What Symptoms Are Caused By The Reduced Levels Of Estrogen In My Body
About 75 percent of women experience hot flashes during menopause, making them the most common symptom experienced by menopausal women. Hot flashes can occur during the day or at night. Some women may also experience muscle and joint pain, known as arthralgia, or mood swings.
It may be difficult to determine whether these symptoms are caused by shifts in your hormones, life circumstances, or the aging process itself.
Understanding The Menopausal Transition
Menopause is a point in time 12 months after a woman’s last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.
The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity. During perimenopause, the body’s production of estrogen and progesterone, two hormones made by the ovaries, varies greatly.
The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.
What Happens After Menopause
After menopause you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can mean that you have a serious health problem.
You may experience any of the following after menopause:
- Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.
- Menopause symptoms instead of period problems. After menopause, most women get relief from period problems or menopause symptoms. However, you may still experience symptoms such as hot flashes because of changing estrogen levels. One recent study found that hot flashes can continue for up to 14 years after menopause.6,7
- Vaginal dryness. Vaginal dryness may be more common post-menopause. Learn more about treatments for vaginal dryness.
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Cancer Risk And Age At Menopause
According to the American Society of Clinical Oncology, women who experience late-onset menopause have an increased risk of uterine and breast cancer. This is due to having an increased exposure to hormones such as estrogen. As women menstruate longer, they have more ovulations which also increases the risk of ovarian cancer. Women with a long reproductive life, menarche before the age of 12 years and menopause after age 55 years have an increased risk of these hormone-dependent cancers. A pooled analysis of data from more than 400,000 women found for every year older a woman was at menopause, breast cancer risk increased by approximately 3%.
What Other Factors Influence When Perimenopause Starts Or When A Woman Reaches Menopause
New research published online on April 12 in Menopause, the journal of NAMS, looked at the various factors that may affect the age when natural menopause occurs.
They found that there are factors that do seem predictive of when a woman will approach menopause, such as higher and follicle-stimulating hormone levels, which weve known for a while,” says Streicher. Irregular menstrual bleeding and hot flashes were also indicators of earlier menopause, she adds.
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One new finding uncovered in the research was around alcohol consumption. The authors observed that participants tended to increase their alcohol consumption when approaching menopause, making it a potential clue that the change was coming.
That makes sense, says Streicher. This can be a time of added stress for women, and we know that any can cause someone to drink more, she says.
Although this study didnt find a strong association with smoking, other research has indicated that smoking is related to early onset of menopause, says Streicher.
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The Course Of Perimenopause
A change in your periods is often the first sign of perimenopause, but there are other signs to look out for. The most common are hot flashes, sleep problems, vaginal dryness, mood changes, and a decrease in sex drive. Not every woman will experience all of these symptoms. For those who have symptoms, they may come in any order.
Once these symptoms arrive, most women can expect menopause itself to be a few years away.
There are many treatments to help with bothersome symptoms like hot flashes and sleeplessness. Even a few years of hormone therapy can help you get through the worst of it.
If you are prone to anxiety or depression, know that perimenopause can bring those conditions back to the surface. Finding a support network can make a big difference. Antidepressants also may be an option.
Why Am I Gaining Weight During Perimenopause
The shift in hormones slows down your metabolism. Its very common for women in perimenopause to gain weight once their estrogen levels start to decline. Maintaining a healthy diet and regular exercise can help prevent weight gain during the transition to menopause.
A note from Cleveland Clinic
Perimenopause is the transition to menopause. During perimenopause, you may start having menopause-like symptoms, such as hot flashes, mood swings or vaginal dryness. Most perimenopause symptoms are manageable. But if you need help managing symptoms, medications and other treatments are available. Perimenopause ends when youve had no period for a full year. At that point, you enter menopause.
Last reviewed by a Cleveland Clinic medical professional on 10/05/2021.
References
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Why Does Menopause Occur
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- Natural menopause occurs when levels of oestrogen and progesterone decline naturally.
- Premature menopause is when periods stop before the age of 40 years. This can be due to many reasons including medical conditions such as diabetes or underactive thyroid , and surgery or medications that have affected the blood supply to the ovaries. Genetic factors may also play a part as premature menopause can run in families. Women who smoke are also more likely to go through premature menopause. Sometimes, however, there is no identifiable cause.
