Why do menopausal symptoms occur and what can we do about them?
Menopausal symptoms, which affect about 70% of women, are believed to be due to the changing hormone levels, particularly estrogen, but many factors such as diet and exercise, lifestyle and other medication can influence the symptoms. Therefore, for some people, life-style factors such as reducing/stopping smoking, reducing alcohol intake, reducing caffeine intake, reducing stress, eating healthily and taking regular exercise can considerably help the symptoms of menopause. For others, HRT can be very beneficial, and indeed menopausal symptom control is the main indication for using HRT. If HRT is taken for symptom relief only, a trial period of stopping HRT is recommended every 2 years or so to assess whether or not treatment is still required. If, on stopping HRT, it's found that menopause symptoms recur then treatment can be restarted if it is felt that the benefits outweigh the risks. Alternative therapies may also be considered for menopause symptom control.
When do menopausal symptoms begin?
Many women notice early symptoms while still having periods, when the hormone production is declining very gradually. This stage of gradually falling and fluctuating hormone levels is often called the "climacteric" or the "change" and often begins in the 4th decade and can last for several years. Because ovarian function fluctuates, women may experience menopause symptoms intermittently. Some women experience an early, or premature menopause following which, symptoms may occur immediately, depending on the cause. Immediate onset of menopause symptoms often follows a surgical menopause. The duration of "early" symptoms is very variable from a few months to many years and the severity varies between individuals.
Early Menopause Symptoms
Early menopause symptoms include Physical, Sexual and Psychological problems.
Physical symptoms include:
- Hot flushes
- Night sweats
- Joint aches
- Headaches - visit: www.headacheexpert.co.uk
The hot flush, or flash, is well known as the classic menopausal symptom and affects 60–85% of menopausal women. Hot flushes and sweats are called vasomotor symptoms and vary immensely in both their severity and duration; for many women, they occur occasionally and do not cause much distress, but for about 20% they can be severe and can cause significant interference with work, sleep and quality of life. Women are affected by vasomotor symptoms on average for about 2 years but, for about 10%, symptoms can continue for more than 15 years. Hot flushes usually last 3–5 minutes and are thought to be caused by a change in the temperature-controlling part of the brain.Normally, there is a daily pattern of rises and falls in your body temperature, being lowest at about 3am and highest in the early evening. These small changes are not normally noticed, but a menopausal woman may flush with every temperature rise, whether these are normal changes or not – for example, moving between areas of different temperature or having a hot drink – because of a change in the setting of the temperature control centre in your brain; your body thinks that it is overheating even when it isn’t. To try to cool your body down, a variety of chemical reactions cause the blood vessels in the skin to open up, giving the sensation of a rush of heat, and sweat glands release sweat to dissipate heat. It is believed that the changes in various hormone levels that occur around the time of the menopause, lead to the change in the setting of the temperature control centre, but the exact underlying mechanism is still unclear. Other factors that can also cause flushes include being overweight, alcohol, excess caffeine, spicy foods, monosodium glutamate and some medications. Eating a healthy diet and losing weight if necessary can be helpful. Other simple measures that can help include:
- wearing cotton clothing rather than man-made fibres
- wearing loose thin layers of clothing rather than thick tight-fitting clothes
- keeping your bedroom temperature fairly cool at night – either leave a door or window open or consider a fan (partner permitting of course!).
Flushes affect every woman differently and, for many, no specific treatments will be required. When flushes are embarrassing, disruptive and affecting your quality of life, then help is available and your doctor will give you an individualised treatment plan – we are all unique! Headaches, palpitations (sensation of heart racing) and dizziness can be associated with vasomotor symptoms. Excess caffeine can worsen palpitations, so take coffee, tea and caffeinated soft drinks in moderation. Visit the flushes discussion on our Forum to find out how others have coped with flushes.
Insomnia (sleeplessness) or
disturbed sleep (leading to tiredness and fatigue), may be partly due to the
night sweats, control of which can lead to an improved sleep pattern.
Link: Visit our forum and read how other women have dealt with insomnia.
Joint aches commonly occur, often affecting neck, wrists, and shoulders but recognition of their possible association to menopause is often lacking. Visit our Forum for more information on menopausal joint aches and to find out how others have coped.
Psychological menopause symptoms such as mood swings, irritability, anxiety, difficulty concentrating, difficulty coping and forgetfulness may be related to hormonal changes, either directly or indirectly e.g. due to sleep disturbance. However, other life events such as worry over elderly relatives, teenage children, and pressures from work commonly occur around the time of menopause and may contribute to such "symptoms".
Sexual Problems may be caused by vaginal dryness due to low estrogen levels, resulting in discomfort during intercourse. Effective treatments are available. As both men and women get older, interest in sex may decrease but this particularly affects women. Treatment of other menopausal symptoms may indirectly improve libido by improving feelings of well-being and energy levels, e.g. by improving sleep through control of night sweats, but restoring hormone levels can also improve sensation. Relationship problems have an obvious effect on libido, so hormonal treatment may not always be the "magic" solution!
Later Menopause Symptoms
Later menopause symptoms are due to the effects of estrogen deficiency on the bladder and vagina and include:
- Passing urine more often by day and/or by night
- Discomfort on passing urine
- Urine infection
- Leakage of urine
- Vaginal dryness, discomfort, discharge, burning and itching
Although bladder and vaginal symptoms can occur in the early stages of the menopause, they most often occur a few years after the last period, or a few years after stopping HRT.
Vaginal and bladder symptoms are very common and can cause significant distress yet are often under-reported and under-treated. Women are frequently too embarrassed to discuss these problems. Very effective treatments are available and should be discussed. For vaginal dryness, non-hormonal vaginal moisturisers may be used. For bladder and vaginal symptoms, and to treat the underlying cause, ie lack of estrogen, local vaginal estrogen (tablet, cream, pessary or ring) can be very helpful. Low dose, vaginal estrogen can be used when systemic estrogen is inappropriate and can be continued in the long-term without any known adverse effects. Vaginal estrogen may be required in addition to systemic HRT since in some women, the systemic HRT, although helping symptoms such as flushes, may not be sufficiently helpful for vaginal symptoms.
Download a checklist of symptoms you can print out and take to your GP or nurse to help you start a discussion: PDF (117K)
For more information about bladder problems,
visit our sister website
Download the Love Hurts leaflet (pdf file, 4 pages, 219Kb, added 20th October 2008).
Vaginal symptoms questionnaire September 2005: See the results here.
Watch a 5 minute movie (wmv
Entitled "Breaking the silence", it deals with the common menopausal problem of vaginal atrophy and its treatment.
Other menopause symptoms
Otherlater menopause symptoms include effects from changes in collagen production, a protein in skin, hair, nails and tendons. As its production is affected by falling estrogen levels, the skin may become dryer, thinner, less elastic, more prone to bruising and skin itching may occur. Occasionally, a "crawling" sensation may be experienced but it is unclear whether this is due to skin changes or changes in the peripheral nerves. Skin symptoms often respond to estrogen replacement, but some women have developed skin itch when taking HRT. In this situation, a change in type or route of HRT may help.
dryness and the growth of unwanted hair can be explained by the lack of estrogen
and the relative excess of androgens in the menopause (the adrenal glands and
the ovaries continue to produce some androgens including testosterone, the
effect of which is no longer overridden by estrogen). However, hair loss may
be more dependent on age rather than hormone related and response to HRT is
unclear. Thyroid disease and iron deficiency can also cause hair loss
and should be considered, particularly if there are other signs.
Score Sheet: Measure your own symptoms by completing the menopause symptom score sheet
Books: See our recommended menopause and self-help books.