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SYMPTOMS OF MENOPAUSE

SYMPTOMS

SYMPTOMS OF MENOPAUSE

There are approximately 33 menopausal symptoms that can be divided into 3 types: Physical or Somatic, Urogenital, and Psychosocial. Most menopausal women experience these symptoms as they transition from perimenopause to menopause to finally reach the postmenopausal stage. Symptoms can last several months or even years and may evolve or change over time.


Period changes

The first sign of perimenopause is usually changes in the menstrual cycle. The duration between periods can either shorten or lengthen, and the number of days for each period may also vary. Moreover, the extent of bleeding may vary, ranging from heavier to lighter, and the flow can differ from month to month. Once a woman reaches menopause, she will cease to experience menstrual periods.

Hot flashes (vasomotor symptoms)

Menopause is commonly recognized by the vasomotor symptoms (VSM) of hot flashes and night sweats. They happen when the body suddenly feels warm and starts sweating. These symptoms are caused by changes in hormones during perimenopause, which makes the blood vessels expand and contract irregularly. Sometimes hot flashes can make the heart beat faster also. Different racial and ethnic groups may experience these symptoms differently.

Night sweats (vasomotor symptoms)

During perimenopause and menopause, many women experience night sweats along with hot flashes. This could be the body's way of trying to cool down when it suddenly experiences a hot flash. Thus, the woman might end up sweating a lot and getting night sweats.

Heart palpitations

The amount of estrogen in the body goes up and down during perimenopause, which can cause the heart to beat fast and flutter. A woman may also experience heart palpitations when she has a hot flash. Palpitations feel like the heart is beating faster than usual. Sometimes, the heart might even skip a few beats or flutter. The pounding heart can be felt from the chest up to the neck and throat.

Joint pain

During perimenopause, women may experience joint pains due to decreasing estrogen levels, a common challenge caused by hormonal fluctuations affecting the musculoskeletal system. Those with arthritis may feel increased pain as estrogen levels drop. Common types of joint pain during menopause include osteoarthritis, rheumatoid arthritis, and carpal tunnel syndrome. General joint discomfort can also affect various joints in the body. To alleviate symptoms, recommended treatments include physiotherapy procedures like physical exercises, massage, and manual therapy to manage joint pain and improve mobility.

Headaches and/or migraines

During perimenopause and menopause estrogen hormone levels fluctuate along with lack of sleep, stress, and mood changes related to menopause, all these can lead to headaches. These symptoms are influenced by hormones. This is also why migraines are more prevalent in women compared to men. Women who are prone to migraines may experience longer and more frequent attacks. Hormonal headaches and migraines may improve with menopause, when estrogen levels become low and stable and menstrual periods stop.

Fatigue

Many women experience fatigue during menopause, but they don't always talk about it and/or seek treatment. Symptoms like feeling tired all the time, lacking energy even after resting, and struggling to concentrate can make daily life challenging. As women approach menopause, changes in hormone levels can disrupt sleep, leading to constant tiredness.

Dry skin

When women go through menopause, their skin goes through some changes that are easy to notice. The skin becomes less elastic and smooth, which means it's more likely to feel tingly or like there are bugs crawling on it. This happens because when estrogen levels drop during perimenopause, it affects the nerves and blood vessels in the skin's collagen. As a result, the skin can become dry, loose, thin, and itchy.

Hair loss/texture changes

After menopause, a decrease in progesterone can make androgens like testosterone have a stronger effect on the oil glands and hair follicles. This might result in more facial hair and less hair on the head. As women age and go through hormonal changes during menopause, their hair properties are affected, making it seem like there is less hair coverage. The hair on the head may become thinner due to androgens, which can lead to hair loss during menopause.

Breast tenderness

As the levels of estrogen and progesterone hormones spike up and down, it can give rise to symptoms of breast tenderness. When estrogen levels drop, the quality of the connective tissue supporting the breast also decreases which may cause the breasts to feel tender and uncomfortable. Some women may feel tenderness, burning, or soreness as they progress through perimenopause and into menopause, while others may experience sharp stabbing, or throbbing pain. Breast pain can occur in one or both breasts.

Sleep issues

Hormonal changes during menopause, like lower estrogen and higher FSH levels, can affect how women sleep. Progesterone and estrogen hormones usually help prevent sleep apnea, a condition where breathing stops and that starts during sleep. However, when women reach menopause, they produce less progesterone, making them more at risk for sleep apnea. Other than hormones, women may experience sleep disturbances during menopause, like waking up multiple times due to sleep disruptive factors like hot flashes and night sweats. Factors like sleep-disordered breathing including sleep apnea, mood changes, depressive symptoms, health conditions, and socioeconomic status can also contribute to causing sleep issues.

