Menopause is an individualized experience. Some women notice
little difference in their bodies or moods, while others find the
change extremely bothersome and disruptive. Estrogen and
progesterone affect virtually all tissues in the body, but everyone
is influenced by them differently.
Hot flashes, or flushes, are the most common symptom of
menopause, affecting more than 60 percent of menopausal women in
the U.S. A hot flash is a sudden sensation of intense heat in the
upper part or all of your body. Your face and neck may become
flushed, with red blotches appearing on the chest, back, and arms.
This is often followed by profuse sweating and then cold shivering
as body temperature readjusts. A hot flash can last a few moments
or 30 minutes or longer.
Hot flashes occur sporadically and often start several years
before other signs of menopause. They gradually decline in
frequency and intensity as you age. Eighty percent of all women
with hot flashes have them for 2 years or less, while a small
percentage have them for more than 5 years. Hot flashes can happen
at any time. They can be as mild as a light blush, or severe enough
to wake you from a deep sleep. Some women even develop insomnia.
Others have experienced that caffeine, alcohol, hot drinks, spicy
foods, and stressful or frightening events can sometimes trigger a
hot flash. However, avoiding these triggers will not necessarily
prevent all episodes.
Hot flashes appear to be a direct result of decreasing estrogen
levels. In response to falling estrogen levels, your glands release
higher amounts of other hormones that affect the brain's
thermostat, causing body temperatures to fluctuate. Hormone therapy
relieves the discomfort of hot flashes in most cases.
With advancing age, the walls of the vagina become thinner,
dryer, less elastic and more vulnerable to infection. These changes
can make sexual intercourse uncomfortable or painful.
Tissues in the urinary tract also change with age, sometimes
leaving women more susceptible to involuntary loss of urine
), particularly if certain chronic illnesses or
urinary infections are also present. Exercise, coughing, laughing,
lifting heavy objects or similar movements that put pressure on the
bladder may cause small amounts of urine to leak. Lack of regular
physical exercise may contribute to this condition. It's important
to know, however, that incontinence is not a normal part of aging.
Rather, it is usually a treatable condition that warrants medical
evaluation. Recent research has shown that bladder training is a
simple and effective treatment for most cases of incontinence and
is less expensive and safer than medication or surgery.
Within 4 or 5 years after the final menstrual period, there is
an increased chance of vaginal and urinary tract infections. If
symptoms such as painful or overly frequent urination occur,
consult your doctor. Infections are easily treated with
antibiotics, but often tend to recur. To help prevent these
infections, urinate before and after intercourse, be sure your
bladder is not full for long periods, drink plenty of fluids, and
keep your genital area clean. Douching is not thought to be
effective in preventing infection.
A popular myth pictures the menopausal woman shifting from
raging, angry moods into depressive, doleful slumps with no
apparent reason or warning. However, a study by psychologists at
the University of Pittsburgh suggests that menopause does not cause
unpredictable mood swings, depression, or even stress in most
In fact, menopause may even enhance your mental health. It is
not necessarily a negative experience. The Pittsburgh study looked
at three different groups of women: menstruating, menopausal with
no treatment, and menopausal on hormone therapy. The study showed
that the menopausal women suffered no more anxiety, depression,
anger, nervousness or feelings of stress than the group of
menstruating women in the same age range. Although more hot flashes
were reported by the menopausal women not taking hormones,
surprisingly they had better overall mental health than the other
two groups. The women taking hormones worried more about their
bodies and were somewhat more depressed. However, this could be
caused by the hormones themselves.
It's also possible that women who voluntarily take hormones tend
to be more conscious of their bodies in the first place. The
researchers caution that their study includes only healthy women,
so results may apply only to them. Other studies show that women
already taking hormones who are experiencing mood or behavioral
problems sometimes respond well to a change in dosage or type of
The Pittsburgh findings are supported by a New England Research
Institute study which found that menopausal women were no more
depressed than the general population. About 10 percent are
occasionally depressed and 5 percent are persistently depressed.
The exception is women who undergo surgical menopause. Their
depression rate is reportedly double that of women who have a
natural menopause. Studies indicate that women of childbearing age,
particularly those with young children at home, tend to report more
emotional problems than women of other ages.
Studies also have indicated that many cases of depression relate
more to life stresses or "mid-life crises" than to menopause.
Family roles are often altered. Children grow up and move out of
the house, no longer "needing" mom. Social support networks may
change due to divorce. Parents, spouses or other close relatives
may die. Many people are trying to cope with their own aging and/or
a physical illness. People have very different responses to stress
and crisis. Your best friend's response may be negative, leaving
her open to emotional distress and depression, while yours is
positive, resulting in achievement of your goals. For many women,
this stage of life can actually be a period of enormous
For some women, menopause brings a decrease in sexual activity.
Reduced hormone levels cause subtle changes in the genital tissues.
This is thought to be linked to a decline in sexual interest. Lower
estrogen levels decrease the blood supply to the vagina and the
nerves and glands surrounding it. This makes delicate tissues
thinner, drier, and less able to produce secretions to comfortably
lubricate before and during intercourse. Avoiding sex is not
necessary, however. Estrogen creams and oral estrogen can restore
secretions and tissue elasticity. Water-soluble lubricants can also
While changes in hormone production are cited as the major
reason for changes in sexual behavior, many other interpersonal,
psychological, and cultural factors can come into play. For
instance, a Swedish study found that many women use menopause as an
excuse to stop sex completely after years of disinterest. Many
physicians, however, question if declining interest is the cause or
the result of less frequent intercourse.
Some women actually feel liberated after menopause and report an
increased interest in sex. They say they feel relieved that
pregnancy is no longer a worry.
For women in perimenopause, birth control is a confusing issue.
Doctors advise all women who have menstruated, even if irregularly,
within the past year to continue using birth control.
Unfortunately, contraceptive options are limited. Hormone-based
oral and implantable contraceptives are risky in older women who
smoke. Only a few brands of IUD are on the market. The other
options are barrier methods--diaphragms, condoms, and sponges--or
methods requiring surgery such as tubal ligation.
Concerns About Partner's Interest
Some men go through their own set of doubts in middle age. They,
too, often report a decline in sexual activity after age 50. It may
take more time to reach ejaculation, or they may not be able to
reach it at all. Many fear they will fail sexually as they get
older. Remember, sexual problems can arise at any age if there are
doubts about performance. If both partners are well informed about
normal genital changes, each can be more understanding and make
allowances rather than unmeetable demands. Open, candid
communication between partners is important to ensure a successful
sex life well into your seventies and eighties.
Other signs of menopause include achy joints, insomnia, early
wakening, night sweats, difficulty concentrating or remembering
things, headaches and symptoms associated with premenstrual