Menopause and PCOS (Polycystic Ovarian Syndrome) are often shrouded in myths and misconceptions, leaving many women uncertain about their health during these critical phases of life. In this insightful conversation, Dr. Franz Fischl debunks common menopause myths, highlights effective treatments, and shares actionable advice for managing PCOS symptoms.
Myths About Menopause Debunked by Dr. Franz Fischl
FAB: What are some common misconceptions or myths about menopause that you have encountered in your practice? How can women embrace this natural phase of life?
Doctor: As you mentioned, menopause is a natural process. In Europe, the average lifespan is about 84 years, with menopause occurring around ages 51 to 52. This means a woman will live approximately 30 years without ovarian-produced sexual hormones. Three hundred years ago, the average age of menopause was 47 to 49 years, and the average lifespan was about 55–56 years, leaving women with 8–10 years without these hormones. Factors like nutrition, lifestyle, and medical care likely contributed to the higher lifespan in our time. Menopause only occurs in humans and primates; other animals do not have a set deadline for childbearing age. Menopause may bring various symptoms and problems, sometimes severely impacting daily life. Common symptoms include hot flashes, sweating, sleep disturbances, lack of concentration, heart palpitations, and mood swings, all of which can disrupt normal life.
Effective Treatments for PCOS and Menopause Symptoms
FAB: What treatment options are available to help manage these symptoms? How can women advocate for their own menopause health needs?
Doctor: Treatment varies among individuals due to cultural influences, ability to discuss symptoms, country of origin, and socio-economic status. Exercise is crucial, as it helps alleviate symptoms. Hormone therapy, using natural hormones, can be taken for up to ten years and can improve the menopause experience. Early hormone therapy can also lower the risk of cardiovascular disease and colon cancer. Women who take oestrogen hormones are at a lower risk of developing colon cancer and cardiovascular diseases if they start early. That’s the point; you should start taking them at the onset of menopause.
Many women fear that hormone therapy increases breast cancer risk, but this risk is low compared to the higher risk associated with obesity or alcohol consumption. Oestrogen as monotherapy has no higher risk of breast cancer, and you have no time limit for taking it. If you have a uterus, you must take a combination of oestrogen and progesterone; therefore, you have a time limit of about ten years, and as I mentioned above, there is a small increase in breast cancer risk.
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FAB: If you undergo hormone treatment for menopause symptoms for ten years, what happens afterward?
Doctor: You should regularly consult your doctor while on hormone therapy. He will control the hormone levels in the blood and discuss the reduction or even disappearance of your menopause symptoms and how you feel in general. If you decide to stop hormone therapy, you should gradually reduce the dose rather than stopping abruptly. Hormones should not be taken if there are no problems. In cases of osteoporosis, hormones can only prevent, not treat, the condition, although starting hormones at menopause can help maintain bone health.
FAB: Beyond physical symptoms, women also experience mental health issues during menopause. How can these be managed?
Doctor: In my long time of practice, I’ve seen all kinds of cases. If you give them hormones—a combination of oestrogens and progesterones—then it becomes much better. There are studies and ongoing discussions showing that the risks of diseases like Alzheimer’s can be lowered with hormonal treatment (oestrogens). It’s still ongoing. We know hormones play a role in these diseases, but we don’t know exactly how they work. In the future, maybe it will be a preventive medication to lower the risk of Alzheimer’s.
FAB: What is the purpose of a pap smear?
Doctor: A pap smear is important. Maybe things will change a little bit in the coming years. It is an investigation of the cervix. You take cells, and the cells will be coloured and put under the microscope to see if there are cancer cells or not. It is for cervical cancer. It is important for young females who are hormonally active. When you get older, the risk of having cancer in the uterus goes to the cavity. If, after reaching full menopause, you suddenly start to bleed again, this may be a sign, and you should react. You should visit your gynaecologist and run some tests. Not all bleeding after menopause means cancer. It could be other things; it might be nothing dangerous.
FAB: Some women are reluctant to undergo routine checks due to discomfort or fear of results. How important are these screenings, and what should women expect?
Doctor: Routine screenings are vital. You should not be scared of cancer if you’re taking hormones. You must take it the right way. There are indeed some people with a high risk of developing genetic breast cancer. They are about 5–8% of the population in Europe. It’s only a very low number, but if you’re one of these people, you should not take hormones. Overall, anyone can get cancer. If that happens, it depends on the cancer and whether, from a medical point of view, hormone replacement therapy is possible or not.
