Symptoms of menopause can very widely from woman to woman. The most common symptoms associated with the transition into menopause include irregular periods, hot flashes, night sweats, and vaginal dryness.
The 4 to 6 years leading up to the final menstrual period are called perimenopause. It is during this time that symptoms are usually most bothersome. Symptoms that are commonly experienced include:
- Irregular periods
- Breast tenderness, especially in the early stages of menopause
- Hot flashes, which are moments of feeling intensely hot, flushed, and sweaty. Hot flashes can last anywhere from 30 seconds to 5 minutes, and can occur multiple times a day.
- Night sweats
- Heart pounding or palpitations
- Vaginal dryness, which may make sex uncomfortable or painful
- Mood changes, irritability, and depression
Menopause can put you at risk for other conditions. Falling estrogen levels also can have hidden effects, such as bone loss and cholesterol changes that increase heart disease risk Table 01.
Estrogen has protective effects on the bones and heart. This is one of the reasons why younger women do not suffer from osteoporosis and heart disease to the extent that older women do.
The period of most rapid postmenopausal bone loss occurs in the first 5 years following menopause. One out of every two women over the age of 50 is at risk for osteoporosis, and one in four will get it unless she takes steps to prevent it. Osteoporosis can result in bone breaks after minor injuries, or even without injury in elderly women.
Women at higher risk for developing osteoporosis include:
- Thin Asian and white women
- Women who drink alcohol excessively
- Women who lead a sedentary lifestyle
- Women who have poor nutritional habits, especially a lack of calcium in the diet
- Women who take certain medications, such as corticosteroids and medications for thyroid problems
Heart disease is the number one killer of women. Heart disease worsens more rapidly after menopause because or falling estrogen levels in the body. Less estrogen in the blood increases bad cholesterol (LDL) and decreases good cholesterol (HDL) levels. An unfavorable ratio of these blood fats can lead to heart attack and other cardiovascular (heart and circulation) problems. Table 01.
Loss of the female sex hormone progesterone increases risk of abnormal thickening of the uterine lining (endometrial hyperplasia) and cancer in some women Table 01.
Endometrial hyperplasia is an abnormal thickening of the uterine lining (endometrium) that usually is not a serious health risk. However, if endometrial hyperplasia is left untreated it can progress to cancer in some women. Women who have a uterus and take estrogen replacement without accompanying progesterone replacement may increase the risk of developing endometrial hyperplasia.
Women who are obese or drink alcohol excessively are more vulnerable to endometrial hyperplasia and cancer, as are those with a family history of endometrial cancer, diabetes, or liver disease.
Irregular vaginal bleeding may indicate an endometrial problem. If you experience changes in your menstrual cycle that last more than 3 months, see your clinician to find out if the changes are related to menopause or another cause.
Table 1. Risks Associated With Menopause
Conditions that may occur due to the hormonal changes of menopause Factors that put you at greater risk for developing the condition Osteoporosis Age (bones weaken with age) Race (white, Asian) Female sex Family history Slender frame Smoking Medications (corticosteroids, anticonvulsants, aluminum-containing antacids, thyroid medications) Poor nutrition Sedentary lifestyle Heart disease Smoking Hypertension Postmenopausal status Diabetes High LDL cholesterol Low HDL cholesterol High triglycerides Family history Uterine cancer Obesity Excessive hair Abnormal vaginal bleeding Liver disease Diabetes Family history High alcohol intake
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