During the years that your cycles are irregular, so may be your menstrual symptoms. The variability in bleeding is indicative of varying hormone levels. Coincident with this are peri-menopausal symptoms that can be bothersome, and sometimes even worrisome. Many women complain that their breasts are swollen for weeks at a time. Bilateral swelling and tenderness are signs of hormonal change, and rarely a concern of malignancy. Many women who have underlying depression or anxiety may note an exacerbation of symptoms with menopause, especially premenstrually. Because of the irregularity of cycles, it may be difficult to discern that these mood swings are premenstrual. Mild anti-depressants such as fluoxetine can be very helpful in managing mood swings. Many women note that they begin to gain weight in their 40’s. As hormone levels decline, so does metabolism, and changes in diet and exercise can decrease this trend.
Menopausal symptoms can certainly occur before menses cease, but hot flashes and night sweats are most frequent in the two years after the last menstrual period. A hot flash is usually dramatic: sudden onset of heat, often beginning in the chest, and often accompanied by sweating or flushing of the neck and face. It usually last minutes. Some women feel cold afterwards, probably from perspiration evaporating. Some women feel like they want to tear their clothes off, and decide to dress in layers to facilitate the undress. Many women may have milder versions. It is typical to feel warm more often, and less tolerant to mild changes of increased temperature. At night, most women fall asleep normally, but will be awakened at night with a flash of heat and sweating. In the extreme degree, your nightgown is soaked and the sheets are wet, and need to be changed. In a mild degree, you might kick of the covers and go back to sleep. This might occur several times during the night, and if a woman has trouble falling back to sleep, she may truly suffer sleep deprivation. Some women wake up and don't perceive that they are hot, but still experience a sleep disturbance. Studies have determined that women only perceive about 60% of their hot flashes. Sleep deprivation can lead to fatigue, memory disturbances, mood changes, and decreased productivity.
Some women experience mood changes as they progress through the perimenopause and menopause. Depression, anxiety and irritability are more common in women who have had depression and anxiety prior to menopause, or who have suffered these symptoms premenstrually. It is not uncommon to experience fatigue and cognitive changes in menopause, and these may be present even without sleep deprivation. Women sometimes will experience lack of focus, and a decrease in executive function skills. Women may find it difficult to continue with employment that requires concentration and multitasking.
Vaginal dryness in typical at menopause, and may become worse as the years since the last menses increases.
The physical effects of menopause can be minimal or marked. Typical effects of a low estrogen level are hot flashes and night sweats. A hot flash is a sudden feeling of warmth in your body, which can be accompanied by sweating and flushing. These often occur at night, and may be frequent, awakening you from sleep. Some women have trouble falling back to sleep, and the sleep disruption can be very bothersome. Lack of sleep can lead to fatigue and cognitive problems. Women often notice more mood swings and irritability as they approach menopause. Depression and anxiety may be exacerbated by menopause, and sometimes hormone replacement is beneficial. Antidepressants can also be used for mood, and they can help reduce hot flashes. Your doctor will know if this treatment is appropriate for you.
Vaginal dryness can become a real problem, leading to painful intercourse and decrease in sexual activity. The tissues of the vagina and vulva are estrogen dependent, and the longer a woman has lower estrogen levels, the thinner the vaginal wall can be. There are many treatments for this, including lubricants, vaginal estrogen, and laser treatments. You do not have to stop having intercourse!!
Some women note an increase in body fat in the abdominal wall. Women who never had a gut before will complain of an increased waistline. This body fat can be somewhat resistant to exercise and dieting.
Many women notice thinning of hair as they get older. A loss of body hair in the pubic area, and on the arms and legs is not unusual. Hormones do play a role in hair growth, and marked decreases can be investigated with hormonal blood tests.
Oh, and loss of height! Many of my patients are shocked to see that their height decrease as they get older. The two most common causes are osteoporosis and decrease in the integrity of intervertebral discs. It happens to everyone, and should be expected. Bone density should be monitored as changes in the density of the bone occurs more rapidly after menopause. Family history is the greatest risk factor for osteoporosis, and all the calcium and exercise you can manage may not obviate the effect of your genetics.