Most women tend to experience fluctuating symptoms of menopause that can sometimes affect their personal and social lives.5 The top six symptoms of menopause are hot flashes, vaginal dryness, urinary problems, weight gain, sleep difficulties, and mood changes.
Menopause is a complex physiological and psychological condition in women. The term is derived from the Greek “meno”, meaning month and “pausis”, or pause of the monthly cycle. 8 On average, menopause occurs between 51- 52 years of age, marking the end of the fertility period.5
Menopause is clinically diagnosed at twelve months after the last menstrual cycle. The doctor documents the symptoms and obtains a history of menstrual changes.6 Management and treatment of symptoms can be challenging because the severity of the symptoms can vary.
Top 6 symptoms of menopause:
- Hot flashes or night sweats. Characterized by episodes of sudden, intense heat, sweating, and flushing that typically last between two and twenty minutes.3 It starts in the face and chest then spreads throughout the body and might be accompanied by heart palpitations. 6 Often mistaken for panic attacks, hot flashes are the most common reported symptom. 4, 6
- Vaginal dryness. Vaginal dryness is associated with itching and irritation. It is strongly linked to estrogen deficiency.4 Low estrogen levels can cause thinning in the vulvar mucosa and decreased lubrication, which results in painful intercourse and sometimes bleeding.1
- Urinary problems. Painful urination or frequent urinary tract infections are also the result of low estrogen levels.1, 4 The symptoms are progressive and can have a serious impact on the quality of life of a menopausal woman.7 Urinary problems and vaginal dryness are not frequently reported by women because they are often reluctant in addressing these symptoms with their doctor.2 Referred to as genitourinary syndrome, it is the most underdiagnosed and undertreated condition.2
- Weight gain. Obesity tends to be more common in menopausal women.2 Even though studies suggest that weight gain is associated with aging rather than menopause, the redistribution of body fat, specifically visceral fat, is associated with menopause. Visceral fat around the abdominal organs leads to an increase in waist circumference and a noticeable change in body shape.2 Weight gain might also increase the prevalence of hot flashes.
- Sleep difficulties. Sleep quality often declines with age.4 However, menopause appears to be associated with sleep difficulties in women. Sleep disturbances are also related to night sweats. Women who experience vasomotor symptoms at night have inefficient sleep patterns and a reduced feeling of rest during the day compared to women with day-time vasomotor symptoms.2
- Mood changes. Fluctuations in hormonal levels may cause agitation, loss of interest, nervousness, irritability, anxiety, or depression.5
Other less common symptoms of menopause may include:2, 5
- Osteoporosis
- Osteoarthritis
- Reduction in skin thickness, elasticity, and hydration and decline in total collagen content
- Changes in hair distribution i.e., facial hair and balding
- Decrease in muscle mass
- Worsening of adult acne
Managing the symptoms of menopause
Menopause does not require medical treatment. Instead, individualized treatments focus on relieving or managing the symptoms. Hormonal (Estrogen) Therapy is the most effective therapy, but it requires careful consideration of benefits versus risks. This treatment option, which can be topical or systemic, is associated with an increased risk of cancer, especially breast cancer.4
Beneficial lifestyle modifications for:1, 2, 6
- Hot flashes. Avoid smoking, limit alcohol consumption, and dress in layers.
- Genitourinary syndrome. Hormonal or non-hormonal vaginal moisturizers and water-based lubricants can relieve vaginal dryness. Drink adequate water, use unscented products, and wear loose-fitting cotton underwear to reduce urinary tract infections.
- Mood changes. Exercise and relaxation techniques like massage, yoga, and meditation are good to help your mood and reduce stress. Talking things out with friends or a healthcare provider can also be helpful.
- Sleep difficulties: Work on your sleep hygiene and if needed, temporarily try over-the-counter sleep medications.
- Weight gain and muscle loss: Cardio and resistance exercises paired with eating enough protein can help manage weight gain and muscle loss.
- Skin and hair problems: Use moisturizers and conditioners and avoid long showers to reduce dryness and hair loss.
Menopause is a natural process but for many women, it can be a challenging journey. Symptoms usually last up to four years but can be effectively managed. Consulting a medical professional is the best option to determine which treatment options are appropriate and safe.
References
- Hill, D. A., Crider, M., & Hill, S. R. (2016). Hormone therapy and other treatments for symptoms of menopause. American Family Physician, 94(11), 884–889.
- Monteleone, P., Mascagni, G., Giannini, A., Genazzani, A. R., & Simoncini, T. (2018). Symptoms of menopause – global prevalence, physiology and implications. Nature Reviews. Endocrinology, 14(4), 199–215. https://doi.org/10.1038/nrendo.2017.180
- Miller, V. M., Kling, J. M., Files, J. A., Joyner, M. J., Kapoor, E., Moyer, A. M., Rocca, W. A., & Faubion, S. S. (2018). Whatʼs in a name: Are menopausal “hot flashes” a symptom of menopause or a manifestation of neurovascular dysregulation? Menopause (New York, N.Y.), 25(6), 700–703. https://doi.org/10.1097/GME.0000000000001065
- Al-Safi, Z. A., & Santoro, N. (2014). Menopausal hormone therapy and menopausal symptoms. Fertility and Sterility, 101(4), 905–915. https://doi.org/10.1016/j.fertnstert.2014.02.032
- Pajalić, Z., & Raboteg-Šarić, Z. (2020). Determinants of menopause-related symptoms in women during the transition to menopause and the postmenopausal period – A systematic literature review. Journal of Health Sciences (Sarajevo), 10(1), 1–33. https://doi.org/10.17532/jhsci.2020.885
- Peacock K, Ketvertis KM. Menopause. [Updated 2021 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507826/
- Calleja-Agius, J., & Brincat, M. P. (2015). The urogenital system and the menopause. Climacteric : the Journal of the International Menopause Society, 18(sup1), 18–22. https://doi.org/10.3109/13697137.2015.1078206
- Khatoon, A., Husain, S., Husain, S., & Hussain, S. (2018). An overview of menopausal symptoms using the menopause rating scale in a tertiary care center. Journal of Mid-Life Health, 9(3), 150–154. https://doi.org/10.4103/jmh.JMH_31_18
