menopause Treatment Methods? (Hormone Therapy, Herbal Supports, etc.)
The most effective method for managing menopausal symptoms is hormone replacement therapy. Combined estrogen-progesterone tablets, patches or gels rapidly reduce vasomotor and urogenital complaints. However, a history of breast cancer, thrombosis or liver disease is investigated before starting treatment; with appropriate patient selection, it can be used safely in the short and medium term. Among herbal supports, preparations containing soy isoflavones, red clover extract and resveratrol can alleviate symptom severity, but it should be noted that these are not as effective as pharmaceutical hormones and drug interactions should be considered. Alternative approaches such as cognitive behavioral therapy, acupuncture and hypnotherapy can also help with hot flashes and sleep problems. Calcium, vitamin D and sometimes bisphosphonate therapy are added to reduce the risk of osteoporosis.
Nutrition and Lifestyle Recommendations During Menopause
A balanced diet during menopause is one of the cornerstones in terms of relieving symptoms and reducing long-term health risks. Whole grains, colorful vegetables and fruits, along with rich sources of calcium (low-fat milk, yogurt, cheese) and vitamin D supplements in the diet protect bone health. Fish, walnuts and flaxseed, which contain omega-3 fatty acids, can reduce inflammation and alleviate vasomotor symptoms. Avoiding processed sugar and excessive salt consumption is important for blood pressure and weight control. A regular exercise program, at least 150 minutes of moderate-intensity aerobic activity per week and pelvic floor strengthening exercises are recommended. Smoking should be stopped; alcohol and caffeine intake should be reduced. For sleep hygiene, the bedroom should be kept cool, electronic device use should be limited before going to bed, and relaxation techniques (deep breathing, meditation) should be applied.
Menopause Treatment Prices 2026
In 2026, hormone replacement therapy packages, programs that include annual follow-up examinations and laboratory checks in Türkiye are priced between ₺10,000 and ₺15,000. While monthly prescription estrogen-progesterone preparations cost ₺800 and ₺1,200, subcutaneous patch forms are sold between ₺1,500 and ₺2,000. Menopause support packages containing soy isoflavones and herbal formulations are around ₺1,000 and ₺1,500, while calcium-vitamin D supplements for osteoporosis protection are around ₺300 and ₺600. Office-type laser or acupuncture sessions applied in clinics are in the range of ₺2,000 and ₺3,000 per session; three-five session treatment packages can reach a total of 6,000 ₺ – 12,000 ₺. While menopause diagnosis and basic follow-up can be done free of charge within the scope of SGK, a contribution fee may be requested for hormone therapy and special support programs. Payment conveniences and installment options vary from clinic to clinic.
Frequently Asked Questions
At What Age Does Menopause Start and How Many Years Does It Last?
Menopause usually begins between the ages of 45 and 55, on average around age 51, and is confirmed 12 months after the last menstrual period. Perimenopause, the transition to menopause, can sometimes last 2–8 years; symptoms such as irregular menstrual cycles, hot flashes, and sleep problems are seen during this phase. The incidence decreases after true menopause, the years after the last menstrual period; the postmenopause period continues throughout life, during which time low estrogen levels can continue to affect the bone, cardiovascular, and urogenital systems.
Can Menopause Be Delayed?
The onset of natural menopause cannot be radically altered by current medical approaches; the number of ovarian follicles is determined by genetic factors, environmental influences, and lifestyle. However, the severity of menopausal symptoms can be alleviated and some of its effects can be reversed by hormone replacement therapy (HRT). Osteoporosis is slowed, vasomotor complaints are reduced, and vaginal atrophy may regress with prophylactic estrogen support; however, the actual termination of ovulation cannot be interfered with.
Is Pregnancy Possible During Menopause?
During perimenopause, some women may ovulate irregularly and still have the potential to conceive. However, during true menopause, which is defined as the cessation of menstruation for 12 months from the last menstrual period, the chance of natural pregnancy drops to almost zero. Studies show that the chance of pregnancy drops dramatically during perimenopause due to the rapid decline of a woman’s ovarian reserve, and that pregnancy after menopause is only possible with assisted reproductive technologies such as donor ovum transfer.
Is Hormone Therapy Necessary?
Hormone replacement therapy is the most effective method for reducing menopausal symptoms and the health risks of long-term estrogen deficiency, but it is not mandatory for every woman. HRT is recommended if there are severe hot flushes, night sweats, vaginal dryness and a risk of osteoporosis; however, the risk-benefit balance should be assessed on an individual basis in women with a history of breast cancer, deep vein thrombosis or liver disease. Lifestyle changes and herbal support may sometimes be sufficient for individuals with mild symptoms or low preference for HRT.
How Does Menopause Affect Sexual Life?
Low estrogen causes thinning and dryness of the vaginal tissue, which can cause pain caused by friction during intercourse (dyspareunia) and decreased pleasure. Decreased libido, mood swings, and sleep disorders also contribute to decreased sexual desire. Hormone replacement therapy can restore vaginal barrier thickness, local estrogen applications relieve dryness, and increase sexual comfort. Additionally, psychosocial support, couples therapy, and the use of lubricants are effective additional approaches to improving the quality of sexual life that changes with menopause.