Breast cancer is normally a sickness for the elderly. The highest percentage is between 45 and 60 years old. It also depends on the kind of life you’ve lived. E.g., if you’ve had ovarian cancer and gotten cured, hormonal usage will be open for discussion, whether it is to be continued or not. In some cases, you can, and in others, you should not. If you’ve had cancer in the past and you’re now in menopause, you have to discuss it with your doctor. You have to strike a balance between risks and benefits.
FAB: When should a person start taking hormones? Are they available as vaccines or pills, and can they be accessed globally?
Doctor: Hormones are usually in creams and are absorbed well through the skin. Pills are less preferred because they burden the liver. Creams should be applied daily to the same spot on the upper arm. If you have an uterus, you need a combination of hormones (oestrogens and progesterone); if not, you can take only oestrogens without a time limit.
Fertility and Hormone Therapy: Dr. Fischl’s Advice
FAB: Can you provide an overview of PCOS and its impact on women’s health?
Doctor: PCOS means polycystic ovarian syndrome. First of all, it’s not an illness you should be afraid of. I tell my patients to be careful. If it’s a very young girl, you find it much more often, but it’s not usually PCOS because it’s the onset of menstruation and there’s still a lot going on. PCOS is common in women from 30 to menopause. It stops at menopause.
There are different classifications of PCOS. There is a classification of females who are obese and have high levels of testosterone and DHEA-S. If you look at the ultrasound, you’ll see that the ovaries are a little bit bigger than normal, and they have a lot of small cysts, classically marginally located. That’s classic PCOS. But it also affects very tall or very small females.
The problem with PCOS is that the fertile phase can be shorter than normal, and getting pregnant becomes more difficult because of immature oocytes at ovulation time. It means you have ovulation with immature ovaries, so you never know if you have functional ovulation. Or you have only a few ovulations per year; your cycle is irregular, so it is difficult to find the right ovulation time during a year.
I advise ladies with PCOS not to wait with their pregnancy until the end of their fertile time. The latest age to get spontaneously pregnant for the first time is around the beginning of the 40s; it’s very late. I tell them not to wait too long. It’s easy to explain, but often it’s difficult to live. You have no partner, or you are studying or doing an apprenticeship. That’s why I also advise social egg freezing. Social egg freezing is stimulating females of young, fertile age to harvest eggs and freeze them till they’re ready to get pregnant. With modern procedures like IVF, you can fertilise the oocytes with your partner’s sperm. At the moment, the only problem is that it’s very expensive because you have to pay for it yourself without insurance.
The problem with PCOS is more often obesity and hair growth in the face and chest. When ladies come to complain about their hair, most times we do a hormone test and discover high testosterone levels. Again, it’s advisable to get pregnant early if you have PCOS. The chance to become pregnant reduces as you grow older. PCOS and endometriosis are two halves of infertility problems. You can have other diagnoses for infertility, such as male problems like a low sperm count, low sperm motility, high pathologic forms of the sperm, or all together. Normally, PCOS doesn’t hurt; it can mess with menstruation.
FAB: How many times should you get a checkup in a year if you have PCOS? Is it possible to be asymptomatic with PCOS?
Doctor: I don’t give a diagnosis without a check. Many of the females think they have a chronic disease, and they are afraid of it. If you are 20 years old, you should not think you have PCOS. If a young patient insists, then you have to do something. Sometimes the symptoms are there, and sometimes there are no symptoms. Most of them have no symptoms, sometimes irregular menstruation. Hormone levels should be tested at the correct time in the menstrual cycle, ideally within the first five days, to avoid inaccurate results. Asymptomatic PCOS is common, and regular check-ups help manage long-term reproductive health.
FAB: Is it normal to have your period flow twice a month?
Doctor: If you have any questions about the cycle lasting less than 21 days, then it means the ovulation happens during your bleeding. That means it might be difficult to get pregnant because women don’t usually have intercourse during menstruation. Few women have short cycles like this. You’ll have to do therapy to lengthen the cycle. You should have normal bleeding in the first phase of your life. But you don’t have to bleed every month in the first phase of your life. It’s also healthy if you bleed just 4 or 6 times in a year, except if you’re looking to get pregnant.
You also should not start with menarche (the first time of bleeding) too late. If you’re around 15 and you have not bled, you should go see a doctor. If your mom had a late menarche, the daughter could have too, and in that case, you can still wait it out. But if it isn’t, you’ll have to see a doctor to find the cause. The uterus doesn’t grow to its full size until you’re 18, if you have no menstruations.
