Menopausal Symptoms: In Depth

MENOPAUSAL SYMPTOMS: IN DEPTH

Menopause is a transition into a life phase where you no longer menstruate. It occurs when you have not menstruated for 12 consecutive months, and it isn’t due to pregnancy or illness. Menopause is a normal part of aging. And it happens because the female sex hormone – estrogen and progesterone – levels naturally reduce as you grow older.

CAUSES OF MENOPAUSE

Though menopause occurs naturally during midlife for most women, it can happen earlier for other reasons. Menopause can be caused by various factors, including:

Natural menopause

Your ovaries start to make less estrogen and progesterone – the hormones that regulate menstruation – as you grow older. This hormone reduction continues until your ovaries eventually stop releasing eggs, thus triggering menopause.

Surgery to remove ovaries

Your ovaries produce hormones, including estrogen and progesterone. So, surgical removal of your ovaries causes immediate menopause, which triggers menopausal symptoms.

However, removing the uterus alone does not cause immediate menopause because your ovaries still release eggs and produce hormones.

Chemotherapy and radiation therapy

These therapies can cause the ovaries to stop working, thus inducing menopause. This can result in menopausal symptoms during or after the treatment.

This effect can be temporary or permanent. The chances of this happening depend on the individual’s age and the type and location of the treatment.

No matter the cause of menopause, the symptoms are the same. However, the symptoms with surgery or therapy-induced menopause may be more severe because the change occurs abruptly compared to the gradual decline in natural menopause.

ONSET OF MENOPAUSE

Many factors determine when you’ll hit menopause, including genetics and ovary health. It usually begins between the ages of 45 and 55. However, it can start much earlier if you’ve had surgery to remove your ovaries or you’re receiving certain treatments for cancer. It can also start later than this age range.

Furthermore, about 1% of women begin menopause before the age of 40. This is known as premature menopause or primary ovarian insufficiency. Another 5% begin menopause between the ages of 40 and 45. This is known as early menopause.

STAGES OF MENOPAUSE

Menopause causes your ovaries to stop producing eggs. This makes your period stop and pregnancy impossible. Menopause usually happens in 3 stages:

Perimenopause

This is the period when your hormone starts to change in preparation for menopause. During perimenopause, your period becomes irregular. So, it may be late or absent in some months. Your flow may also become heavier or lighter.

This stage can last for a few months or as long as several years.

Many women begin perimenopause in their mid-40s, while others do not experience this stage at all. Instead, they enter straight into menopause. You can get pregnant in perimenopause if you’re still getting your periods.

Menopause

Here, your menstruation has stopped for at least a year or for clinical reasons, like surgery.

Postmenopause

This refers to the years after you have hit menopause. But it can be challenging to know when menopause finishes and postmenopause starts.

MENOPAUSAL SYMPTOMS.

The hormonal changes that come with menopause can cause many uncomfortable symptoms. However, most women do not require treatment for these symptoms.

While every woman’s menopause experience is unique, the symptoms are usually more severe when menopause occurs suddenly or over a very short period. In addition, some conditions that affect ovary health, such as cancer, ovary removal, or lifestyle choices like smoking, can also increase the severity and duration of your symptoms.

Menopausal symptoms may start before your menstruation ends and can last for several years. Their impact on your quality of life can also range from mild to severe. Some of the symptoms include:

Irregular periods

This is the classic sign of menopause.

Your periods may become more or less frequent, heavier or lighter, or last longer or shorter than before.

However, any bleeding, even if it’s spotting, after menopause is not normal. If this happens, you should talk to your doctor.

Hot flashes and night sweats.

Hot flashes can make you suddenly feel hot in your upper body for no apparent reason. This sensation may start in your face, neck, or chest and progress upward or downward. Your heart may even begin to beat faster.

Night sweats are hot flashes that happen while you’re asleep. They can be so intense that they wake you up.

This symptom varies in severity for every woman and can last for 1 to 5 minutes. In addition, you can have several episodes within an hour, one per week, or never experience them.

Hot flashes usually occur within the first year after your period stops. But some women experience them for years.

Mood changes

Menopause can affect your mood, causing you to feel sad, irritable, tired, anxious, or depressed. If you have a history of depression or anxiety, menopause may worsen your symptoms.

How you feel about menopause can also affect your mood. For instance, worrying about low libido or end of fertility can worsen menopause-associated depression.

