Symptoms of Menopause
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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.
Vaginal/Urinary Tract Changes
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 ( incontinence ), 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.
Changes in Mood
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 women.
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 estrogen.
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 freedom.
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 help.
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 syndrome.
National Institutes of Health
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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