In this blog I am are going to explain what the menopause is and the symptoms. We will not discuss treatments which will be covered elsewhere.
What is the menopause?
The menopause has three stages: perimenopause; menopause; and post menopause. Perimenopause is the time when a woman may start to experience menopausal symptoms because of fluctuations in the level of oestrogen, such as hot flushes, mood swings, vaginal dryness and a change in her periods.
The menopause is defined as the last period and is complete in a woman under 50 years if she goes for 24 months without a period. For a woman over 50 it is when if she goes for 12 months without a period. The woman is then postmenopausal.
The menopause typically happens between your mid-40s to mid-50s, with an average age of 51 years. 1% of women go through the menopause before the age of 40 (premature menopause) and 10% before the age of 45. The hormones involved in the menstrual cycle stop being produced and the ovaries run out of eggs. The menopause marks the end of a woman’s fertile years.
Every woman’s experience of the perimenopause will be different. Some women will have no symptoms but the majority of women will experience symptoms.
For all of these symptoms, if they are affecting a woman’s wellbeing, it is advisable for her to see her doctor, ideally a gynaecologist, as there are treatments that can be offered to reduce the symptoms.
Short term perimenopause symptoms
- Menstrual cycle changes
The first change that a woman normally notices is a change in her menstrual cycle; often it may become shorter but then longer, and periods may become lighter, heavier, more painful or less painful and there may be bleeding mid-cycle. These changes occur as the levels of oestrogen and progesterone fluctuate. There may be an increase in premenstrual syndrome, which may correspond with other mood changes.
It would be advisable to always carry period protection because the period can be unpredictable.
- Hot flushes and night sweats – vasomotor symptoms
Vasomotor symptoms are called hot flashes in the United States and hot flushes in the United Kingdom. They often occur in the perimenopausal period and are experienced by 75% of women.
Hot flushes are a sudden feeling of being really hot that can make women red and sweaty. They can range from a gentle feeling of warmth to a feeling of being unbearably hot all over the body, but especially the neck and face and can bring on a feeling of nausea and dizziness. They can last for a few seconds to five minutes and the number of hot flushes can vary from a few times a week to several a day. They can happen at any time of the day. If they happen at night, they are called night sweats and can affect sleep and make women feel tired during the day so they become more irritable and moody.
Hot flushes can occur due to non-menopausal reasons, including obesity; dietary problems; hyperthyroidism; anxiety; heart problems; fever; tuberculosis; some cancers; and certain medications.
Hot flushes are not a major medical problem, but they can be really inconvenient and make a woman anxious.
- Effects on mood – psychological symptoms
The menopause can result in psychological symptoms that are similar to the issues seen with premenstrual syndrome (PMS), including: mood swings; inexplicable emotions; irritability; depression; sadness; anger; anxiety; increased stress; lack of energy; lack of motivation; decreased patience; concentration problems, brain fog; a decrease in memory affecting the recall of words and numbers; disruptions to everyday behaviour, for example losing household items, needing to use memory aids and forgetting appointments.
Mood swings are defined as an emotional response that is inappropriate to its trigger and they can be extreme. A very small event can provoke a huge response.
- Genital and urinary problems
These include vaginal dryness; itchy genitals; pain during sex; an increased risk of genital infections; issues with the urinary system such as incontinence and an increase in the frequency of urination.
- Sexual difficulties
More than 80% of women find sex painful during and after the menopause. The symptoms that affect the vulva and vagina described above in (4) can make sex uncomfortable. There are several menopausal changes that can affect a woman’s libido.
- Joint and muscle pain
Perimenopausal joint pain may include aches; pain; warmth; stiffness; or swelling of a joint. It affects the hips, hands, fingers and knees the most, but can also affect the back. Most women will find these pains are worse in the morning.
Women may also experience unexplained muscle pain during the perimenopause. Muscles may give twinges of pain, cramps, fatigue, feel tense or tight, tender or spasm. As we age, our muscle mass decreases.
