Comprehensive Hormone and Health Management from Perimenopause Onwards

Published: 18.04.2025 · Last Updated: 05.08.2026 · Prepared by the Academic Hospital Web and Editorial Board.

Academic Hospital Menopause diagnoses the hormonal changes of perimenopause and menopause and manages the wide range of symptoms that extends from hot flushes and sleep disturbance to osteoporosis and cardiovascular risk, using treatment plans tailored to each woman. The unit works in coordination with gynecology specialists, endocrinologists and, where necessary, cardiology and physical medicine and rehabilitation specialists.

Contents

What Is Menopause?
Which Diseases and Conditions Are Treated?
When Should You Consult Us?
Diagnostic Methods
Treatment Approaches
Menopause at Academic Hospital
Frequently Asked Questions
References

What Is Menopause?

Menopause is the women's health subspecialty unit that focuses on the healthy management of the hormonal transition caused by declining ovarian function. In Türkiye the average age at menopause is between 47 and 51. The unit offers assessment and treatment across a broad spectrum, from the sudden onset of hot flushes to the long-term increase in osteoporosis and cardiovascular risk.

Which Diseases and Conditions Are Treated?

Perimenopause (the transition to menopause; marked by irregular periods and temporary symptoms)
Menopause (permanent loss of ovarian function, defined by 12 months without a period)
Early menopause (spontaneous menopause before the age of 40)
Premature ovarian insufficiency (early menopause diagnosed before the age of 40)
Surgical menopause (sudden menopause following surgical removal of both ovaries)
Vasomotor symptoms (hot flushes, night sweats)
Urogenital atrophy (genitourinary syndrome of menopause, GSM) (vaginal dryness, recurrent urinary tract infections, dyspareunia)
Osteoporosis and fracture risk related to menopause
Increased cardiovascular risk related to menopause
Mood disorders related to menopause (depression, anxiety, sleep disturbance)
Hormone replacement therapy after menopause

When Should You Consult Us?

Irregular periods, missed periods or longer intervals between periods
Hot flushes and night sweats that disrupt daily life
Vaginal dryness, pain during intercourse or recurrent urinary tract infections
Marked fatigue, sleep disturbance, difficulty concentrating or forgetfulness
Mood swings, depression or anxiety
Vaginal bleeding that returns after menopause (requires urgent assessment)
Bone or joint pain and loss of height
Periods stopping or becoming irregular before the age of 40
A request for information and assessment regarding hormone therapy during menopause

Diagnostic Methods

Method	What it is used for
FSH (follicle stimulating hormone)	A high FSH level (40 mIU/mL and above) indicates that the ovarian reserve has decreased and that menopause is approaching.
Estradiol (E2)	Measurement of the estrogen level; used in the diagnosis of menopause.
AMH (anti-Mullerian hormone)	A sensitive biomarker used to assess ovarian reserve and the perimenopausal process.
Thyroid function tests (TSH)	Thyroid disorders that can mimic menopausal symptoms are ruled out.
Bone mineral density (DEXA scan)	Measures bone density at the lumbar spine and hip and establishes a diagnosis of osteopenia or osteoporosis. It is recommended within the first 1 to 2 years after menopause.
Lipid panel and cardiovascular risk assessment	Determination of the LDL and HDL balance that changes with menopause and of the overall cardiovascular risk profile.
Endometrial assessment (transvaginal ultrasound)	Examination of the lining of the uterus in patients who report bleeding; a biopsy is planned where necessary.

