The average age of menopause diagnosis is 53 years old. Ovarian dysfunction, reduction of estrogen quality and quantity may start as early as 40 and escalate by the age of 50. The permanent stop of menses before the age of 40 is defined as premature menopause. The diagnosis can be established by measuring blood FSH, LH, estradiol and performing ultrasound estimating the volume of the ovaries and the number of antral follicles. Once there is no menses for 6 months and the woman complains for hot flashes the clinical diagnosis of menopause is usually obvious. It is important to understand that menopause presents a permanent condition whereas several biological processes deteriorate and degeneration of tissues starts. The vessels loose their elasticity and arteriosclerosis and hypertention follow soon after. Osteopenia could develop in 2-3 years after menopause leading to osteoporosis. Decrease of estrogens, also causes degeneration and dysfunction of the bladder, ureters and vagina. In several cases the symptoms of recurrent urinary infections, unstable bladder, urinary stress incontinence are intense and affect normal life. Degeneration of the brain cells leads to decreased cognitive functions, like reduced memory, disorientation, decreased concentration, anxiety, insomnia and chronic fatigue.
The first 3 years of menopause are crucial because if hormonal replacement therapy is taken within this time frame, then degenerative process stops, natural tissue repair and recovery is feasible. However, in cases that for whatever reason the HRT was not administrated early enough after menopause, arteriosclerosis, osteoporosis and tissue atrophy are permanent and HRT will be of no help to recover the damage. Usually these patients have already high blood pressure around 140/90mmHg and several symptoms reported above are well obvious. Hence, HRT within the first 6 months of menopause is essential and provides the best preventive measure for all degenerative functions by delaying aging and providing an active life style. It has to be clear that HRT is not a therapeutic treatment but mainly a preventive measure hence offered to women in menopause for more than 3 years will compromise their cardiovascular function. Perimenopausal women might also experience severe symptoms of hot flashes, vaginal atrophy, depression and cognitive dysfunction. HRT is of high importance to these patients in order to alleviate their burden and improve their quality of life.