Menopause Management: individualised hormone therapy and symptom care in Turkey

What exactly is menopause, and what changes in the body?

Menopause is the point at which the ovaries stop releasing eggs and periods end permanently, confirmed once there have been twelve months without a period. It happens because the ovaries make much less oestrogen and progesterone, and this hormone fall is what drives the familiar symptoms. The average age is around 51, with most women reaching menopause between about 45 and 55; menopause before 40 is called premature. Although it is a natural stage rather than an illness, the drop in oestrogen affects many tissues — from the brain's temperature control to the vagina, bladder and bones — which is why a thoughtful management plan can make a real difference.

Perimenopause, menopause, postmenopause — what is the difference?

These three terms describe stages of the same transition, and knowing where you are helps choose the right treatment. Perimenopause is the run-up, often lasting several years, when cycles become irregular and symptoms such as hot flushes can begin while periods still come. Menopause itself is the single point twelve months after the last period, and everything after that is postmenopause, when symptoms may continue but periods have stopped. Treatment is tailored to the stage: in perimenopause, irregular bleeding and contraception still matter, while in postmenopause any new bleeding is a reason to be assessed.

Source: The Menopause Society, menopause and hormone therapy guidance

Which symptoms are caused by menopause?

The most common symptoms of menopause are hot flushes and night sweats, together called vasomotor symptoms, which affect up to about 80 percent of women. Many also notice disturbed sleep, mood changes or low mood, difficulty concentrating, and joint aches, while vaginal dryness and discomfort during sex tend to appear and persist later. Symptoms vary greatly: some women have very few, while others have daily flushes for years that disrupt work and sleep. Recognising which symptoms are due to menopause, and how much they bother you, is the starting point for deciding whether and how to treat them.

How is menopause diagnosed — are tests needed?

In most women over about 45, menopause is diagnosed from the symptoms and menstrual history alone, without any blood test. Hormone tests are unreliable in perimenopause because levels swing from day to day, so guidelines advise against routine testing in this age group. Blood tests, such as follicle-stimulating hormone, are more useful in younger women, where premature menopause is suspected, or where the picture is unclear. The aim of the assessment is not just to confirm menopause but to understand your symptoms, your personal and family history and your risks, so that treatment can be matched to you.

What are the options for managing menopause?

There is no single right treatment for menopause; the choice depends on your symptoms, your health and your own preferences. Broadly there are four paths: menopausal hormone therapy, non-hormonal medicines, local vaginal treatment for dryness, and lifestyle measures, and these are often combined. For troublesome hot flushes and night sweats, hormone therapy is the most effective option, while women who cannot or prefer not to use hormones have effective non-hormonal alternatives. The plan is built with you and reviewed over time, because needs change as the years pass.

Hormone therapy (MHT/HRT): how it works and who it suits

Menopausal hormone therapy replaces the oestrogen the ovaries no longer make, and it is the most effective treatment for hot flushes and night sweats while also helping to protect bone. If you still have your uterus, a progestogen is added to protect the lining of the womb from overgrowth; if you have had a hysterectomy, oestrogen alone is enough. Oestrogen can be taken as a tablet or through the skin as a patch or gel, and the transdermal route does not raise clot risk the way tablets can, so it is often preferred. For most healthy women under 60 or within 10 years of menopause, the benefits outweigh the risks, and treatment is given at the lowest effective dose and reviewed at least once a year.

Source: Endocrine Society, treatment of the symptoms of menopause clinical practice guideline

What non-hormonal options can help?

For women who cannot take hormones or prefer not to, several non-hormonal treatments can meaningfully reduce hot flushes. These include certain antidepressants used at low dose (SSRIs and SNRIs), gabapentin, and newer neurokinin-receptor antagonists developed specifically for vasomotor symptoms, as well as cognitive behavioural therapy, which has good evidence for flushes and sleep. Lifestyle steps such as keeping cool, regular activity, limiting alcohol and caffeine and stopping smoking also help. We choose among these according to your symptoms, other health conditions and what fits your life, rather than applying one solution to everyone.

Source: National Institute for Health and Care Excellence (NICE), menopause diagnosis and management guideline

Vaginal dryness and bladder symptoms: what helps?

