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Symptoms of Menopause

Menopause is a natural stage in life, marked by the permanent cessation of menstrual cycles due to the ovaries no longer producing reproductive hormones for at least 12 consecutive months. It is a diagnosis made retrospectively. In the months or years leading up to menopause, many women experience various symptoms that act as early indicators of what’s to come. This phase is known as perimenopause, and these symptoms affect up to 75% of women going through it.

What are the Symptoms of Menopause?

Here’s an extensive list of common and less common symptoms associated with menopause and perimenopause. Common symptoms include:

Irregular periods

Why is that? As oestrogen and progesterone levels fluctuate, menstrual cycles may become shorter, longer, heavier, lighter, or skipped altogether. This irregularity is one of the first signs of perimenopause.

Vaginal dryness

Why is that? Reduced oestrogen levels lead to thinner, less lubricated vaginal tissues, causing dryness, discomfort, and painful intercourse (dyspareunia).

Hot flushes

Why is that? Hormonal changes affect the body’s temperature regulation, leading to sudden heat sensations, often accompanied by sweating and redness. These can last for several minutes.

Night sweats

Why is that? Similar to hot flushes but occurring during sleep, night sweats can disrupt rest and are linked to fluctuations in oestrogen levels.

Sleep problems

Why is that? Hormonal imbalances, night sweats, and anxiety can disrupt the body’s ability to maintain a consistent sleep pattern, causing insomnia and frequent waking.

Mood changes

Why is that? Changing hormone levels, particularly fluctuating oestrogen and progesterone, can lead to mood swings, anxiety, and depression.

Brain fog

Why is that? Cognitive functions, such as memory, concentration, and focus, may be impacted by fluctuating hormone levels, stress, and sleep disturbances.

Decreased libido

Why is that? Lower oestrogen and testosterone levels can reduce sexual desire and responsiveness, often accompanied by vaginal dryness or discomfort.

Weight gain

Why is that? Hormonal changes can slow metabolism and cause a redistribution of fat, particularly around the abdomen. Decreased activity and muscle mass with age may also contribute.

Thinning hair

Why is that? Reduced oestrogen levels can lead to thinning hair on the scalp, while higher testosterone levels might promote hair growth on other parts of the body, such as the face.

Dry skin

- Why is that? Oestrogen helps maintain skin moisture and elasticity. Lower levels result in drier, less supple skin that may wrinkle more easily.

There are also a range of less common symptoms which you may experience:

Fatigue

Why is that? Hormonal imbalances, disrupted sleep, and stress can lead to chronic tiredness, making it difficult to feel rested even after sleeping.

Joint pain or stiffness

Why is that? Lower oestrogen levels can lead to inflammation, affecting the joints and causing stiffness, aches, and pain, particularly in the morning.

Palpitations

Why is that? Hormonal fluctuations can affect the autonomic nervous system, causing heart palpitations or a racing heart, particularly during hot flushes.

Headaches

Why is that? The decrease in oestrogen, particularly during perimenopause, can trigger headaches or migraines, especially in individuals prone to hormonal headaches.

Breast tenderness

Why is that? Fluctuations in oestrogen and progesterone during perimenopause can lead to swollen, tender, or sore breasts, similar to premenstrual symptoms.

Urinary issues

Why is that? Decreased oestrogen can weaken the tissues of the bladder and urethra, leading to increased urgency, frequency, or urinary incontinence.

Dizziness

Why is that? Hormonal changes may affect circulation or blood pressure, causing occasional lightheadedness or dizziness.

Bloating

Why is that? Changes in oestrogen levels can lead to water retention and a feeling of fullness or bloating, often linked to gastrointestinal changes.

Tingling in extremities

Why is that? Oestrogen fluctuations may affect the nervous system, leading to numbness or a tingling sensation in the hands and feet.

Changes in body odour

Why is that? Hormonal changes can cause the body’s natural scent to change, especially during hot flushes or night sweats due to increased sweating.

Increased sensitivity to allergens

Why is that? As the immune system shifts during menopause, some women may notice increased sensitivity to allergens or irritants.

Changes in taste

Why is that? Hormonal changes can affect the senses, leading to altered taste, such as a metallic taste or heightened sensitivity to certain flavours.

Gum problems

Why is that? Declining oestrogen levels can affect oral health, leading to inflamed or bleeding gums and a higher risk of gum disease.

Osteoporosis risk

Why is that? Lower oestrogen reduces the body’s ability to maintain bone density, increasing the risk of fractures and osteoporosis over time.

Dry eyes

Why is that? Reduced oestrogen affects moisture production, leading to dry eyes and discomfort, sometimes accompanied by an increased risk of eye infections.

Burning mouth syndrome

Why is that? Hormonal fluctuations can affect the nerves in the mouth, causing a burning sensation on the tongue or in the mouth, often without an obvious cause.

Changes in cholesterol levels

Why is that? Oestrogen helps regulate cholesterol. As levels drop, LDL (bad cholesterol) can increase, and HDL (good cholesterol) may decrease, raising cardiovascular risks.

Electric shock sensations

Why is that? Some women report brief, sudden sensations like electric shocks, which may be linked to shifting hormone levels affecting the nervous system.

Anxiety and panic attacks

Why is that? Hormonal imbalances, coupled with changes in life circumstances during menopause, can lead to increased anxiety and, in some cases, panic attacks.

