When hormones step out of line

Meet the Park Igls medical experts and hear what they have to say about menopause and infertility

Dr Peter Gartner, Dr Sonja Schottkowsky and Professor Bettina Toth, have given us an interesting insight into the menopause, infertility and all things hormonal!

Park Igls expert on hormones

Meet the experts

Ask the experts: menopausal symptoms

A woman’s fertile phase doesn’t end suddenly; it’s a gradual process. What happens to the body during this time?

Bettina Toth: Hormone function declines, with fewer and fewer egg cells produced until the ovaries finally cease production altogether. It affects each woman differently, but we know from research that around 80% to 85% of women complain of menopausal symptoms. These range from difficulty sleeping, hot flushes, lethargy and reduced concentration, to loss of libido and declining general vitality.

At what age does the menopause begin?

Toth: On average, between the ages of 50 and 52. Early symptoms can appear in the transition phase (or perimenopause), as early as two to three years before the actual menopause. I have also had patients with premature ovarian failure (which affects about 1% to 2% of women) who were already menopausal at 17.

How are symptoms treated?

Toth: A thorough consultation is required to determine precisely the type of symptoms a patient is experiencing and how severely they are interfering with her day-to-day life. If a woman is still working and is experiencing extreme lethargy or difficulty sleeping to the point that she has difficulty doing her job, hormone replacement therapy (HRT) is recommended. That can turn things around within a few days.

Sonja Schottkowsky: Phytoestrogens are effective plant-based medicines that have minimal side effects. One is black cohosh (Cimicifuga racemosa) which is used in drop or tablet form. For perimenopausal symptoms, I recommend red clover supplements which are available over the counter. But I also advise all women with clear gynaecological complaints to visit their gynaecologist.

Peter Gartner: To add to that, Mayr physicians have been aware of the hormone regulating effect of Mayr therapy for many years.

Toth: In my experience, many women are sceptical about HRT because they worry about an increased risk of breast cancer. It is of course possible that hormone drugs can slightly increase the risk, but there are many other, just as serious, risk factors at play, like obesity, number of births, age at the time of giving birth etc. If a patient has an increased risk of breast cancer, for example if there is a family history of the disease, they should also be cautious of herbal medicines like black cohosh that bind to oestrogen receptors. In such cases it is recommended to seek specialist advice.

Gartner: 70% of the immune system is in the gut. The intestinal cleansing involved in Mayr therapy strengthens the immune system, thereby reducing the risk of all cancers, including breast cancer.

Is this range of general symptoms always related to the menopause?

Toth: If the patient does not suffer from depression, and symptoms like lethargy don’t disappear after treatment despite a sufficient oestrogen supply, you have to think beyond gynaecological causes. For instance, thyroid problems can cause similar problems with fatigue and exhaustion. And new research shows that female patients who are not diabetic but do have increased insulin resistance suffer more hot flushes. Adjusting sugar intake will eradicate these symptoms. So, gynaecologists are the first, but not necessarily the only, point of contact when it comes to menopausal symptoms.

What role does lifestyle play?

Toth: Exercise (around two and a half hours per week) and a healthy diet are key! I recommend a balanced diet, with coffee and alcohol in moderation. We also know that every cigarette damages ovary function and therefore hormone production.

Gartner: Nutrition, exercise and regeneration – this is what Modern Mayr Medicine is all about!

Is gynaecological endocrinology a well-researched field?

Toth: There is an extreme shift happening right now. Current studies about the adrenal glands are revealing exciting results: Even in unborn babies, malformations that affect hormonal balance can develop in the adrenal glands. In the next five to ten years, we expect to have new findings about the genetic background of menopausal symptoms. We will be able to use these to fine tune and improve hormone replacement therapies.

How long does the menopause usually last?

Toth: Women normally need hormone therapy for five to ten years, but there are women of 80 still suffering with menopausal symptoms. Our aim is to support women through the menopause in the best way possible, bearing in mind that while fewer female hormones are produced in old age, the female body still turns masculine hormones in the fatty tissue into oestrogen.

Is it true that osteoporosis occurs more commonly in older women?

Toth: Not necessarily. We see more and more younger people with osteoporosis due to an increase in eating disorders which in turn lead to menstrual cycle problems. Imbalanced oestrogen levels increase the risk of osteoporosis.

Schottkowsky: As a precaution, we recommend a balanced diet, exercise and a sufficient intake of vitamin D and calcium. In winter we often lack vitamin D in our diets and it is important to take a supplement at this time of year. It is recommended that people of all ages regularly have their vitamin D levels in the blood checked, especially women after the menopause.

Park Igls Mayr Clinic menopause symptoms infertility affect

Ask the experts: menopausal symptoms

Around 80% of couples who try for a baby become pregnant within a year. At what stage do we start to call it infertility?

Toth: In line with the latest guidelines for Austria, Germany and Switzerland, we recommend that women over 35 who have been trying to become pregnant for six months come to see us, because after that the chances decrease. Our aim is to help women fall pregnant as naturally as possible, so early diagnosis is important to determine possible causes.

What could the causes be?

Toth: There are so many. Sometimes it’s simply that women are not aware of when they are ovulating; they just need to learn to recognise the signs. Another cause, polycystic ovary syndrome (PCOS) which affects the development of eggs, can easily be rectified. Endometriosis, where the lining of the womb grows outside of the uterus, is also treatable.

Gartner: An international study from 2019 shows that a healthy gut with an intact microbiome (gut bacteria) improves the symptoms of polycystic ovaries and increases fertility.

What is the effect of lifestyle?

Toth: We know there is a connection between sugar metabolism and fertility. Being either obese or underweight, consuming excessive alcohol or coffee, and smoking all affect fertility.

Gartner: Exercise as well as a thorough detoxification with a Mayr programme are known to improve sugar metabolism considerably.

What about the 30% of cases where the man is infertile?

Toth: A low sperm count or poor-quality semen can have genetic or hormonal causes, many of which are easily rectifiable. We also know that certain environmental factors have an increasingly negative effect on semen production.

Are you happy with current legislation on reproductive medicine?

Toth: Austria has quite a liberal legal position on reproductive medicine. What we need are better social structures so that young, qualified women can decide to have children without worrying about falling behind in their career.

What is your advice for couples who come to you with fertility issues, having already tried everything?

Toth: They come to me as a couple. I want them to leave as a couple, too. So I advise them to have a kind of timetable of how long and how often they want to try for a baby before seeking alternatives. Every couple should ask themselves that question before treatment. I encourage every couple to take this path, as the causes are usually easily rectifiable.

Gartner: To bring in the Mayr perspective, Mayr physicians have long been aware that every Mayr therapy can increase fertility. We have seen time and again women who want to have a baby falling pregnant after a Mayr treatment.

Park Igls Mayr Clinic menopause symptoms infertility affect
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Photo credits: Park Igls, iStock

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