Menopause is a natural stage of life, but the transition can affect sleep, mood, concentration, sexual health and everyday wellbeing. Some women experience only mild changes, while others develop hot flushes, night sweats, irregular bleeding or vaginal and urinary symptoms that significantly reduce their quality of life.
These symptoms do not simply have to be endured. A gynecologist can assess whether they are related to perimenopause or menopause, exclude other possible causes and discuss hormonal and non-hormonal treatment options.
At Republikas laukuma klīnika in central Riga, our gynecologists provide individual assessment and treatment for women experiencing perimenopausal and menopausal symptoms.
What is menopause?
Menopause is the final menstrual period. Natural menopause is diagnosed retrospectively after 12 consecutive months without menstruation when there is no other medical or physiological explanation.
It most commonly occurs between the ages of 45 and 55, with the average age being around 51. Menopause occurring between 40 and 44 is described as early menopause. Loss of ovarian function before the age of 40 requires medical assessment for possible premature ovarian insufficiency.
Menopause itself is a point in time. The years before it are called perimenopause, while the years after it are known as postmenopause.
What is perimenopause?
Perimenopause is the transition leading up to menopause. During this period, ovarian function and hormone levels fluctuate, ovulation becomes less predictable and menstrual cycles may change.
Perimenopause often begins in the forties, although it may start earlier, and can last for several years. Symptoms may appear while periods are still occurring and may vary considerably from month to month.
Irregular periods during perimenopause do not mean that pregnancy is impossible. Contraception may still be required until menopause has been confirmed according to the woman’s age, menstrual history and contraceptive method.
Common symptoms of perimenopause and menopause
Symptoms differ between individuals and may change over time. Common symptoms include:
- hot flushes;
- night sweats;
- difficulty falling asleep or waking during the night;
- irregular, shorter, longer, heavier or lighter periods during perimenopause;
- changes in mood, irritability, anxiety or low mood;
- problems with concentration or memory, sometimes described as “brain fog”;
- vaginal dryness, burning or irritation;
- pain or discomfort during sexual intercourse;
- reduced sexual desire;
- urinary urgency, recurrent urinary infections or urinary discomfort;
- headaches or migraines that change in frequency;
- joint and muscle discomfort;
- palpitations;
- changes in body composition and a greater tendency to gain abdominal fat;
- dry skin and changes in hair quality.
Not every symptom in midlife is caused by menopause. Thyroid disease, anaemia, sleep disorders, depression, medication effects and other health conditions can produce similar complaints. Persistent, severe or unusual symptoms should therefore be medically assessed.
How is menopause diagnosed?
In otherwise healthy women aged 45 or older, perimenopause and menopause are usually identified from symptoms and menstrual history. Routine FSH, oestradiol or other hormone blood tests are generally unnecessary because hormone levels fluctuate and a single result may be misleading.
Blood tests may be appropriate when:
- symptoms occur before the age of 45;
- premature ovarian insufficiency is suspected before the age of 40;
- periods cannot be assessed reliably because of contraception or previous surgery;
- another condition, such as thyroid disease or anaemia, needs to be excluded.
A gynecological examination, ultrasound or other investigations are not automatically required for every woman. They are selected according to the symptoms, bleeding pattern, medical history and examination findings.
When is bleeding abnormal?
Changes in menstrual bleeding are common during perimenopause, but not every change should be attributed to hormones without assessment.
Arrange a gynecologist consultation if bleeding becomes very heavy, lasts unusually long, occurs after sexual intercourse, repeatedly occurs between periods or is accompanied by pain, weakness or dizziness.
Any vaginal bleeding after menopause—after 12 consecutive months without a period—requires medical evaluation. There are several possible causes, many of which are benign, but endometrial and cervical disease must be excluded.
Menopause treatment
Menopause itself is not a disease. Treatment is considered when symptoms affect quality of life or when a specific health issue requires management.
The most suitable approach depends on:
- the main symptoms and how severe they are;
- age and time since the final menstrual period;
- whether the uterus is present;
- personal and family medical history;
- risk factors for thrombosis, cardiovascular disease, osteoporosis and cancer;
- current medicines;
- personal preferences.
Treatment may include lifestyle measures, menopausal hormone therapy, local vaginal treatment or prescription non-hormonal medication.
