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Menopause: The Basics

Menopause

Menopause may be a natural part of the aging process, but it can also be a confusing and distressing time for many women. Especially if you are not sure whether changes in your health and well-being are linked to menopause, or a sign of something else. Here’s a look at 12 of the most common symptoms of menopause and what causes them so you can feel more empowered about “the change.” 

What is menopause?

Menopause is officially diagnosed after a year of having no menstrual periods. Your doctor or pharmacist can recommend lab tests to look at your hormones, which can also give some indication of where you are in the menopause process. 

Estrogen levels during menopause

When you reach menopause, sex hormones such as estrogen and progesterone are no longer produced by your ovaries. At the same time, your body stops releasing eggs from your ovaries and your menstruation ceases. After one year of no periods, your doctor can retrospectively diagnose you as menopausal. These hormonal changes are linked to many of the common symptoms of menopause.  

Premature menopause can occur as a result of medical or surgical factors, such as premature ovarian failure, hysterectomy, or chemotherapy. With surgical menopause, women experience many of the same symptoms following an oophorectomy (removal of the ovaries). Menopause is generally considered to be “early” if it happens before the age of 40.  

The biological process of menopause can take up to ten years. Not having periods for as long as 60 days is quite common in the perimenopause, especially as you move towards the full menopause. After you reach menopause, the years following this are often known as post-menopause. Many menopause symptoms start to disappear in postmenopause but there can still be health risks linked to the fact that your body has stopped producing hormones. Bone health, for example, is one of these concerns. 

What is perimenopause?

Before entering menopause, most women experience perimenopause. “Peri” means “around”, therefore, perimenopause is a term used to describe the transition period before you enter menopause. The symptoms that are experienced during perimenopause are a sign that your body is preparing for menopause. 

Estrogen level through out menopause age timeline

In the years leading up to menopause, levels of sex hormones such as estrogen and progesterone start to fluctuate and/or drop. In addition to the loss of estrogen and progesterone, you will also experience a change in androgens (e.g. testosterone and DHEA) in perimenopause.  Many women also notice a change in their menstrual cycle in perimenopause with periods often becoming less regular as estrogen levels rise and fall. For example, you may only menstruate every couple of months during perimenopause. 

Symptoms more commonly associated with menopause are often also experienced during perimenopause. Hot flashes, trouble sleeping, mood issues, and vaginal dryness are some of the most commonly reported symptoms. 

For many women, perimenopause will begin to occur between the ages of 40 and 50. This is not always the case and for some women they experience menopause prematurely. Peri-menopause generally lasts for around 4 years, although this can vary from woman to woman with some taking almost 10 years from start to finish. 

During perimenopause, exercise, healthy eating, supplements, hormone replacement therapy, and a variety of other medications have been shown to have benefits for some patients. 

12 Common Symptoms of Menopause

Changes to your hormones during menopause and perimenopause can have a lot of effects on your body. You won’t necessarily develop all of them, but here are 12 of the most common menopause symptoms and why they occur:

Menopause symptoms and physical changes

12 Most Common Symptoms of Menopause
  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Mood swings
  • Hair loss
  • Sleep issues
  • Fatigue
  • Weight gain
  • Brittle nails
  • Breast pain
  • Bone health
  • Memory 

Hot flashes

Hot flashes

Hot flashes are one of the “classic” symptoms of menopause. They refer to sudden, intense feelings of heat and are often accompanied by sweating and facial flushing. This can last for a matter of seconds or several minutes (although it may feel a lot longer, especially if you are embarrassed or distressed by the situation). 

Hot flashes can be linked to lower estrogen levels. (1) It’s thought that this can make it harder for your body to keep a stable temperature. As blood vessels close to the surface of your skin widen in an attempt to cool you down, it encourages your body to start sweating. 

There are no set patterns with regard to how long hot flashes occur. Some women only experience them in the short term but they can potentially last for years, even in postmenopause.  Click here for more in-depth information on hot flashes.

Night sweats

Night sweats

Some women experience hot flashes that occur in the night. These episodes are referred to as night sweats. As with hot flashes, the causes of night sweats can be linked to hormone changes and problems in regulating body temperature.  Many women find that they become drenched in sweat and need to change clothes or sheets, even if their bedroom is cool. Night sweats can wake you up and have a significant effect on your sleep patterns. Click here for more in-depth information on night sweats.

Vaginal dryness

It is also very common that the wall of the vagina becomes thinner during menopause and natural lubrication is decreased. This can make the vagina more sensitive and can lead to discomfort, especially during intercourse. It can also increase the chances of developing vaginal infections or urinary tract Infections (UTIs). The vagina can also change structurally and become shorter and narrower. 

Vaginal dryness

While many menopause symptoms start to reduce in postmenopause, vaginal dryness can become more severe. [2]  Multiple options for vaginal dryness and atrophy (thinning, drying, and inflammation of the vagina due to the loss of estrogen) exist and range from lubricants, estrogen therapy and other vaginal moisturizers. For a select few it can also improve over time, regardless of whether estrogen therapy is delivered. Click here for more in-depth information on vaginal dryness

Mood swings

It’s not uncommon to feel as those you are experiencing something similar to Premenstrual Syndrome (PMS) during menopause. A sudden and chronic dip in your mood can be another sign of menopause. Emotional changes are a common occurrence and can include irritability, depression, anxiety, and anger.  Women describe this as weepiness, rage, or annoyance among other descriptors. 

