At menopause, the type and level of hormones produced by the body changes. Less oestrogen is produced. Progesterone production usually ceases and testosterone levels continue to decrease. These hormone changes affect the body in different ways. Loss of oestrogen tends to be the main cause of menopausal symptoms. The ongoing decrease in testosterone levels can also attribute to the symptoms of decreased libido (sex drive) and energy levels.
Why Is Oestrogen So Important?
Oestrogen exerts its effects throughout most of the body – vagina, uterus, brain, bowel, heart, blood and skin.
- It plays an important role in keeping the lining of the uterus (endometrium) healthy and maintaining muscle tone in the vagina and cervix.
- Oestrogen also helps in the protection of cardiovascular and bone health.
- It also prevents the accumulation of fat around the abdomen.
Not every woman will have physical or emotional symptoms of menopause, but up to at least 60% will experience mild to moderate symptoms. 20% of women are considered to suffer severe symptoms which impact greatly upon their quality of life. Menopause as a result of medical treatment or surgery is considered to increase the severity of symptoms. Symptoms can include:
Hot Flushes and Night Sweats - Vasomotor Symptoms
- Considered the hallmark symptom of menopause and likely the most recognised by women.
- It affects up to 80% of women and can be quite debilitating in up to 20% of these women.
- The exact mechanism is not known but flushes and night sweats are thought to be caused by a loss of homeostasis by the central thermoregulatory centre.
- Hot flushes usually involve the face, head, neck and chest.
- They are described as a sensation of burning, overheating and can involve reddening of the skin, sweating and increased heart rate.
- Varying degrees of severity are described with episodes lasting for a few minutes up to 30minutes, ranging from a single episode up to 20 episodes per day.
- Mainly described as “mood swings’, whereby the fluctuating levels of female hormones can cause extreme or rapid change in mood.
- Women often describe irritability, tearfulness, anxiety, feeling low or depressed. But can also report lack of energy and increased fatigue and tiredness.
- Women with a past history of depression have an increased likelihood of depression recurrence during the time of menopause.
- Other symptoms of menopause and their severity can also impact on a woman’s emotional health particularly, severity of hot flushes, sleep disturbance, vaginal dryness and discomfort which impacts on relationship intimacy.
- Concurrent changes in personal, family and professional roles during this time can also attribute.
Vaginal Dryness and Discomfort
- Vaginal dryness is a very common symptom in women experiencing menopause and is a direct effect of the loss of oestrogen.
- More than half of women in menopause are reported to be affected.
- The lack of moisture or lubrication in this area can be very distressing and result in an itching or burning sensation and painful intercourse (dyspareunia). A dry and painful vulval area has also been described.
- Vulval and vaginal dryness also has a major impact on sexual sensation and satisfaction.
- In some cases, women can cease having intercourse altogether due to the associated discomfort. This can cause further emotional distress and affect personal relationships.
- The lack of oestrogen also means that the vaginal tissues are less healthy, resulting in a decreased amount of “good bacteria” (lactobacilli). This can result in undesirable, malodourous vaginal discharge and also infections (vaginitis).
- Vulvo-vaginal symptoms can occur in 50 to 75 percent of women with breast cancer or during treatment with Tamoxifen and aromatase inhibitors.
Sexuality and Libido
- In addition to changes to a woman’s vaginal tissues, some women also describe changes in sexual desire during menopause and in the post-menopausal phase.
- Women often report a decrease in libido or sexual drive.
- This is due to the reduced levels of oestrogen and testosterone but can also be secondary to discomfort during intercourse due to decreased vaginal lubrication.
Bladder and Urinary Symptoms
- Changes to the urinary system of a woman are also common during menopause.
- Up to 50 percent of women describe stress incontinence – the accidental loss of urine caused by weak pelvic floor muscles, particularly during coughing, sneezing, laughing, lifting or exercise.
- The lack of oestrogen causes thinning to the lining of the urethra, which weakens the muscles which support and control urine leakage.
- Women can also report urge incontinence – whereby there is an urgency to empty the bladder, even with the smallest amount of urine in the bladder.
- Frequent urinary tract infections can also occur.
Memory and Menopause
- Memory loss is another common symptom experienced during menopause and also during the perimenopause phase.
- Oestrogen stimulates neurotransmitters in the brain to achieve memory.
- When the levels of oestrogen in the brain decrease, this results in the brain not being able to function at its best potential.
- This is a common symptom affecting at least 50 percent of women.
- It can be impacted by other symptoms of menopause such as hot flushes and night sweats.
Bone and Joint Aches
- Although this is generally considered a common problem in both men and women as they age, joint pain is also a recognised symptoms of menopause.
- The fluctuation in hormones can play a major role in a woman’s bone and joint health.
- When a woman’s hormones are imbalanced during menopause, joint pain is often experienced. It is thought that oestrogen usually helps to decrease inflammation in joints. As the levels of oestrogen fall, joints are more prone to swelling and inflammation and therefore joint pain results.
- The risk of osteoporosis (bone loss) also increases following menopause.