Symptoms are different for every woman. However for many, changes to your period cycle is the main indicator that menopause is on the horizon. Sometimes, menstrual periods will skip a month, or several, and then return. You may also note that your periods have shorter cycles, so they may become closer together. Despite this, becoming pregnant is still a possibility.

It's important to visit your doctor frequently during and after menopause, and you should always seek medical advice if you suffer vaginal bleeding after menopause.

What Causes Menopause?

Menopause can be caused by various factors, such as:

Natural decline of reproductive hormones - The most common cause of menopause is the loss of hormones. When you approach your late 30s, the ovaries start making less oestrogen and progesterone - these are the hormones that regulate menstruation and increase fertility. When you reach your 40s, menstrual periods can become longer or shorter, heavier or lighter, or more or less frequent. On average, by 51, your ovaries will stop producing eggs and you will not experience any more periods.
Hysterectomy - A hysterectomy is a surgical procedure to remove your uterus (womb).This operation, which leaves your ovaries in place, usually doesn't cause immediate menopause. although you won't have periods, your ovaries will still produce oestrogen and progesterone, and release eggs. However, a total hysterectomy that removes your uterus and ovaries will cause immediate menopause. The symptoms following this can be severe due to the abrupt changes in hormones.
Chemotherapy and Radiotherapy - Chemotherapy uses drugs, usually through an injection or tablets, to treat different types of cancer. Radiotherapy involves the use of radiation, usually X-rays, to treat illness. These cancer treatment therapies can encourage menopause to occur, sometimes causing symptoms such as hot flushes during or after treatment. However, the stoppage of menstruation and fertility is not always permanent.
Primary ovarian insufficiency - Around 1% of women experience premature menopause (menopause before age 40). Menopause can happen if your ovaries fail to produce normal levels of reproductive hormones. Often there is no cause of this, but it can stem from genetic factors or autoimmune disease.

What are the Problems Associated with Menopause?

After menopause, you may increase your risk of certain medical conditions, such as:

Urinary Incontinence - A loss of elasticity in the vagina during menopause can results in frequent, sudden and urges to urinate, that is often followed by involuntary leakage of urine. It's important to strengthen your pelvic floor muscles to prevent this.
Cardiovascular (heart and blood vessel) disease - As your oestrogen levels drop, the risk of cardiovascular disease increases. Heart disease is one of the most common causes of death in women, so it's important to maintain a healthy weight and diet.
Osteoporosis - During the beginning of menopause, you can lose bone density at a rapid weight, which increases your risk of developing osteoporosis. This condition causes bones to become weak and brittle, and postmenopausal women are extremely susceptible to spine, hip and wrist fractures.
Sexual function - Decreased moisture production and a loss of elasticity in the vagina can cause vaginal dryness. This often causes discomfort and slight bleeding during sexual intercourse. This can also impact upon your libido.
Weight gain - Your metabolism will slow during your transition into menopause, causing you to gain weight. You may have to eat less and exercise more in order to maintain your prior weight.

How Does Menopause Affect The Pelvic Floor?

Menopause can cause your pelvic floor muscles to weaken. These muscles are vital for supporting your pelvic organs, which means as they weaken you will be at risk of developing a pelvic floor disorder such as incontinence or pelvic organ prolapse.

Weight gain can also have a significant impact on the pelvic floor during menopause. It is common to gain weight during menopause as your metabolism slows, however these added pounds put more stress onto your pelvic floor, weakening it as a result.

Pelvic floor exercises are vital during this period of a woman's life, and can be beneficial in a number of ways if performed correctly.

How Can You Treat Menopause?

The main treatment for menopause is hormone replacement therapy (HRT), which helps alleviate symptoms by replacing the oestrogen and progesterone that the body no longer produces. HRT is available in various forms, including tablets, patches, gels, and implants. It can help manage symptoms like hot flushes, night sweats, mood swings, and vaginal dryness, and also reduces the risk of osteoporosis.

For women who cannot or choose not to take HRT, alternative treatments such as lifestyle changes, non-hormonal medications, and natural remedies may be recommended.

Sources

Cancer Research UK (2023) What is Radiotherapy? [online]. Cancer Research UK [viewed 01/10/2024]. Available from https://www.cancerresearchuk.org/about-cancer/treatment/radiotherapy/what-is-radiotherapy

Macmillan Cancer Support (2022) Chemotherapy [online]. Macmillan Cancer Support [viewed 01/10/2024]. Available from https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy

Mayo Clinic (2024) Menopause [online]. Mayo Clinic [viewed 01/10/2024]. Available from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

NHS (2022) Hysterectomy [online]. NHS [viewed 01/10/2024]. Available from https://www.nhs.uk/conditions/hysterectomy/

NHS (2022) Menopause [online]. NHS [viewed 01/10/2024]. Available from https://www.nhs.uk/conditions/menopause/

Pelvic Floor First (2023) Menopause [online]. Continence Foundation of Australia [viewed 01/10/2024]. Available from https://www.pelvicfloorfirst.org.au/pages/going-through-menopause-or-post-menopausal.html

NICE (2024) Over 14,000 people will benefit from NICE's final guidance recommending abaloparatide for treating postmenopausal osteoporosis in cases of very high fracture risk. [viewed 01/10/2024]