Treatment Approaches

Treatment	How it is applied
Hormone replacement therapy (HRT)	Replacing the declining estrogen level is the most effective treatment for menopausal symptoms. It reduces hot flushes by 75 to 90 percent, slows bone loss and relieves urogenital symptoms. Combined estrogen and progesterone is used in women who still have a uterus, and estrogen alone in women whose uterus has been removed. The balance of risk and benefit is assessed individually for each woman.
Low-dose vaginal estrogen	In women with urogenital symptoms only, it is applied as a local vaginal cream, tablet or ring with minimal systemic absorption.
Non-hormonal drug treatments	In cases where HRT is contraindicated or not preferred, SNRI and SSRI antidepressants and gabapentin are used as options for hot flushes.
Phytoestrogens and herbal support	Plant sources such as soy isoflavones and flaxseed may help with mild hot flushes; however, they are not as effective as HRT and should be used with the knowledge of a physician.
Osteoporosis prophylaxis and treatment	Calcium (1,000 to 1,200 mg daily) and vitamin D supplementation is the basic protective approach. Depending on the DEXA results, bisphosphonates (alendronate, risedronate), denosumab or HRT are used in the treatment of osteoporosis.
Cardiovascular risk management	The rising LDL and falling HDL levels seen in menopause are controlled through lifestyle measures and, where necessary, statin therapy. Stopping smoking, regular exercise and blood pressure control are the priority recommendations.
Psychological support and sleep management	Psychological counselling, sleep hygiene advice and, where necessary, psychiatric consultation for mood disorders and sleep problems.

Book an appointment with the Academic Hospital Menopause Unit.

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Menopause at Academic Hospital

The Academic Hospital Menopause Unit addresses the whole period from perimenopause to the postmenopausal years within a single follow-up plan; decisions on hormone therapy, bone health and cardiovascular risk monitoring are handled by the same team. The unit works routinely with the following departments:

Gynecology and Obstetrics: assessment of irregular periods and endometrial examination
Endocrinology and Metabolic Diseases: interpretation of hormone levels and exclusion of thyroid disorders
Cardiology: assessment and follow-up of the cardiovascular risk that rises with menopause
Physical Medicine and Rehabilitation: exercise programmes for bone health and musculoskeletal complaints
Urogynecology: urogenital atrophy, urinary incontinence and recurrent urinary tract infections
Nutrition and Diet: calcium and vitamin D intake and a weight management plan
Psychiatry: consultation for mood disorders and sleep problems

Frequently Asked Questions

What is the difference between perimenopause and menopause?

Perimenopause is the transitional period that begins with irregular periods and lasts until menopause; it may continue for several years. Menopause is defined as 12 uninterrupted months without a period. Postmenopause covers the whole of life after that date. It is determined according to the FSH (follicle stimulating hormone) value measured on day 3 of the cycle.

Does hormone replacement therapy increase the risk of breast cancer?

Combined estrogen and progesterone therapy may lead to a slight increase in breast cancer risk when used for longer than 5 years. This increase is considered to be at a level similar to the contribution of one glass of alcohol per week to breast cancer risk. The balance of risk and benefit is determined with a physician according to the individual's age, age at menopause and personal medical history.

Does early menopause require different treatment?

Yes. In menopause occurring before the age of 40, the long-term risks of osteoporosis, heart disease and cognitive decline are higher. For this reason it is generally recommended that hormone replacement therapy be continued until around the age of the natural menopause, in the sixties.

Is weight gain during menopause inevitable?

Weight gain is mainly due to the slowing of metabolism that comes with age rather than to menopause itself. The fall in estrogen can make it easier for fat to accumulate around the abdomen. Calorie balance, a protein-focused diet and resistance exercise can substantially offset this change.

Why is vaginal bleeding after menopause important?

Vaginal bleeding after menopause (after more than 12 months without a period) may be a sign of serious conditions, including uterine cancer. This should never be ignored and must be assessed urgently.

What should be done to protect bone health during menopause?

As estrogen levels fall, bone mineral density can decrease rapidly, which increases the risk of osteoporosis. Alongside hormone replacement therapy, calcium (1200 mg daily) and vitamin D supplementation, weight-bearing exercise (walking, dancing, light weight training) and limiting tobacco and alcohol are the basic protective measures. In postmenopausal women under 65 with risk factors, a DEXA scan (bone density measurement) is recommended; drug treatment may be planned according to the result.

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References

The general information given on this page about menopausal symptoms, diagnostic methods and treatment options is supported by the reliable health sources listed below.

The Menopause Society, "Position Statements", menopause.org
National Library of Medicine (MedlinePlus), "Menopause", medlineplus.gov
World Health Organization, "Menopause", who.int
Mayo Clinic, "Menopause: Symptoms and causes", mayoclinic.org

The information on this page is for informational purposes only; it does not replace medical examination, diagnosis or treatment. Please consult a healthcare institution regarding your complaints.