Weight gain

During menopause, many women encounter weight gain, especially around the waist. Lower estrogen levels, muscle loss, poor and emotional eating habits, and lack of physical activity can contribute to this. Genetics can also play a role in the increase in body fat and waist size. Menopause causes changes in estrogen levels, which affects the body's ability to control hunger hormones leading to an increase in appetite and overeating. Hormonal imbalance in perimenopause can also cause fat redistribution from the buttocks and thighs to the waist area, leading to weight gain and increasing risk of heart disease, stroke and diabetes.


Up to 84% postmenopausal women experience discomfort in their vaginal, sexual, and urinary areas, often due to decreased estrogen levels. This condition, known as Genitourinary Syndrome of Menopause (GSM) will rarely resolve on its own. GSM is caused by a decline in estrogen that leads to thinning of the vaginal lining, including the urethra and bladder. These symptoms can have a significant impact on the quality of life of a woman. Unfortunately, very few women connect these symptoms to menopause and seek treatment.

Vaginal symptoms range from dryness to irritation, and/or discharge. Sexual symptoms include decreased vaginal lubrication, low libido, bleeding after intercourse, and painful/uncomfortable sex. Urinary symptoms include urinary tract infections (UTIs), urinary frequency and urgency, increased urinary leaks, and incontinence.

1 in 2

postmenopausal women experiences GSM symptoms, but less than 25 percent of them seek help.

Nearly 1 in

women experience decreased libido during menopause.

GSM is Chronic

unlike vasomotor symptoms, which improve over time, GSM is a prolonged condition that can worsen over time if not treated.

More than 50%

of postmenopausal women are affected by urinary incontinence.

Urinary frequency and urgency

Menopause can have many negative effects on the pelvic area, such as pelvic floor muscle weakness and urogenital atrophy due to decreased estrogen production. This can weaken the vagina, urinary tract, bladder, and urethra, making it difficult to control urinary functions. Bladder issues can also be related to age, nerve function, muscle strength, and other factors like medical conditions or emotional well-being.

Urinary incontinence and Urinary leaks

Over 50% of postmenopausal women experience urinary incontinence, the inability to hold urine. When estrogen levels decrease during perimenopause, it can affect the urethra and vagina by making the walls thinner and causing the pelvic floor muscles to weaken due to aging. This may result in an overactive bladder and urinary incontinence, showing signs like frequent urination and loss of bladder control with urine leaks.

Urinary tract infections (UTIs)

Postmenopausal women often experience UTIs along with the signs and symptoms of GSM. Estrogen hormone is important for vaginal and urethral health, but levels drop during menopause, leading to thinning tissues and increased UTI risk. It also helps maintain muscle strength in the urethra and promotes healthy bacteria growth in the vagina and bladder. After menopause, lower estrogen levels mean fewer protective bacteria. Also, menopausal women may struggle to fully empty their bladders, raising the risk of bladder infections.

Vaginal/vulva dryness

As women get older and go through menopause, they may experience vaginal dryness, a common symptom of GSM. There is less moisture in the skin around the vagina which can happen due to a decrease in blood flow, thinning of the vaginal lining, changes in theprotective bacteria, and inflammation. Women may experience vaginal dryness as irritation, itching, or a burning sensation even when not engaged in sexual activities. Over 50% of women with vaginal dryness do not report this symptom to their doctors, even though this symptom can be effectively and safely treated in many women.

Low libido (low sex drive)

About one-third to one-half of perimenopausal and postmenopausal women experience low libido, meaning they have less interest in having sex and becoming sexually aroused. This decrease in sexual desire can be attributed to lower levels of estrogen, which can also lead to reduced blood flow to the genital area, reduced vaginal lubrication, painful intercourse, atrophic vaginitis and painful uterine contractions. Apart from the hormonal changes during menopause, factors like depression or relationship issues can also influence a woman's sexual experience.

Painful sex

During or right after sexual intercourse, some menopausal women may experience recurring or ongoing pain. This can happen because the muscles in the pelvic floor tighten or become less toned because of lower estrogen levels during menopause. These lower estrogen levels can also lead to vaginal thinning and dryness causing discomfort in having sex.


Cognitive Symptoms

During the perimenopausal phase, there are fluctuations in FSH levels, while in the post-menopausal phase, there is a significant decrease in estrogen levels. These periods are often linked to changes in cognitive performance, such as issues with memory, focus, and communication. While many women seem to go through perimenopause without lasting negative impacts, a considerable number of women may face a higher risk of cognitive decline.

