Signs and Symptoms of Menopause

The symptoms of the menopause transition can be divided into early and late onset symptoms. Early symptoms include irregular vaginal bleeding, hot flashes, and night sweats. Late symptoms include vaginal dryness and irritation and osteoporosis. These symptoms are discussed in detail below.

Early Onset Symptoms

Irregular Vaginal Bleeding

Irregular vaginal bleeding may occur during menopause. Some women have minimal problems with abnormal bleeding during perimenopause whereas others have unpredictable, excessive bleeding. Menstrual periods (menses) may occur more frequently (meaning the cycle shortens in duration), or they may get farther and farther apart (meaning the cycle lengthens in duration) before stopping. There is no “normal” pattern of bleeding during the menstrual transition, patterns vary from woman to woman. It is common for women in perimenopause to get a period after going for several months without one. There is also no set length of time it takes for a woman to complete her menopausal transition, as all women are different. It is important to remember that all women who develop irregular menses should be evaluated by her doctor to confirm that the irregular menses are due to menopause and not as a sign of another medical illness.

Hot flashes & night sweats

Hot flashes are common among women undergoing menopause. A hot flash is a feeling of warmth that spreads over the body. A hot flash is sometimes associated with flushing and is sometimes followed by perspiration. Sometimes hot flashes are accompanied by night sweats (episodes of drenching sweats at nighttime). The cause of hot flashes is not yet understood. Recent research theory suggests that women with hot flashes seem to start sweating at a lower environmental temperature than women without hot flashes. There is currently no method to predict when hot flashes will begin and how long they will last. Hot flashes occur in up to 40% of regularly menstruating women in their forties, so they may begin before the menstrual irregularities characteristic of menopause even begin. About 80% of women will be finished having hot flashes after 5 years. Sometimes (in about 10% of women), hot flashes can last as long as 10 years. There is no way to predict when hot flashes will cease, though they tend to decrease in frequency over time. On average, hot flashes last about 5 years. For more, please read the Alternative Treatments for Hot Flashes article.

Read More: Alcohol During Pregnancy Appears to Increase Risk of Atopic Dermatitis in Newborns

Mood Symptoms

There is considerable controversy about exactly which behavioral symptoms are due directly to menopause. Research in this area has been difficult for many reasons. First, mood symptoms are so common to begin with, that it is sometimes difficult in a given woman to know if they are due to menopause. Also, women who have been diagnosed with depression in the past may be sensitive to a recurrence of depression toward the time of menopause, but the menopause isn’t really “the cause” of the depression, strictly speaking. To further complicate matters, mood swings could actually be linked with the sleep disturbance triggered by menopausal night sweats. Researchers are now trying to determine what factors can influence mood symptoms during menopause. Factors that have been suspected and are being analyzed for their impact on menopausal mood symptoms include education level, exercise level, familial support system, and history of depression.

Late Onset Symptoms

Vaginal Symptoms

Vaginal symptoms tend to begin some years after the cessation of menses. Postmenopausal women (the term for women who have completed their menopausal transition) may experience vaginal dryness, itching, or irritation due to the lack of estrogen. Pain with intercourse (dyspareunia) can also result from the loss of estrogen. However, these types of vaginal symptoms can be due to other causes as well, and should be evaluated by a physician.

Osteoporosis

Osteoporosis is the deterioration of the quantity and quality of bone that causes an increased risk of fracture. The density of the bone (bone mineral density) normally begins to decrease in women during the 4th decade of life. However, that normal decline in bone density is accelerated during the menopausal transition. As a consequence, both age and the hormonal changes due to the menopause transition act together to cause osteoporosis.

The osteoporosis process can operate silently for decades. Some osteoporosis fractures may escape detection until years later. Patients may not thus be aware of their osteoporosis until suffering a painful fracture. The symptoms are then related to the location of the fractures.

Skin Changes Associated With Menopause

Many menopausal women notice changes in their skin-especially increased dryness and wrinkling. These changes are believed to be due in part to the breakdown of collagen in the skin due to decreasing estrogen levels, which also decreases the blood vessel supply to the skin. Smoking and sun exposure also contribute to skin dryness and wrinkles. Hormone replacement therapy appears to increase skin thickness and elasticity and restore blood flow and moisture, thereby decreasing wrinkling.

Specialized estrogen creams also have beneficial effects on facial skin. In one study, skin elasticity and firmness improved markedly after six months of treatment with topical estrogen creams. Additionally, wrinkle depth decreased by 61% to 100% in all women who participated in the study. Treatment with topical estrogen appears to increase the amount of collagen-the substance responsible for skin thickness and elasticity-in the skin.

Topical estrogen creams do not raise the level of estrogen in the body. Women who cannot tolerate oral forms of estrogen may be able to use topical forms of the hormone without negative side effects. Because these creams are not commonly used, you may need to see a dermatologist if you are not taking HRT. Other antiwrinkling treatments, such as acidic creams and gels, also may be prescribed, especially if sun damage also is a problem