Symptoms of Menopause

Symptoms of Menopause

Menopause is the natural culmination of a woman’s reproductive cycle. Usually occurring between the ages of 47 and 55, menopause happens when the ovaries stop producing an egg each month. Accompanying the end of egg production is also the decrease in hormones produces by the ovaries: estrogen and progesterone.

It is the decrease in estrogen and progesterone, or rather the ups and down that mark a gradual decrease in estrogen and progesterone production, that produce the most noticeable symptoms of menopause. Different women will experience symptoms of menopause to different degrees. Some women—a minority—report no symptoms at all. For others, multiple symptoms of menopause can be experienced at the same time. The vast majority of women will experience at least one symptom as they transition into menopause. Most symptoms are related to changes in estrogen and less so, progesterone.

This page deals with specific aspects surrounding symptoms of menopause, namely their physical, mental, and emotional effects. It also addresses the relationship between the symptoms of menopause and follicle stimulating hormone (FSH) and luteinizing hormone (LH). For more (and more detailed) information regarding menopause and the symptoms of menopause, please visit our comprehensive overview of menopause.

Symptoms of Menopause Throughout the Body

While the list 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 review of options for menopause treatment. 

Estrogen is the hormone that is primarily responsible for the changes a woman will experience during menopause, such as changes in her normal menstrual cycle patterns, hot flashes, sleep problems, vaginal dryness, mood swings, or undesirable (and often unpredictable) hair growth.

Estrogen levels restabilize after menopause. These new, lower levels bring about a decline in the symptoms of menopause for most women. Still, getting to this point can be characterized by a number of different changes that fluctuating estrogen levels bring about throughout the body. These changes can affect:

• Reproductive and Urinary System -- Noticeable vaginal dryness, itching or burning, which may lead to painful intercourse or, occasionally, urinary symptoms.
  
  
• Skeletal System -- As women enter the later stages of the transition into menopause, they enter a period of about 5-10 years when their bone density begins to decline more rapidly than it did throughout their adult life. This puts many women at risk for osteoporosis, loss of bone density, and—if undiagnosed and untreated--broken bones.
  
  
• Cardiopulmonary System -- After menopause, women have an increased risk of heart attacks and other heart-related problems.
  
  
• Nervous System -- Changes in estrogen are strongly linked to hot flashes and night sweats. Up to 85% of women will experience this classic symptom of menopause. Hot flashes can cause disturbances in sleep, and lead to daytime sleepiness and fatigue. Estrogen fluctuations can also affect the emotional state, causing shifts between sadness, anger, confusion, and in some cases, anxiety or depression. Women are at an increased risk of a new episode of depression as they go through the menopause transition.

As estrogen levels change, and women stop ovulating and producing progesterone, the ovary becomes less and less responsive to the hormones FSH and LH, that influence the production of estrogen and the growth of egg-containing follicles in the ovary. These hormones rise with the onset of the transition and remain elevated throughout the remainder of a woman’s life. FSH, in particular, is often measured to support a diagnosis of menopause. However, in most cases this is an unnecessary test. A woman who is over the age of 45 and is experiencing irregular menstrual cycles or stops cycling entirely and has symptoms of estrogen deficiency need not confirm the diagnosis of menopause with blood tests.

Early Menopause

Women who go through menopause earlier than age 45 have ‘early menopause,’ whereas the condition is called ‘premature menopause’ or ‘premature ovarian insufficiency’ if it occurs before age 40. Women with premature menopause should be treated with hormones to prevent the early onset of osteoporosis. For women who experience premature menopause symptoms, yet would still like to have children there may be treatment options available.

Follicle Stimulating Hormone (FSH). Ovulation occurs when mature ovarian follicles are released. The maturation process of ovarian follicles is compromised during menopause when levels change. Follicle stimulating hormone causes the growth and maturation of ovarian follicles, increasing their overall numbers, and can induce fertility in women who have enough eggs left in their ovaries to respond. In cases of premature menopause, however, the egg supply is often critically low, and FSH is already high as the body tries to encourage the remaining eggs to grow. In these cases, supplying additional follicle stimulating hormone is often ineffective.

Luteinizing Hormone (LH). Working in tandem with the follicle stimulating hormone, luteinizing hormone helps cause the final maturation of follicles, induces their ovulation and maintains progesterone production after ovulation occurs. Luteinizing hormone is released in pulsatile bursts about once an hour, and at the middle of the cycle, a very large burst of LH is produced, known as the preovulatory luteinizing hormone surge.

Note: While some women who have premature menopause are given follicle stimulating hormone and luteinizing hormone in order to become pregnant, currently there are no research studies to support the fact that they help with such pregnancies.

Symptoms of Menopause: Bone Loss

One of the symptoms of menopause listed above was bone loss. Menopausal women lose bone more rapidly, due to the lack of estrogen, and are at increased risk for osteoporosis. Fortunately there are many steps that can be taken to minimize and treat bone loss associated with menopause. They include:

• Exercise -- Just as muscles maintain strength with daily exercise, so too do bones. Regular weight-bearing activities, such as walking--or even lifting light weights for just 20 minutes a day can help prevent bone loss. Conversely, a sedentary lifestyle after menopause can actually increase the rate of bone loss.
  
  
• Calcium -- This is critical to maintaining bone mass. In fact, in their early 30s, women should be taking in 1,200 mg of calcium every day, with that level increasing to 1,200-1,500 at around the age of 50—when menopause generally occurs. A balanced diet, marked by sufficient dairy intake should become an everyday habit, if it is not already.
  
  
• Vitamin D -- Calcium is a good idea; it is vitamin D, however, that facilitates the absorption of calcium into the body. Fortunately, sunlight is a natural and readily available source of vitamin D. For many women who lack the ability to spend adequate amounts of time in the sun or who are diligent about wearing sunscreen, vitamin D supplements should be considered. Although vitamin D is present in many common foods, such as milk, cereal, eggs, liver, and salt-water fish, it needs to be converted to its active form in the skin, with sun exposure. Vitamin D3 supplements (the active form of vitamin D) are also available. The recommend amount of vitamin D for adults over 50 is 800-1,000 IU per day.
  
  
• Medication -- In addition to diet and exercise, there are a number of medicines available to help prevent (and in some cases reverse) osteoporosis. They include: Raloxifene, Human Parathyroid Hormone, Calcitonin, Biphosphonates, and Hormone Therapy.
  
  

You can learn more about the prevention of bone loss in our detailed overview of osteoporosis.

Editors:

Richard Santen, MD

Nanette Santoro, MD

April 2008

Learn More About Symptoms of Menopause

The Hormone Foundation is a leading online resource for women experiencing the symptoms of menopause as well as others experiencing any hormone-related changes or diseases. To learn more about the programs and publications we have available, please contact us today.

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