Brain fog

During the menopausal transition, many women may experience what is known as "brain fog," which includes issues with memory concerns and focus. It has been reported that up to 60% of perimenopausal women go through these symptoms. These cognitive challenges are connected to shifts in estrogen levels, vasomotor symptoms, sleep patterns, and mood. Addressing these symptoms could help improve cognitive function.

Forgetfulness

Hormone levels affect women's forgetfulness, especially estrogen which is important for brain function. Low estrogen can cause memory loss. Around 40% of women experience memory and concentration issues during menopause.

Impaired short-term memory

Memory issues during perimenopause can get better as women go through menopause and beyond. It is not just because of lower estrogen levels, but also due to poor sleep, higher levels of depression, and experiencing hot flashes.

Inability to focus

This symptom refers to difficulty concentrating on tasks or activities for an extended period. Individuals may find it challenging to maintain attention or stay engaged, leading to decreased productivity and increased frustration.

Inattentiveness

Inattentiveness involves a lack of sustained focus or attention, resulting in frequent distractions and an inability to maintain concentration. People experiencing inattentiveness may have trouble following conversations, completing tasks, or remembering important details.

Poor word retrieval

Over 50% of women going through menopause report poor concentration, fatigue, and memory problems at work. This cognitive symptom refers to difficulties in recalling or finding the right words during conversation or communication. Individuals experiencing poor word retrieval may struggle to express themselves effectively.

Mood Symptoms

Lower levels of estrogen hormone in menopause can lead to anxiety, difficulty concentrating, impatience, irritability, low motivation or energy, tearfulness, mood changes and sleep issues for some women. Hormonal fluctuations can also affect the hormones associated with positive mood (serotonin levels) and level of happiness(norepinephrine), potentially contributing to depression. Decreased levels of the calming hormone (progesterone) can also result in irritability and difficulty relaxing for some women.

  • Anxiety (increased worry)
  • Difficulty concentrating
  • Feeling not yourself
  • Impatience
  • Irritability
  • Low motivation or energy
  • Mood swings
  • Tearfulness

It is essential to seek help if symptoms interfere with daily life of a woman for more than two weeks.

Navigating Menopause's Lasting Effects

Long-Term Health Complications
due to Menopause

After menopause, decreased estrogen levels can affect the heart, bones, brain, and urinary/sexual/vaginal health (known as Genitourinary Syndrome of Menopause). While some symptoms may improve with time, it is important to be aware of and manage health risks postmenopause. Understanding the personal risks of the woman, making lifestyle changes to improve health, and seeking treatment for any symptoms or conditions are essential steps to take.

Heart

Estrogen is vital for keeping blood vessels open and flexible, and balancing cholesterol levels. After menopause, decreased estrogen production can increase the risk of hypertension, heart attacks, and strokes in women. More attention needs to be paid to women's cardiovascular health, as one in three women will develop heart disease.

# 1 Heart disease remains the number one cause of death among women worldwide.

50% Roughly 1 in 2 women over the age of 50 will die from heart disease.

Risk Doubles A woman’s risk of stroke doubles with each decade after age 55.

Early Risk Factor Women who reach menopause early have more cardiovascular health issues later in life.

Bones

Estrogen plays an important role in maintaining strong and healthy bones, which is why women face a higher chance of developing weak bones (osteopenia) and osteoporosis after menopause, particularly within the initial three to five years post menopause. The bone-mineral density can drop rapidly and severely for many women. A bone scan (DEXA), used to assess bone-mineral density, can help identify individuals at risk of osteoporosis or brittle fractures. It is important to consult with a doctor in case a woman’s family has a history of osteoporosis or if she breaks a bone after turning 50.

1 in 3postmenopausal women will have fractures connected to osteoporosis.

80% osteoporotic women: more women than menin India, out of 6.1 Crore individuals who suffer from osteoporosis, women are 80 percent of this population.

30% - 45%Indian women who suffer from osteoporosis and weak bone (osteopenia) are 31% and 44% respectively.

20% of Indian women above the age of 50 yearsare estimated to have osteoporosis. The rate is 5-10 percent more than Western countries.

10–20 years earlier in Indiapeak incidence of osteoporosis usually occurs 10–20 years earlier in India than in Western countries.

A Woman's Riskof breaking a hip is equal to her risk of all gynae cancers (breast, uterus, and ovary) combined.

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