A 2018 article also suggests that there may be a link between menopause and suicide. So, if you find yourself thinking about suicide when you’re going through menopause, you should see your doctor.

Furthermore, feeling sad, irritable, or tired does not necessarily indicate depression. But you should see your doctor if you feel down for more than a few weeks.

Vaginal dryness and discomfort

This can start during perimenopause and continue into menopause. Vaginal dryness can result in chafing and discomfort during vaginal sex. And if your skin breaks in the process, it puts you at higher risk for infection.

The thinning, drying, and inflammation of your vaginal wall – known as atrophic vaginitis – can also sometimes occur.

Urinary incontinence

The lower estrogen level that comes with menopause may cause your pelvic muscles to get weaker. This reduces the muscles’ ability to control your bladder, which can result in urinary incontinence.

Sleep disturbances

You may find yourself waking up during the night or having trouble going to sleep. This sleep disturbance can be due to:

• Mood changes in the form of anxiety,
• Night sweats, or
• An increased need to urinate.

Difficulty concentrating and learning

More than 60% of women may experience difficulty with concentration and memory when going through menopause.

Lower sex drive

Some women lose interest in sex or have trouble getting aroused when they are in menopause. The vagina dryness can also make sex painful.

Physical changes

You may experience some physical changes around the period of menopause. Some of these changes include:

• Accumulation of abdominal fat.
• Weight gain.
• Breast reduction and tenderness.
• Changes in hair texture, volume, and color.
• Stiff joints.

However, the association between these changes and menopause is not entirely clear. Because some of the changes may occur independently. Your age and lifestyle can also affect the extent of these changes.

Increased risk of certain health conditions

The risk of some health issues appears to increase after menopause. Menopause itself does not cause these issues, but the associated hormonal changes may play some role. Some of these health issues include:

• Osteoporosis
• Cardiovascular disease
• Breast cancer

MANAGEMENT OF MENOPAUSAL SYMPTOMS

While menopause is not a health problem, it can trigger many unwanted physical and mental changes. If these changes significantly affect your quality of life, you should speak with your doctor, who may recommend one or more of the following:

Hormone Therapy

Hormone therapy provides your body with supplemental estrogen and progesterone to help balance your body’s hormone levels. This can help reduce the occurrence of hot flashes and other menopausal symptoms.

Hormone therapy is available in various forms, including skin patches and topical creams. However, it may increase your risk of developing some health issues. Therefore, you should avoid it if you family or personal history of the following health issues or if you have risk factors for them:

• Heart disease.
• Liver disease.
• Breast cancer.
•  
• Blood clots.
• Gallbladder disease.
• High blood triglycerides level.

You should discuss the benefits and associated risks with your doctor before you start hormone therapy.

Other Treatment Options

The following can also help relieve some of your symptoms:

• Over-the-counter gels or prescription pills, creams, and rings for vaginal dryness.
• Low doses of hormonal birth control pills for hot flashes, mood changes, and vaginal dryness.
• Low doses of antidepressants for hot flashes – even for people without depression.
• Medications to prevent or treat osteoporosis, including calcium, magnesium, and vitamin D.

Lifestyle Interventions

The following tips can help you ease menopausal symptoms:

• Exercise regularly.
• Maintain a healthy diet, including lots of fresh fruits, vegetables, and whole grains.
• Quit smoking and avoid secondhand smoke.
• Do Kegel exercises to strengthen your pelvic muscles and improve urinary incontinence.
• Limit your intake of alcohol, caffeine, hot beverages, and spicy foods, as they can trigger hot flashes.
• Dress in loose and layered clothing, especially during warm weather and nighttime.
• Get lots of rest and establish good sleeping habits.
• Seek counseling for mood changes and relationship concerns.
• Pick up a new hobby or join a local club.
• Talk to your friends and family about your menopause experience.
• Practice relaxation and deep breathing exercises.

Note that, even though you cannot get pregnant when you hit menopause, you should still use barrier protection during penetrative sex to protect yourself against sexually transmitted infections.

SUMMARY

Menopause is usually a natural occurrence that marks the end of a woman’s fertility. This transition usually happens during midlife, but genetics and certain conditions can cause it to happen earlier.

Many women experience menopausal symptoms, which can start before menopause and continue for years after menopause. These symptoms can generally be managed with lifestyle adjustments. But some medications can provide you with some relief if your symptoms are severe.