What To Expect

Symptoms

Common Symptoms At A Glance

  • Hot flashes
  • Night sweats
  • Insomnia
  • Vaginal dryness and painful intercourse
  • Reduced libido (sex drive)
  • Hair Loss
  • Mood swings and/or depression
  • Headaches
  • Short-term memory loss
  • Stress incontinence
  • Weight gain
  • Dry skin
  • Increased cholesterol levels
  • Atherosclerosis (hardening of the arteries)
  • Osteoporosis (thinning, weakening of bones)

Every Woman Is Different

It’s important to remember that a woman’s hormones are incredibly complex and every woman’s symptoms are different, depending on her genes and environmental influence. You’ve probably heard of common symptoms such as hot flashes, sleep disturbances and night sweats. But there are many others, with each symptom being individual to each woman.

Your mother may have experienced nosebleeds and depression. You may experience less of that but may have difficulty driving for long periods of time due to blurred vision. And your sister could have yet another set of symptoms.

If you’ve had flawless skin all your life, you may notice your first telltale facial wrinkles. Some women find that a lifelong battle with acne-prone skin ends at menopause. And, some women’s hair thins; then, after a few months on good vitamin or herbal supplements, it thickens again, or becomes wavy.

Vaginal Changes

You may also notice significant changes in your vaginal tissue. Because estrogen declines, you may find your vagina might be a little (or a lot) dry or, you may notice other changes outlined below.

Dry Vagina

Decreased lubrication, dryness and itching are often the first signs of change during perimenopause or as a result of surgical or induced menopause. This dryness is due to diminished blood flow to the vaginal walls, fewer cells lining the walls, less mucous produced by the cervix, and less fluid in general. Without the usual moisture, the vagina fails to lubricate properly during sexual arousal and intercourse, which may result in difficult or painful sexual relations. At least half of women over 60 have some degree of vaginal dryness. Some good news is that regular sexual intercourse actually helps keep the vagina moist and toned.

Vaginal Thinning

As estrogen continues to decline and menopause occurs, the vaginal walls become thinner, less elastic and pale in a process called atrophy. The stretchy wrinkles that provided the expansion required for childbirth smooth out and disappear. The thin, less flexible surface can be easily irritated during intercourse, especially if it is infrequent.

pH level changes

The loss of estrogen also produces a change in the vaginal pH from a normally acidic low to a higher, more alkaline pH. This less acidic environment discourages the growth of important protective organisms such as lactobacillus, which act as a bacterial guard against abnormal bacteria and yeasts. In the absence of lactobacillus, bacterial vaginal infections may occur more frequently, causing discharge and irritation, and contributing to increased urinary tract infections.

Tissues Shrink

Since estrogen has a major role in maintaining the health and function of not just the vagina, but all tissues including the uterus, urinary bladder, and urethra, low levels of the hormone may cause these organs to weaken and shrink. When the bladder is affected, urinary incontinence, infection or painful urination may occur.

Urinary Incontinence May Occur

Because of the changes to the vaginal tissues, you may find yourself suffering from slight or increased urinary incontinence. While symptoms are obvious (involuntary loss or leakage of urine) many people are embarrassed, and hide the condition from family, friends, and their physicians. They mistakenly assume it is just a part of aging to be accepted. In fact, treatments are now available to manage urinary incontinence or to correct underlying conditions. Your primary care physician or OBGYN can help.

Silent Changes

More insidious than the obvious, are the silent effects. One of the jobs of estrogen in the body is to protect the heart. Some women not on hormone replacement therapy (HRT) may have their first problems with heart disease, and increased cholesterol during menopause. Many women also experience depression during this time, because of the complicated interplay of physical, emotional, and environmental factors.

The good news is there are ways to alleviate or manage all the effects of your hormonal changes. Learn how to manage and treat menopausal hormone changes through lifestyle, diet, HRT and more.

Stages of Menopause

Although every woman’s menopause experience is different, the majority of women go through certain phases during the menopause process.

