Menopause Symptoms

Menopause Symptoms

As a naturally occurring stage in every woman’s life, menopause is the time when a woman is no longer able to become pregnant. As menstrual cycles cease, changes in hormone levels also occur.

Menopause occurs when the egg supply of a woman’s ovaries becomes critically low. As this occurs, the levels of female hormones (estrogen and progesterone) produced by the ovaries undergo changes, and eventually decrease and decline to negligible levels.

For most women, menstrual cycles are regular when they are in their teens until their mid to late 40’s. Women will first notice a skipped menstrual period or increasing irregularity (more than 7 days) in the length of their menstrual cycle (the time from the beginning of one period to the beginning of the next period). This defines the beginning of the menopause transition. The next change that woman will notice is that her periods are becoming farther apart, and often menstrual periods are lighter in flow. When a woman has had more than 60 days without a period, she has entered the late menopause transition. Once she has gone for 12 months without a period, she is considered menopausal.

There are other menopause symptoms, however, that women can experience that they may not initially relate to menopause. This can be especially true for those experiencing early menopause. These menopause symptoms will get a closer look in the next section. At any point, however, that you wish to find more (and more detailed) information, please visit our menopause symptoms page.

Primary Symptoms of Menopause

Many menopause symptoms are directly related to fluctuations in estrogen levels, which rise significantly early in menopause, then drop significantly. This fluctuation manifests in a number of menopause symptoms—the most noticeable of which are usually changes in the frequency of periods (i.e. skipped periods or more periods than normal), as well as heavier flows.

While the menopause symptoms below might seem overwhelming, it’s important to note that not all women experience all symptoms and that symptom severity varies greatly from woman to woman. Although about 60% of women will visit a doctor to discuss their symptoms of menopause, only about 20-25% have severe symptoms and require prolonged treatment. It’s important to remember that all symptoms can be treated, and that not all treatment is hormonal. For more information on treating menopause symptoms, see our menopause treatment options page.

Because hormones regulate more than just the menstrual cycle, though, other changes occur. Often, the first menopause symptoms a woman will notice are mood swings and hot flashes. Occasionally, related menopause symptoms can include sleep disturbances, depression, and reduced libido. As estrogen levels stop fluctuating and restabilize after menopause, these related menopause symptoms usually subside.

Women who are experiencing excessive sadness or suspect that they are depressed should seek professional help. Women are at risk for new onset of depression during the menopause transition. Fortunately, depression is a treatable condition and hormone therapy is often used in conjunction with antidepressant medication and talk therapy to help limit the duration of symptoms.

Further still, menopause symptoms can affect other areas of the body:

• The bones -- When women reach the late part of the menopause transition, bones begin to become more porous . If undetected, this process can lead to osteopenia (low bone mass) or osteoporosis in some women. While osteoporosis is a “silent” disease, you can read more about it in our osteoporosis symptoms  section. Your doctor will be able to advise you whether or not you should have your bone density checked and how to keep your bones healthy. Some information is included below.
• The genitals -- Physical menopause symptoms related to the genitals may include vaginal dryness, itching, and painful intercourse and can be troublesome for up to 40% of menopausal women. Fortunately, treatment with estrogen can reverse these problems.

While most menopause symptoms pass with time, there are a number of menopause symptoms that should be discussed with a doctor as they may be early warning signs of risks associated with osteoporosis, breast cancer, or heart disease. These menopause symptoms can also influence menopause treatment options.

Hormone Therapy and Early Menopause Treatment Options

There are two primary categories of menopause treatment: hormone therapy and non-hormone therapy. Each treatment is unique and for women experiencing early menopause hormone therapy may not be the preferred method of treatment. Learn more about early menopause on our comprehensive menopause section.

Hormone Therapy. Because many menopause symptoms are directly related to lowered estrogen levels, many women take some form of estrogen to relieve some of these symptoms. Women who have a uterus need to take estrogen with progesterone in order to avoid a risk for hyperplasia or—if prolonged estrogen is given without progesterone—uterine cancer. For women who have had their uterus surgically removed, this is not a concern. In such cases, women can safely be given estrogen alone, without a progestin.

For women who still have their uteri, estrogen is still an option when taken with progestin, which is a form of progesterone. This combination is what is formally known as “hormone therapy”. For women with a family history of breast cancer, uterine cancer, heart disease, blood clots, and liver disease, hormone therapy and estrogen therapy are not usually the best options.

Non-Hormone Therapy. When hormone therapy is not the preferred option, either for reasons listed above or because of early menopause, there are other non-hormone options that can help control menopause symptoms. Some of these include:

• Counseling -- This option can help women develop coping mechanisms that address common menopause symptoms, such as mood swings and feelings of sadness, depression, and lack of sexual desire.
• Moisturizers and lubricants -- To help address the pain and discomfort that can come from a reduction of natural vaginal lubrication and/or the thinning of vaginal tissues, there are a number of over-the-counter products, such as Vagisil and K-Y Jelly that are effective in addressing varying degrees of moisture needs.
• Low-dose vaginal estrogen -- While technically a hormone treatment, estrogen sometime be taken doses low enough to present minimal increases in estrogen levels while still being sufficient to address problems such as vaginal dryness or thinning vaginal tissues.
• Gabapentin, Medroxyprogesterone Acetate, Megestrol Acestate, and Clonidine -- These drugs can all be used to control or treat hot flashes. The latter is also used as a blood pressure lowering drug and its use warrants a discussion between patient and doctor.
• Reuptake Inhibitors -- Both Serotonin Norephinephrine Reuptake Inhibitor and Selective-Serotonin Reuptake Inhibitor (SNRI and SSRI, respectively) have proven effective in treating not only hot flashes, but also in treating depression.

Naturally, any decision regarding whether to implement hormone therapy or other treatment options to address menopause symptoms requires consultation with your doctor. To learn more about hormone therapy and other menopause-related items, please visit our menopause symptoms page.

Editors:

Richard Santen, MD

Nanette Santoro, MD

April 2008

Learn More About Menopause – Symptoms and Therapy

The Hormone Foundation is a leading online resource for information regarding menopause symptoms and other hormone-related changes that can affect the body. If you would like to learn more about the education programs and informational publications we provide, please contact us today.

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