Dryness, irritation, discomfort during sex and some bladder symptoms are grouped together as the genitourinary syndrome of menopause, and unlike hot flushes they tend to persist or worsen with time rather than fade. Low-dose vaginal oestrogen is very effective for these symptoms and acts locally with very little absorbed into the body, so it can often be used even by women who do not use systemic hormones. Non-hormonal vaginal moisturisers and lubricants also help, and can be combined with local oestrogen. Because these symptoms are common but under-reported, we ask about them directly so they are not left untreated.

How does menopause affect bones and the heart?

Beyond day-to-day symptoms, the fall in oestrogen at menopause speeds up bone loss and changes the balance of heart-disease risk over the longer term. Bone density can decline noticeably in the first years after menopause, increasing the risk of osteoporosis and fractures later, and hormone therapy is one of the measures that helps protect bone. Weight-bearing exercise, enough calcium and vitamin D, not smoking and limiting alcohol all support both bones and heart health. We look at these longer-term issues alongside symptom relief, so that a plan does more than treat flushes.

Source: American College of Obstetricians and Gynecologists (ACOG), management of menopausal symptoms

Who should be cautious about hormone therapy?

Hormone therapy is safe and effective for most women in the early menopause window, but it is not right for everyone, and an honest risk discussion is essential. Combined oestrogen-progestogen therapy carries a small increase in breast cancer risk that grows with longer use, and tablets carry a small increase in the risk of blood clots, which is lower with patches and gels. Women with a history of breast cancer, certain clotting disorders, unexplained vaginal bleeding or significant liver disease usually need non-hormonal options instead. We weigh your personal and family history carefully, explain the numbers plainly, and never present hormone therapy as risk-free.

What is our approach to managing menopause?

At the heart of our approach is individualised care: matching the treatment to your symptoms, your health and your goals, at the lowest effective dose, and reviewing it as your needs change. We assess each woman as a whole — her symptoms, her personal and family history, her bone and heart risks and her preferences — and decide together whether hormone therapy, a non-hormonal medicine, local vaginal care, or a combination is right. Where hormone therapy suits, we favour the safest effective route and the shortest duration consistent with your goals, and we are equally ready to offer non-hormonal care when that is the better fit. As Associate Professor Dr. Cengiz Andan and our team, we believe that taking the time to explain the real benefits and risks, and revisiting the plan regularly, is what makes management both safe and effective.

Why does experience matter in menopause care?

Menopause management is less about a single procedure and more about sound judgement — weighing benefits against risks for each individual woman over time. That judgement is shaped by experience across the whole of women's health, because menopausal symptoms overlap with conditions such as abnormal bleeding, fibroids and thyroid problems that must not be missed. The 18 years of experience of Associate Professor Dr. Cengiz Andan, across more than 2,000 gynaecological procedures and a broad clinical practice, supports a careful, individualised approach to treatment and follow-up. Even so, we want to be clear that every treatment carries some risk and that responses can vary from person to person, which is why regular review matters.

How does follow-up work, including from home?

Menopause management is an ongoing relationship rather than a one-off visit, so follow-up is built into the plan from the start. After starting treatment, symptoms and any side effects are reviewed, the dose or route adjusted if needed, and the decision to continue is revisited at least once a year. Because this is medical rather than surgical care, it lends itself well to remote follow-up: your assessment, plan and prescriptions are prepared so your own doctor at home can continue them, and we can support the review remotely. Any unexpected bleeding on treatment is always assessed promptly, and we coordinate with your local doctor where that is needed.

Care in Europe or in Turkey — what is the difference?

For menopause management the difference between Europe and Turkey is not the quality of care but access and cost. The same international guidelines, the same hormone preparations and the same individualised principles are followed in both; the gap comes from the exchange rate and lower operating costs, which lower the price rather than the standard. For many women an added difference is being able to have an unhurried assessment quickly and to keep continuity with one responsible doctor, instead of waiting weeks for an appointment.

How does the process, accommodation and follow-up work from abroad?

For patients coming from abroad, menopause care usually begins — and can often largely be managed — without travel, because it is medical rather than surgical. You first share your history and any recent results, and discuss your symptoms and the options in an online pre-consultation. If you choose to visit for an in-person assessment and baseline tests, a short stay of about 2–3 days in Turkey is usually enough, with no recovery time needed afterwards. Because there is no operation, there are no flight restrictions, and your plan and prescriptions are prepared so they can be continued and reviewed at home, with remote support.