Women going through the menopause transition often experience one or more menopause-related symptoms. You want to make sure that your symptoms are normally caused by menopause or may be signs of something else, such as a thyroid disorder, depression, a side effect of medication, or just normal aging. Get the straight story on your symptoms from our expert advisors and put your mind at ease.
Q. What symptoms might I expect as I approach menopause?
A. Each woman’s menopause experience is different. Many women who undergo natural menopause report no symptoms at all during the perimenopausal years except for irregular menstrual periods that eventually stop once they reach menopause. Other symptoms may include hot flashes, vaginal dryness, difficulty sleeping, memory problems, mood disturbances, and vaginal dryness. Not all these symptoms are hormone related, and some, such as hot flashes and memory problems, tend to resolve after menopause. Maintaining a healthy lifestyle during this time of transition is essential for your health and can even prevent or alleviate some of these symptoms.
Q. I am bleeding more often and with heavier periods than I used to. I’m 45 years old. What’s wrong with me?
A. Probably nothing. As a woman reaches perimenopause, changes in menstrual flow and frequency are common. A few women simply stop menstruating one day and never have another period. But about 90% of women experience 4 to 8 years of menstrual-cycle changes before their periods finally stop at menopause. Most women report irregular periods. These are caused by erratic production of hormones by the ovaries and less frequent ovulation.
But, it should not be assumed that any abnormal bleeding is simply a part of normal menopause. Most of the time it is, but abnormal uterine bleeding can be a sign of other problems such as fibroids, polyps, infections, and even cancer. It’s always best to be evaluated by a healthcare provider if the bleeding is very heavy or prolonged.
Q. How can I counteract vaginal dryness during menopause?
A. Vaginal dryness is extremely common during menopause. It’s just one of a collection of symptoms known as the
genitourinary syndrome of menopause (GSM) that involves changes to the vulvovaginal area, as well as to the urethra and bladder. These changes can lead to vaginal dryness, pain with intercourse, urinary urgency, and sometimes more frequent bladder infections. These body changes and symptoms are commonly associated with decreased estrogen. However, decreased estrogen is not the only cause of vaginal dryness. It is important to stop using soap and powder on the vulva, stop using fabric softeners and anti-cling products on your underwear, and avoid wearing panty liners and pads. Vaginal moisturizers and lubricants may help. Persistent vaginal dryness and painful intercourse should be evaluated by your healthcare provider. If it is determined to be a symptom of menopause, vaginal dryness can be treated with low-dose vaginal estrogen, or the oral selective estrogen-receptor modulator (SERM) ospemifene can be used. Regular sexual activity can help preserve vaginal function by increasing blood flow to the genital region and helping maintain the size of the vagina. Without sexual activity and estrogen, the vagina can become smaller as well as dryer.
Q. Does menopause cause urine leakage?
No. Women and girls have urinary incontinence (involuntary leaking of urine) but it tends to increase with age. Other factors that have been associated with incontinence include diabetes, obesity, weight gain, depression, hysterectomy, family history, and use of hormone therapy. Some disorders of the pelvic floor (the muscles, ligaments, and connective tissue that support a woman’s internal organs) also may be responsible for the urinary leakage. Embarrassment and lack of awareness about effective treatments are the main reasons women do not seek care. Once you have been examined to determine the cause of the leakage, your healthcare provider can provide you with strategies and treatments to manage this condition, no matter what the cause.
Q. I’m having trouble sleeping, and I’m tired all the time. Is this because of menopause?
A. Some women report sleep disturbances (insomnia) around the time of menopause, and women and their healthcare providers sometimes attribute sleep disturbances to menopause. However, there are many reasons for sleep disturbances besides night sweats (simply, hot flashes at night). Your sleep disturbances may be caused by factors that affect many women beginning at midlife, such as sleep-disordered breathing (known as sleep apnea), restless legs syndrome, stress, anxiety, depression, painful chronic illnesses, and even some medications. Any treatment should first focus on improving your sleep routine—use regular hours to sleep each night, avoid getting too warm while sleeping, avoid stimulants such as caffeine and dark chocolate. When lifestyle changes fail to alleviate sleep disturbances, your clinician may want to refer you to a sleep center to rule out sleep-related disorders before initiating prescription treatment. If your sleep disturbance is related solely to hot flashes, hormone therapy may help.
Q. I’ve been having headaches lately. Is this a symptom of menopause?
A. Studies suggest that hormones may play a role in headaches. Women at increased risk for hormonal headaches during perimenopause are those who have already had headaches influenced by hormones, such as those with a history of headaches around their menstrual periods (so-called
menstrual migraines) or when taking oral contraceptives. Hormonal headaches typically stop when menopause is reached and hormone levels are consistently low. Most headaches do not require treatment or can be treated with nonprescription pain medications. Some headaches, however, can be serious. More serious headaches, including migraines, may require prescription drugs; however, care should be taken to monitor the use of these drugs. If a headache is unusually painful or different from those you have had before, seek medical help promptly.
Q. My memory is just not as good as it used to be, and it’s really bothering me. Does menopause cause this? Will it ever get better?
A. Memory and other cognitive abilities change throughout life. Difficulty concentrating and remembering are common complaints during perimenopause and the years right afterward. Some data imply that even though there is a trend for memory to be worse during the menopause transition, memory after the transition is as good as it was before. Memory problems may be more related to normal cognitive aging, mood, and other factors than to menopause or the menopause transition. Maintaining an extensive social network, remaining physically and mentally active, consuming a healthy diet, not smoking, and consuming alcohol in moderation may all help prevent memory loss. Atherosclerosis (hardening of the arteries) may also contribute to mental decline. Aim for normal cholesterol, normal weight, and normal blood pressure to help protect your brain. Women who are concerned about declining cognitive performance are advised to consult with their healthcare providers.
Q. My family tells me that I’ve become moody, and I admit that I sometimes feel blue or short-tempered. Menopause?
A. Most women make the transition into menopause without experiencing depression, but many women report symptoms of moodiness, depressed mood, anxiety, stress, and a decreased sense of well-being during perimenopause. Women with a history of clinical depression or a history of premenstrual syndrome (PMS) or postpartum depression seem to be particularly vulnerable to recurrent depression during perimenopause, as are women who report significant stress, sexual dysfunction, physical inactivity, or hot flashes. The idea of growing older may be difficult or depressing for some women. Sometimes menopause just comes at a bad time in a woman’s life. She may have other challenges to deal with at midlife, and menopause gives her one more problem on her list. It has been suggested that mood symptoms may be related to erratic fluctuations in estrogen levels, but limited data exist on why this occurs. Antidepressants are the primary pharmacologic treatment for menopause-associated depression. Hormone therapy and hormone contraceptives can be used as off-label therapies, especially in women with concurrent hot flashes. The wide range of psychological symptoms reported during the menopause transition, from irritability and blue moods to the recurrence of major depression, can be identified and often treated by a woman’s primary care provider or by a menopause practitioner.
Q. How can I find a menopause specialist?
A. The North American Menopause Society maintains a
search feature on this website for those women in the United States or Canada who are looking for an expert interested in helping them manage their health through menopause and beyond. Healthcare providers who have passed a competency examination leading to the prestigious credential of NAMS Certified Menopause Practitioner (NCMP) are noted in the displayed results.