Demystifying Menopause
Part 2: The Signs and Symptoms
As discussed in part 1, menopause is the female reproductive stage marked by your period (or menses) ceasing. Changes in your period’s flow, length and frequency are key signs of perimenopause. Hormone shifts underlie these period changes, but what other symptoms might you notice?
Sleep Disturbances - Studies have found in early perimenopause 32 to 40 percent of women have sleep disturbances. This rate can increase to 38 to 46 percent of women during late perimenopause. Research suggests many possible causes of the poor sleep. While hot flashes may be a primary driver of poor sleep, anxiety, depression, restless leg syndrome, or sleep apnea may also play a role. These conditions are also commonly found in perimenopausal women and may be more to blame.
Joint Pain - The Women’s Health Initiative identified joint pain as a symptom linked to menopause. It is not clear if decreased estrogen drives the joint discomfort, but it was shown to be effectively treated with hormone replacement therapy (HRT). Though joint pain alone would not be an indication for HRT.
Weight Gain - The hormonal changes happening in your body can be blamed for a redistribution of weight in your body (more fat around the abdomen, hips and thighs), but it alone does not explain weight gain. That said, if your joints hurt and you’re not sleeping well, it’s fair to say you’re not necessarily pushing your body as hard as you did before those changes happened. The science says that weight gain in menopause is related to lifestyle and genetic factors, not the hormones. Sorry!
Vaginal Dryness - The tissues, or skin, around the vagina and urethra (opening to the bladder) are estrogen-dependent. When the estrogen decreases, these tissues atrophy or thin. This thinning or atrophy causes dryness, itching and even pain during sexual intercourse. These skin changes can also make a woman more prone to UTIs or urinary/bladder infections.
Sexual Dysfunction - Related again to the decreased estrogen causing thinning of the skin in the vaginal area, there will be decreased lubrication (necessary during sex). There can even be anatomical changes related to the atrophy of the skin. Both of these factors can cause painful intercourse.
Cognitive Changes - Estrogen has been shown to be important for cognitive function. Many women report more memory issues and difficulty concentrating. Depression and anxiety are also potential factors impacting cognition during the menopausal transition. Plus, poor sleep can impact cognition.
Depression - A study by Freeman et al. (2006) showed it was 2.5 times more likely to be diagnosed with depression during perimenopause. The likelihood decreases after menopause. Perimenopause itself does not make women depressed, but during this significant life change, women face the emotional impact of aging, body changes, loss of fertility, poor sleep, and hormone shifts that can affect mood (think teenagers). Obviously, it’s a lot to handle, and for some women, professional support may be helpful.
Breast Tenderness - Pain or tenderness in the breasts is commonly reported during early perimenopause, but decreases later in perimenopause. This symptom may be familiar to some women from hormone changes associated with pregnancy or even their period.
Menstural Migraines - Women prone to cluster migraines around their period may experience worsening frequency or intensity during perimenopause, but these migraines tend to stop completely after menopause when hormone levels remain low.
Hot Flashes - The hallmark symptom of menopause is the hot flash. This symptom is related to the hormone fluctuations during perimenopause and may play a role in many of the other symptoms discussed above. A hot flash is your hypothalamus causing thermoregulatory dysfunction brought on by estrogen withdrawal. Hot flashes are the most common symptom. Up to 80 percent of women experience hot flashes to some degree though only a small number (20 to 30 percent) seek treatment. (More to come on hot flashes in Part 3 of Demystifying Menopause.)
As I write this article, I can feel the dismayed looks of women from all over reading these words. Clearly, there is some unpleasant news about menopause, but many of these symptoms are temporary. What’s more, women are amazingly tough and resilient! Getting older is not for the faint of heart, but with age comes wisdom, experience and no more worrying about tampons. Stay tuned for more information on hot flashes and what to do about all of these symptoms.
Kate Bender is a dual-certified Psychiatric Mental Health and Adult Nurse Practitioner. She knows, firsthand, life is messy and hard. Sometimes people need support and help from a professional. When working with Kate, your mental health will be compassionately addressed in a manner that honors your mind, body, and spirit. She lives with her family on the shoreline in Old Saybrook, Connecticut.