Changes you might notice with approaching menopause. Most of them are treatable.
Hot Flashes:
Hot flashes occur in up to 75% of women. They typically begin as the sudden sensation of heat centered on the upper chest and face that rapidly becomes generalized. The sensation of heat lasts from two to four minutes, is often associated with profuse perspiration and occasionally palpitations, and is often followed by chills and shivering, and sometimes a feeling of anxiety. Hot flashes usually occur several times per day, although the range may be from only one or two each day to as many as one per hour during the day and night. Hot flashes are particularly common at night. Hot flashes will usually resolve on their own in 1-5 years, although some women will continue to have hot flashes until after age 70.
Sleep disturbance:
Sometimes caused by hot flashes and other times not clearly understood causes related to menopause and aging.
Vaginal Dryness:
The vagina is very sensitive to estrogen, and estrogen deficiency leads to thinning of the vaginal lining and decreased functioning of vaginal glands. The result is vaginal dryness, itching and often painful intercourse.
Sexual Dysfunction:
Estrogen deficiency leads to a decrease in blood flow to the vagina and vulva. This decrease is a major cause of decreased vaginal lubrication and sexual dysfunction in menopausal women. In animals, estrogen deficiency causes an abnormality in the functioning of the pudendal nerve. The same abnormality may occur in estrogen deficient women, resulting in decreased sensation in the clitoral and vulvar area and sometimes loss of the ability to have an orgasm. This change appears to be completely reversible with estrogen therapy.
Vaginal dryness and painful intercourse may also contribute to reduced sexual function. The elasticity of the vaginal wall may decrease and the entire vagina can become shorter or narrower. These changes are exquisitely sensitive to estrogen therapy.
Urinary symptoms:
Low estrogen production results in atrophy of the lining of the urethra (the canal between the bladder and the vagina). This change predisposes to irritation, urine leakage and recurrent urinary tract infections in many women.
Depression:
Studies that have investigated the relationship between depression and menopause have been conflicting regarding a relationship with decreasing estrogen and depression. However, a significant association between the menopause transition and risk for depression seems apparent overall. In some women, estrogen therapy seems to help some of the symptoms of depression.
Breast Pain:
This is common in the menopause transition and is difficult to treat effectively unless it is associated with bloating.
Menstrual Migraines:
These are migraine headaches that cluster around the onset of each menstrual period. In many women these headaches worsen in frequency and intensity during the menopausal transition.
Skin Changes:
The collagen content of skin and bones is reduced by estrogen deficiency. Decreased skin collagen may lead to an aged appearance and wrinkling of the skin. Skin collagen can be increased with estrogen replacement.
Joint Pain:
Although the prevalence is not known, some women experience diffuse joint pain during the menopausal transition and postmenopausal period. It is unclear if this is related to estrogen deficiency or a rheumatologic disorder, but in the Women’s Health Initiative, women with joint pain or stiffness at baseline were more likely to get relief with combined estrogen-progestin therapy than with placebo.
Balance:
Impaired balance in postmenopausal women may be a central effect of estrogen deficiency.
Bone Loss:
Bone loss occurs during the menopausal transition and this increases risk of fractures. Bone loss can be minimized with calcium and vitamin D supplementation and weight bearing exercise. Bone loss can be reversed with estrogen and testosterone replacement.
Loss of Libido:
A common cause for loss of interest in sex or sex drive during the menopausal transition is related to decreasing production of testosterone by the ovary. Non-oral replacement of testosterone markedly improves libido when there are no other factors involved.
Loss of Energy:
This is a common complaint in the menopausal transition. Estrogen and testosterone replacement both improve energy level, especially testosterone.
Mental Changes:
Memory and Concentration deteriorate in many women during the menopause transition. Estrogen replacement seems to improve memory and concentration in many women. It “lifts the fog” that some women seem to experience with menopause.
Cardiovascular Changes:
After menopause, women’ risk for cardiovascular disease increases and approaches that of men. This risk returns to premenopausal levels with non-oral forms of estrogen replacement.
Ovarian Cancer:
Do high levels of FSH (follicle stimulating hormone) contribute to ovarian cancer occurrence? Some research suggests that it does, and high levels of FSH occur after menopause which is the most common time for ovarian cancer to develop. Estrogen replacement lowers FSH levels. FSH is produced in the brain.
It would be very unusual for any one woman to suffer from all of the menopausal changes listed above. The list probably is not complete and scientific research continues to try and explain menopause. There are many treatments for menopausal changes available. Some treatments are for one or a few specific symptoms, and others are more global in effect.