Menopausal hormone therapy
Menopausal hormone therapy, sometimes called hormone replacement therapy or HRT, is the most effective treatment for troublesome hot flushes and night sweats. It can also improve sleep when sleep disturbance is related to vasomotor symptoms and helps prevent bone loss while it is being used.
For many healthy women younger than 60 or within approximately 10 years of the onset of menopause, the benefits of hormone therapy for bothersome symptoms are likely to outweigh the risks, provided there are no contraindications. Treatment should always be individualised.
Hormone therapy may be administered as tablets, skin patches, gels or sprays. The route, dose and formulation are selected according to symptoms, health risks and patient preference.
Estrogen and progestogen
Women who still have a uterus generally require a progestogen together with systemic estrogen. The progestogen protects the lining of the uterus from excessive stimulation and reduces the risk of endometrial hyperplasia and cancer.
Women who have had a total hysterectomy can often use estrogen without a progestogen, although individual exceptions may apply.
Does hormone therapy have to stop at age 65?
No. There is no universal rule requiring menopausal hormone therapy to be stopped solely because a woman reaches the age of 65.
Some women continue to experience significant symptoms and may choose to continue treatment after an individual review. The dose, route, ongoing need and balance of benefits and risks should be reassessed regularly. Starting systemic therapy for the first time at an older age or many years after menopause may carry a different risk profile from continuing appropriately selected treatment started earlier.
Hormone therapy should not be started solely to prevent heart disease, dementia or other chronic diseases.
When may systemic hormone therapy be unsuitable?
Systemic hormone therapy may be unsuitable or require specialist assessment in women with certain conditions, including:
- current, previous or suspected breast cancer or another estrogen-sensitive cancer;
- unexplained vaginal bleeding;
- previous or active deep-vein thrombosis or pulmonary embolism;
- previous stroke, heart attack or certain cardiovascular diseases;
- active or severe liver disease;
- a known high-risk thrombophilia;
- other individual conditions that may alter the balance of benefits and risks.
This is not a complete list. A previous diagnosis does not always lead to the same recommendation for every form of treatment. Systemic and low-dose local vaginal therapies have different patterns of absorption and risk, so the decision should be made with a clinician familiar with the individual medical history.
Vaginal dryness and urinary symptoms
The decline in estrogen can affect the vulva, vagina, bladder and urethra. This collection of changes is called genitourinary syndrome of menopause. Symptoms may include:
- vaginal dryness or burning;
- irritation or itching;
- pain during penetration;
- reduced lubrication;
- urinary urgency or discomfort;
- recurrent urinary tract infections.
Unlike hot flushes, these symptoms often persist or worsen without treatment.
Non-hormonal vaginal moisturisers can be used regularly, while lubricants may reduce friction during sexual activity. Low-dose vaginal estrogen is an effective treatment for many women and has much lower systemic absorption than systemic hormone therapy. Other prescription options may also be considered.
Women with a history of hormone-sensitive cancer should discuss persistent symptoms with their gynecologist and oncology team so that treatment can be selected individually.
Non-hormonal treatment options
Women who cannot or do not wish to use hormone therapy may consider prescription non-hormonal treatments for hot flushes and night sweats.
Depending on medical history, symptoms and local availability, options may include certain SSRIs or SNRIs, gabapentin or medicines specifically developed for vasomotor symptoms, such as neurokinin-3 receptor antagonists. These medicines have different benefits, contraindications and possible adverse effects and must be selected by a doctor.
Cognitive behavioural therapy can help some women manage the impact of hot flushes, sleep disturbance and mood symptoms. Treatment for anxiety, depression or a primary sleep disorder should be provided when these are separate clinical conditions.
Herbal products and dietary supplements are not automatically safe because they are described as natural. Product quality, active ingredients and interactions with medicines vary, and evidence of effectiveness is inconsistent. Discuss supplements with a doctor or pharmacist, particularly if you have had breast cancer, liver disease or take regular medication.
What about PRP and hyaluronic acid injections?
Hyaluronic acid products may help some women with vulvovaginal dryness, but formulations and supporting evidence vary. Evidence for vaginal PRP injections remains limited, and these procedures are not considered a replacement for established first-line treatments such as moisturisers, lubricants and appropriately selected local estrogen therapy.
