Menopause is a natural stage of life, not a disease. It marks the end of menstrual cycles and fertility. For some women, this transition is smooth. For others, symptoms can affect sleep, mood, intimacy and daily comfort.
In Lisbon, Dra. Joana Faria offers menopause and perimenopause consultations in Portuguese, English, French, and Spanish. The goal is to listen to your experience, explain what is happening in your body and build a plan that respects your health history and your priorities.
This page focuses on menopause. For more information about birth control choices during this phase, you can also read the contraception page.
What it is
Menopause is defined as the moment when you have had no menstrual periods for 12 consecutive months, not caused by pregnancy, medication or surgery. The years before and after this last period are known as perimenopause and postmenopause.
During perimenopause, hormone levels fluctuate. Cycles become more irregular and symptoms may begin even while you still have periods. Common features of this transition include:
- Cycles that become shorter, longer or unpredictable.
- Changes in flow, with lighter or heavier bleeding.
- Hot flushes and night sweats.
- Sleep difficulties and fatigue.
- Mood changes, irritability or feeling more fragile emotionally.
- Vaginal dryness or discomfort during sexual intercourse.
After menopause, hormone levels stabilise at a lower level. Some symptoms improve, while others, such as vaginal dryness or changes in bone density, may persist and need specific attention.
Main symptoms and when to worry
Many menopause symptoms are bothersome but not dangerous. Even so, you do not need to "just endure" them. A consultation can help you understand which symptoms are linked to hormonal changes and which require a different type of investigation.
You should consider booking a consultation if you notice:
- Hot flushes or night sweats that disturb sleep or daily activities.
- Persistent sleep problems, fatigue or difficulty concentrating.
- Mood changes, anxiety or a sense of not recognising yourself.
- Vaginal dryness, itching, burning or pain during intercourse.
- Low libido that bothers you or your relationship.
- Irregular or very heavy bleeding in your forties or fifties.
Some signs need special attention. You should always seek medical advice if you experience:
- Bleeding after 12 months with no periods.
- Bleeding after sexual intercourse in menopause.
- Sudden weight loss, severe pelvic pain or other unusual symptoms.
These may still have benign causes, but they require a structured evaluation to exclude problems in the uterus, cervix or ovaries.
Diagnosis: exams and what to expect
Menopause is often diagnosed based on age, menstrual pattern and symptoms. Blood tests are not always necessary, especially after 45 years old. However, some exams can be useful to guide treatment and long term prevention.
During a menopause consultation you can expect:
- Detailed clinical history
Discussion of your cycle changes, symptoms, past medical conditions, surgeries, family history of cardiovascular disease, thrombosis, breast cancer or osteoporosis, lifestyle and expectations. - Physical examination
Blood pressure and weight measurement, and when indicated a gynecologic examination to assess the vagina, cervix and pelvic organs. - Pelvic ultrasound when relevant
Recommended in case of irregular or heavy bleeding, pelvic pain or known uterine or ovarian disease. - Laboratory tests in selected cases
Blood tests may be used to check lipids, glucose, thyroid function, vitamin D or other markers. Hormone levels can be measured in some situations, but they are not needed for every woman. - Bone density assessment
In women at increased risk of osteoporosis, bone densitometry can help plan prevention and treatment.
At the end of the consultation, Dra. Joana Faria will propose a plan that may include lifestyle measures, local treatments, non hormonal medicines or hormone therapy when appropriate, always explaining why each option is or is not recommended for you.
Treatment options and follow up
The aim of menopause treatment is not to erase age, but to reduce symptoms that affect your quality of life and to protect long term health, especially bones and cardiovascular system.
Options that may be discussed include:
- Lifestyle measures
Adjustments in sleep routines, physical activity, diet, alcohol and caffeine intake and stress management strategies. - Local vaginal treatments
Moisturisers and vaginal oestrogen in low doses to improve dryness, itching and pain with intercourse, usually with minimal systemic absorption. - Non hormonal medicines
Certain medications can help reduce hot flushes or improve sleep when hormone therapy is not suitable. - Menopausal hormone therapy
Oestrogen alone or combined with progestogen, taken orally, through the skin or via other routes. It can significantly improve hot flushes, night sweats, sleep, mood and vaginal symptoms in selected women. - Bone protection strategies
Adequate calcium and vitamin D, exercise and, when needed, specific medicines to treat or prevent osteoporosis.
The decision to use hormone therapy is individual. It depends on your age, time since menopause, intensity of symptoms and personal and family risk factors. Regular follow up is essential to reassess benefits and risks, adjust doses and decide how long to continue treatment.
How Dra. Joana Faria approaches menopause in practice
Dra. Joana Faria knows that menopause is not only a hormonal event. It can also be a period of change in work, family dynamics and self image. Her approach combines medical knowledge with respect for your story and your preferences.
In daily practice she:
- Starts by listening to how symptoms affect your life, instead of focusing only on numbers or test results.
- Explains in simple language what is known and what is still debated about menopause and hormone therapy.
- Uses up to date recommendations to evaluate whether hormone therapy is safe and beneficial for you.
- Discusses non hormonal options and local treatments when hormones are not indicated or not desired.
- Builds a plan with clear steps and schedules follow up to review how you feel and to adjust treatment if needed.
For many women, having a trusted gynecologist during this transition makes menopause easier to understand and to live, with more comfort and more autonomy in decisions about health.