- Putting on weight
During the menopause, some women find that they put on weight, especially around their stomach, hips and thighs and it is hard to get off.
Metabolic syndrome – which involves conditions such as weight gain and high blood pressure, cholesterol and blood sugar – can increase a person’s risk of cardiovascular disease and diabetes. Women are often vulnerable to the onset of metabolic syndrome when they go through the menopause and those who are overweight and lead sedentary lifestyles are more at risk.
Long-term symptoms
- Osteoporosis
Osteoporosis means ‘porous bones’ and causes significant bone loss that increases the risk of fracture. Women account for 80% of osteoporosis sufferers so millions of women worldwide suffer and about half of women over 50 will have an osteoporosis-related fracture at some time. Thin and small-framed women are more at risk, but there is also a hereditary and ethnicity link.
Many women do not realise they have osteoporosis until they have a fracture, back pain or notice a change in their posture. Spinal compression fractures are the most common. These are small fractures that can cause the vertebrae to collapse and alter the shape of the spine. Wrist, pelvic, hip and other fractures are also common.
- Cardiovascular disease
Cardiovascular disease (CVD) usually refers to narrowing or blocked heart blood vessels that can lead to a heart attack, stroke or angina (chest pain caused by a lack of blood to the heart muscles). There are four main types of CVD, including: coronary heart disease (CHD); strokes; peripheral arterial disease; and aortic disease.
More women die of heart attacks than men and CVD is the leading cause of death in post-menopausal women with almost half of women over 50 dying from CVD. More than one in three women have some sort of CVD.
- Urinary incontinence
Urinary incontinence is the accidental leakage of urine. It affects up to 1 in 3 women at some point in their lives, although it is more common post menopause.
Stress incontinence; occurs during coughing, laughing, exercise and sneezing. The urethra, which leads from the bladder to the outside, is unable to stay closed in response to increased pressure inside the abdomen, resulting in leakage of urine. This is the most common type of incontinence in women.
Urgency urinary incontinence; when there is a sudden urge to urinate, often meaning that the person cannot reach the toilet in time. It is caused by an overactive bladder wall muscle (detrusor muscle). This condition is also known as detrusor overactivity, or overactive bladder. It is more common after the menopause.
Other urinary disorders include nocturia (the need to urinate during the night), and urgency (an increase in the urge to urinate).
- Pelvic organ prolapse
The female pelvic organs are held in place by ligaments, muscles and skin. These structures can weaken and result in a prolapse (falls out of place) of the uterus, urethra, small bowel, rectum (large bowel), bladder and vagina.
Prolapse can happen at any age but is more common after the menopause, due to loss of oestrogen. Prolonged labour, vaginal delivery of a very large baby, smoking and being overweight all increase the risk.
The most common types of prolapse seen in women involve the womb (uterine prolapse), bladder (cystocoele) or bowel (rectocoele). These are caused by weakness in the pelvic floor muscles and ligaments holding the womb and the top of the vagina in place. The prolapsing organ bulges into the vagina, causing a variety of symptoms. After a hysterectomy (operation to remove the womb), the top of the vagina can bulge downwards. This is called a vaginal vault prolapse.
The symptoms include a feeling of ‘pulling down’ or dragging in the pelvis, a bulge in the vagina, difficulty completely emptying the bladder (bladder prolapse), sometimes requiring either standing or placing fingers into the vagina to press on the front wall to help, difficulty completely emptying the bowel (bowel prolapse), sometimes requiring placing of fingers into the vagina to press on the back wall to help, and difficulties during intercourse including discomfort and pain.
- Dementia and Alzheimer’s
Dementia is a syndrome associated with ongoing decline in brain activity, memory loss and difficulties with thinking and problem solving. Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease or a series of strokes. People affected by Alzheimer’s disease have clumps of damaged proteins called plaques in their brains. Alzheimer’s disease and dementia affects women more than men and has a more profound affect in women.
Further information in this YouTube video – what everyone should know about menopause symptoms.
This information is edited from Your Fertile Years, Joyce Harper, 2021, Sheldon Press.
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