Before choosing an injection procedure, the cause of symptoms should be confirmed and the expected benefits, uncertainties, risks, alternatives and costs should be discussed with a gynecologist.
Lifestyle and long-term health
Healthy habits cannot prevent every menopausal symptom, but they support cardiovascular, metabolic, bone and emotional health.
Useful measures include:
- regular resistance and weight-bearing exercise;
- aerobic physical activity appropriate for fitness and health;
- a balanced diet with adequate protein, calcium and vitamin D;
- maintaining a healthy weight without extreme diets;
- stopping smoking;
- limiting alcohol;
- keeping a regular sleep schedule;
- identifying personal hot-flush triggers, such as alcohol, hot drinks or overheated rooms;
- discussing blood pressure, cholesterol, diabetes risk and recommended cancer screening with a healthcare professional.
Bone-density testing is recommended according to age and individual fracture risk rather than simply because menopause has occurred. Risk factors include previous fragility fracture, prolonged systemic corticosteroid use, low body weight, early menopause and certain chronic diseases.
Early menopause and premature ovarian insufficiency
Menopause before the age of 45 deserves medical assessment because a longer period of low estrogen exposure may affect bone and cardiovascular health.
Symptoms or loss of regular periods before the age of 40 may indicate premature ovarian insufficiency. Diagnosis generally requires appropriate clinical assessment and repeated testing rather than a single hormone result.
Unless contraindicated, hormone therapy is often recommended in premature ovarian insufficiency until approximately the usual age of natural menopause—not only for symptom relief but also to reduce health risks associated with early estrogen deficiency. Fertility, contraception and emotional wellbeing should also be discussed.
When should you see a gynecologist?
Book a consultation if:
- hot flushes, night sweats or sleep problems affect your daily life;
- your periods have changed and you are unsure whether the pattern is normal;
- you experience vaginal dryness, pain during sex or recurrent urinary symptoms;
- you want to discuss menopausal hormone therapy or non-hormonal treatment;
- symptoms began before the age of 45;
- you have risk factors for osteoporosis or cardiovascular disease;
- you need advice about contraception during perimenopause;
- you experience any bleeding after menopause.
Seek urgent medical care for extremely heavy bleeding, fainting, chest pain, sudden shortness of breath, one-sided leg swelling or symptoms suggestive of a stroke.
Frequently asked questions about menopause
What is the difference between perimenopause and menopause?
Perimenopause is the transition before menopause, during which hormone levels fluctuate and periods become less predictable. Menopause is confirmed after 12 consecutive months without menstruation when there is no other explanation.
Do I need a hormone blood test?
Usually not if you are aged 45 or older and have typical symptoms and menstrual changes. Tests may be useful when symptoms occur at a younger age, the diagnosis is uncertain or another condition is suspected.
Can I become pregnant during perimenopause?
Yes. Ovulation becomes less predictable but may still occur. Contraception may be necessary until menopause is confirmed and for the recommended period afterwards.
Is menopausal hormone therapy safe?
For many healthy women with bothersome symptoms who start treatment before age 60 or within about 10 years of menopause, the benefits are likely to outweigh the risks. Safety depends on medical history, the type and dose of hormones, the route of administration and the duration of treatment.
Will hormone therapy cause weight gain?
Menopause is associated with changes in body composition and fat distribution. Hormone therapy is not generally considered a direct cause of significant weight gain, although fluid retention or other temporary effects may occur in some women.
How long can menopausal symptoms last?
The duration varies considerably. Hot flushes and night sweats may continue for several years and, in some women, for much longer. Vaginal and urinary symptoms often persist or progress without treatment.
Is bleeding after menopause normal?
No bleeding after menopause should be ignored. Most causes are not cancer, but every episode should be evaluated to exclude important disease.
Do I need regular hormone-level tests while using therapy?
Routine hormone-level monitoring is usually unnecessary. Follow-up focuses on symptom control, adverse effects, bleeding, blood pressure and any individual health risks. Treatment is adjusted according to clinical response rather than a target hormone level.
Menopause consultation in Riga
You do not have to tolerate symptoms that affect sleep, work, relationships or intimate health. Our gynecologists can evaluate your symptoms, explain the available treatment options and develop an individual follow-up plan.
Book a gynecologist appointment
Address: Republikas laukums 3–18, Riga
