Burnout? Depression? No, it’s the transition
Doctors often have a blind spot when it comes to menopausal symptoms. For example, they confuse it with a burnout. Completely unknown territory is that men can also suffer from hormone drops. Gynecologist Dorenda van Dijken and urologist/sexologist Cobi Reisman explain.
One in five women has no problems at all. They cycle through the transition whistling. A third of women do get quite hormonally upset. At night they suffer from lying awake and night sweats. During the day from complaints such as hot flashes, forgetfulness, irritability, palpitations and muscle or joint problems.
“We still don’t know exactly why some people suffer more from the menopause than others,” says gynecologist Dorenda van Dijken, affiliated with the OLVG in Amsterdam and chair of the Dutch Menopause Society. Despite all the complaints, doctors still don’t understand much about the menopause, says Van Dijken: “That applies to gynaecologists, who don’t know everything either, but also to general practitioners, company doctors and rheumatologists. Some women have serious complaints and you have to take them seriously.”
Hormone dip
The hormone estrogen is the common thread in this story. When the ovaries become exhausted and there are no more eggs, estrogen production stops. Dorenda van Dijken: “Your body also produces estrogen in other ways, including in the adrenal glands. And the hormone is stored in your adipose tissue. But that’s much less.” Estrogen influences the functioning of the hypothalamus, a kind of thermostat in the brain. Without estrogen, it gets upset and the body can suddenly become very heated. Those are the hot flashes. Estrogen is also the major collagen builder, according to Van Dijken. “Collagen provides elasticity in your skin and blood vessels. When the production of estrogen stops, your skin and blood vessels become weaker and your hair is no longer what it used to be. Estrogen also serves the ligaments and tendons. As a result, you can get muscle and joint complaints during the transition.” The production of other hormones also decreases. This applies, for example, to oxytocin, the hormone that makes you feel relaxed. This can lead to sleeping problems and feelings of restlessness and irritability. The production of progesterone and (in 10 to 15 percent of women) of testosterone also decreases. In the longer term, the transition increases the risk of bone loss (osteoporosis), cardiovascular disease and dementia. And many women struggle with vaginal dryness, bladder infections or involuntary loss of urine.
Cherish your belly fat
The fat storage also changes. Whoever had a pear-shaped or hourglass figure becomes an apple. Dorenda van Dijken: “You can’t stop it, everyone gets belly fat. On average, women gain two to four kilos. There are women who gain ten, fifteen kilos and blame it on menopause, but that is nonsense.” Belly fat is known to increase the risk of cardiovascular disease. So go to the gym? Not too fanatical, explains Van Dijken: “A little estrogen is still produced and stored in the belly fat. That way you fill in the wrinkles in your skin. In addition, belly fat has a mild protective effect against cardiovascular disease and osteoporosis. Very slim women, who still wear size 36 at a later age, run a higher risk of this. So cherish that belly fat.”
Nutrition and stress
In general, stress worsens the menopausal symptoms and vice versa. Van Dijken: “That’s why you should avoid work stress where you can, although that is sometimes easier said than done. Sometimes burnout complaints are confused with menopausal complaints. That is something GPs and company doctors should take more into account.” It is important that women in the menopause pay attention to their diet and lifestyle. Van Dijken: “Some foods have a stimulating effect on menopausal complaints. This applies, for example, to coffee, alcohol, smoking, some spices and citrus fruits. More exercise helps to reduce many complaints.” And what about sexual changes? “It is a myth that women after the menopause are no longer sensitive to sexual stimuli,” says gynecologist Dorenda van Dijken. “There is only a relatively small group, about 10 to 15 percent, who really no longer make sense. This is often due to lower testosterone.”
taking hormones
Hormone therapy is available for those who have serious complaints. In the Netherlands, 5 percent of women use this, in other European countries it is much higher: 25 to 40 percent. Van Dijken: “I think this is due to our Calvinistic national character, we should not complain about ourselves. We are also hesitant because a few years ago it was reported in the media that hormone therapy increases the risk of breast cancer. But that is really more nuanced. Long-term use of the pill and more than eight to ten glasses of alcohol per week increase the risk of breast cancer than hormone therapy.” And what happens after the transition? Dorenda van Dijken: “Then a stable period begins. Some things don’t come back. You will no longer get a full head of hair, your muscles have become stiffer. But you can look forward to small improvements. Women with migraines have a good chance that this will disappear. Improve concentration problems, reduce heat complaints. It all stabilizes.”
Signals in men
The ‘transition’ in men, men don’t like to talk about that. Still, it concerns quite a few men. In the age group 45 to 70 years, a quarter suffer from complaints due to a decrease in the hormone testosterone, according to urologist and sexologist Cobi Reisman. The reduction of hormone production in men is a gradual process, says Reisman. Unlike in women, it is not a clearly defined period. It happens so gradually that men often do not realize what is going on. He also says that ‘transition’ is actually not a good name. And something like ‘penopause’ is completely wrong. The medical term is “late-onset hypogonadism.” Reisman: “Men often come to me for another reason: they have sexual complaints. Some of these men have depressive symptoms. They often don’t know what’s wrong with it. Doctors sometimes make the mistake of prescribing antidepressants, which only makes things worse. Or they think it’s a burnout. But if a man reports that he is down and tired, has no energy and does not feel like having sex, it could be because of a lack of testosterone.”
Less energy
What is the danger if this is not recognized? Reisman: “A shortage of testosterone has physical consequences, for example the breakdown of bone tissue and the inability to regulate diabetes properly. And if you have less energy – and therefore move less – that increases the risk of cardiovascular disease.” Reisman also points out the consequences for the quality of life, the sexual relationship and the relationship with the partner in general.
Testosterone as medicine
Men can use testosterone as a medicine to counteract the symptoms. After six to nine weeks, the effect on an erection is noticeable. It takes a little longer before it is noticeable on depressive feelings, and after a few months on the bone tissue. But beware, Reisman warns: “Testosterone is not a magic bullet and not a treatment for depression. I certainly don’t always give it. It improves mood, but men also have to get started with their lifestyle. Many have to move more, introduce regularity in their daily pattern and do something about their excess weight. I see that the men who do this in combination with testosterone come out the best. This often also has a positive effect on other conditions, such as better control of diabetes.”
Podcast about the transition
Want to know more about the menopause in women? Listen to the Healthy Conversation podcast. Journalist Karine Hoenderdos talks to gynecologist Dorenda van Dijken about the transition and the impact on your life.
This article previously appeared in Plus Magazine in May 2021. Want to subscribe to the magazine? You can do that in an instant!