Mood swings can be more common during perimenopause and tend to be less severe in postmenopause. Estrogen hasn’t been confirmed as a direct cause of menopausal mood swings, but it’s thought that the effects menopause has on day-to-day life and wellbeing could be an indirect culprit [3]. Click here for more in-depth information on mood swings.

Hair loss

Thinning hair

Hair loss is commonly linked to hormonal changes of the thyroid, androgens and estrogen levels. Thyroid hormone levels are well known to correlate with hair loss and can be checked by your prescriber or by requesting a test kit from the pharmacist at Coast to Coast Compounding. Lower estrogen levels can result in thinner hair and hair loss, especially when it’s coupled with a rise in testosterone. Estrogen and progesterone are both involved in supporting healthy hair growth and lower levels during menopause can affect hair follicles [4]. At the same time, higher levels of testosterone or it’s metabolites can reduce the growth phase. Hair growth is often thinner and slower than before, and hair loss can occur. Click here for more in-depth information on hair loss.

Sleep issues

Insomnia

Menopause can have a significant impact on sleep, especially during perimenopause. Hot flashes and night sweats are an obvious factor but many women find that they struggle falling asleep or wake up repeatedly during the night regardless of whether they experience hot flashes or not. Some patients report a “middle of the night awakening” where they find themselves awake and alert at 3am.  In some studies, a combination of lower estrogen levels and higher levels of follicle stimulating hormone (FSH) have been linked to sleep problems [5]. However, there are various hormonal changes that may be linked to this along with age-related sleep problems. Click here for in-depth information on menopause sleep related issues.

Fatigue

Fatigue

Feeling tired and drained can affect a lot of women in menopause. It can range from a fairly mild sense of fatigue to an overwhelming exhaustion that significantly affects day-to-day life. Hormone changes are a strong factor in menopausal fatigue but there can be other reasons too. Adrenal hormone issues may also be present during perimenopause and menopause and your doctor or pharmacist can do testing to measure your cortisol levels or perform a salivary 4-point cortisol profile from the pharmacists at Coast to Coast Compounding. Even if you strongly suspect that your symptoms are due to menopause, speak to your doctor to rule out these type of causes of fatigue. 

Fatigue can be a byproduct of many menopause symptoms, including poor sleep, mood changes, and hot flashes. The latter can also contribute to dehydration, especially if you sweat a lot during hot flashes and night sweats. Click here for in-depth information on fatigue

Weight gain

Weight gain

Metabolism slows down during menopause and many women find that they gain weight, especially around their midsection. Animal studies have indicated that estrogen may play a role in weight control and this may be why weight gain becomes more apparent when estrogen levels decline [6]. You can explore the link between hormones and belly fat but it is possible to help manage your hormones with diet

Brittle nails

Brittle nails

Many women find that their nails become thin, brittle, and more prone to breaking, splitting, or tearing during menopause. One of estrogen’s less obvious roles is linked to stable fluid levels in the body [7]. Estrogen has a role in regulating water levels in the body and when less is produced during menopause, it can make dehydration more of a problem. Falling estrogen levels can affect the nails and dehydrate them thus, making them brittle. Just like the rest of the body, the nails need water to keep them healthy. Click here for more in-depth information on brittle nails.

Breast pain

Breast pain

Erratic hormone levels can lead to sore and painful breasts during menopause. The irregular nature of the menstrual cycle in perimenopause can be a factor. Fluid buildup in the breasts prior to menstruation can contribute to breast pain and irregular periods can mean that breast pain occurs out of the blue. 

As well as pain and tenderness, you may also notice some differences in the shape and size of your breasts during perimenopause, including lumpiness. Lower estrogen levels can lead to a decline in glandular tissue in the breasts, which can affect denseness and fullness. 

For many women, breast pain will start to reduce after menstrual periods have not occurred for at least a year. Click here for more in-depth information on breast pain.

Bone loss

A strong bone and a weak bone

In the early stages of perimenopause, there is usually little change in bone density but this can start to change in late perimenopause [8]. Low estrogen and progesterone levels can reduce bone density, which can increase the risk factor for developing osteoporosis in the future. 

Menopause is one of the biggest factors in bone loss as women get older and can continue for up to 10 years. As much as a fifth of bone loss can occur in this time frame, largely because bone breakdown can significantly outweigh the building of new bone [9].  Click here for more in-depth information on bone loss.

Memory issues

Memory loss

Research from the University of California indicates that up to 60% of women experience short term memory issues during menopause [10]. This can affect learning, recall and memory [11].

Fuzzy thinking and “brain fog” can be extreme – some women become worried that they’re developing dementia. Fortunately, it tends to be a temporary issue that starts to resolve itself after menopause but it can certainly be very scary. Research from the University of California in 2009, found that most women regained cognitive function after they came out of menopause [10]. 

References:

  1. https://www.nia.nih.gov/health/hot-flashes-what-can-i-do
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2806500/
  3. https://www.health.harvard.edu/womens-health/dealing-with-the-symptoms-of-menopause
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685269/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810528/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889220/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849969/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266953/
  9. https://my.clevelandclinic.org/health/articles/10091-menopause–osteoporosis
  10. http://newsroom.ucla.edu/releases/menopause-transition-may-cause-92903
  11. https://www.ncbi.nlm.nih.gov/pubmed/19470968
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