1. The Climacteric Begins

Beginning in your mid-30s, your body’s estrogen and progesterone levels start to decline. This accelerates as you reach your 50s or your menopause phase. During this period your monthly cycles may become markedly irregular. Your testosterone levels may also decline slightly. You may or may not be symptomatic at various times during this period.

Early climacteric symptoms may include:

  • Hot flashes (with possible associated dizziness, shortness of breath, palpitations)
  • Night sweats
  • Sleep disorders, insomnia
  • Vaginal dryness, painful intercourse
  • Reduced libido (sex drive)
  • Dry hair, hair loss
  • Anxiety, mood swings, headaches, depression
  • Short-term memory loss
  • Stress incontinence

Late climacteric symptoms may include:

  • Dry skin, itching, crawly skin
  • Increased cholesterol levels
  • Atherosclerosis (hardening of the arteries)
  • Osteoporosis (thinning, weakening of bones)

2. Menopause: Your Last Period

Reaching menopause, climacteric symptoms may increase or become more intense. This is because your ovaries have run out of eggs and are no longer producing estrogen and progesterone, though small amounts of estrogen are still present in your body, coming you’re your adrenal glands and fat tissues. Your ovaries do continue to produce testosterone, although in slightly lower amounts. These changes cause you to miss several consecutive periods (after pregnancy and other causes have been ruled out). Once you have not had a period for 12 months, you are traditionally considered to have reached menopause.

In some cases, particularly in younger women with irregular bleeding patterns who have not menstruated for 12 months, an FSH test may be helpful in confirming menopause. An FSH level of over 40 ng/dl indicates that a woman is menopausal.

3. After Your Menopause: The Post-Menopausal Phase

You are considered post-menopausal once your menstrual periods stop, and you can no longer become pregnant. At this time, your reproductive organs become smaller and change position, your vagina and urethra tissues get thinner and your skin loses some of its fat layer and moisture. Your bone density decreases and your muscles may lose tone. The fat content of your breasts increase as milk glands shrink and your cholesterol levels may rise. Also, you may notice your body has changed shape.

For most women, if they’re not on hormone replacement therapy (HRT), climacteric symptoms during this phase will gradually cease as their bodies adjust to lower hormone levels.

Psychological Factors

Menopause is a major physiological event for women – we stop ovulating. But menopause also gets confused with other important life issues, as our relationships change and we grow older.

“For many women, menopause is a marker of aging,” says Carol Landau Ph.D., a clinical psychologist on the faculty at Brown University School of Medicine in Rhode Island, and coauthor of The Complete Book of Menopause.

“A lot of us baby boomers are struggling right now, because we were the youthful ones, we were the ones who said, ‘Never trust anyone over 30.’ Well guess what? It’s our time to be older now,” Dr. Landau states. “We’ve got to turn that around – (menopause) could be a marker for more freedom, a marker for more power.”

Menopause And Depression

Many women become depressed at menopause. But no study so far has been able to show that menopause itself causes depression.

“The studies of women who do become depressed at menopause and they’re not the majority, they’re the minority – suggest that those women are under high social stress,” Dr. Landau states.

Menopause comes at a time when many women are still caretaking: caring for their children, worrying about their husband’s health, and taking on the care of their parents or in-laws. “For some women, menopause is like the straw that breaks the camel’s back,” she says. “The danger in blaming ‘hormones’ alone is that it can prevent women from getting proper treatment for depression.”

Seizing The Moment

Just think of menopause as a wake-up call Dr. Landau advises, “It’s like aging is knocking on your door – time to pay attention.”

She recommends some healthy steps to take:

  • Find social support: “Find women who are either your age or older who have been through menopause.” The womenshealth.com community is here to help.
  • Work hard: “I’ve always believed in hard work,” she says, “something that takes you out of yourself,” such as writing, a career change, or community work, for example.
  • Exercise: Find a form of exercise you like and do it at least 3 times a week for 20 minutes.

The most important thing to remember Dr. Landau says, is that most women get through menopause just fine.

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