- Artificial menopause is a consequence of surgical removal of both ovaries or destruction of the ovaries by some cancer treatments. With artificial menopause there is a sudden drop in hormone levels and menopausal symptoms begin abruptly. Often the symptoms experienced are more severe than those experienced with natural or premature menopause.
Should I Continue Using Birth Control During The Transition To Menopause
Yes. You can still get pregnant during perimenopause, the transition to menopause, even if you miss your period for a month or a few months. During perimenopause you may still ovulate, or release an egg, on some months.
But it is impossible to know for sure when you will ovulate. If you dont want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your birth control needs. Learn more about different birth control methods.
You cant get pregnant after menopause, but anyone who has sex can get sexually transmitted infections . If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or dental dam correctly every time you have vaginal, oral, or anal sex. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sex, exposing you to STIs.
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How Will Menopause Affect Me
Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome . Others may be new to you. For example:
- Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
- Your periods might be heavier or lighter than before.
- You might have hot flashes and problems sleeping.
- You might experience mood swings or be irritable.
- You might experience vaginal dryness. Sex may be uncomfortable or painful.
- You may have less interest in sex. It may take longer for you to get aroused.
Other possible changes are not as noticeable. For example, you might begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke.
Talk to your doctor about possible treatment for your menopause symptoms if they bother you.
How Is Menopause Diagnosed
There isnt a specific test for menopause. Your doctor will help you determine if you are menopausal based on how frequent your periods are and what symptoms you are experiencing. Menopause is confirmed 12 months after your last period. Blood tests are unlikely to accurately predict menopause.
Seek medical advice if you are concerned about irregular cycles, heavy or abnormal bleeding, or symptoms that interfere with your daily life. Your doctor may also suggest other health checks such as a mammogram, or cervical screening.
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How Can Your Doctor Help
If your symptoms are becoming unbearable and self-help tips and herbal remedies havent helped, it might be time to pay a visit to your doctor.
Traditionally doctors would recommend HRT for the menopause. HRT involves the introduction of medication that provides synthetic forms of the sex hormone oestrogen and progesterone. This can help with some symptoms of the menopause initially but for many women coming off of
HRT, they experience symptoms of the menopause all over again as a similar drop in hormones is apparent. HRT has also has some bad publication in recent years due to some of the associated side effects and health risks.
In some situations HRT might be necessary or recommended speak to your doctor for more information and in order to carefully discuss and consider your options.
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How Can I Reduce My Risk Of Perimenopause Complications
Irregular periods are the most common symptom of perimenopause. But its important to know when to talk to your healthcare provider about your periods. Sometimes, irregular bleeding can point to an underlying problem.
You can lower your risk of complications by seeking treatment when necessary. Talk to your healthcare provider if you:
- Bleed for more than seven days in a row.
- Bleed between periods.
- Change pads or tampons every one to two hours.
- Have periods more frequently than every 21 days.
General Recommendations For Ht
Current guidelines support the use of HT for the treatment of severe hot flashes that do not respond to non-hormonal therapies. General recommendations include:
- HT may be started in women who have recently entered menopause.
- HT should not be used in women who have started menopause many years ago.
- Women should not take HT if they have risks for stroke, heart disease, blood clots, and breast cancer.
- Currently, there is no consensus on how long HT should be used or at what age it should be discontinued. Treatment should be individualized for a woman’s specific health profile.
- HT should be used only for menopause symptom management, not for chronic disease prevention.
Initiating Therapy
Before starting HT, your doctor should give you a comprehensive physical exam and take your medical history to evaluate your risks for:
- Heart disease
- Osteoporosis
- Breast cancer
While taking HT, you should have regular mammograms and pelvic exams and Pap smears. Current guidelines recommend that if HT is needed, it should be initiated around the time of menopause. Studies indicate that the risk of serious side effects is lower for women who use HT while in their 50s. Women who start HT past the age of 60 appear to have a higher risk for side effects such as heart attack, stroke, blood clots, or breast cancer. HT should be used with care in this age group.
Discontinuing Therapy
Safety Concerns
Women who should not take hormone therapy include those with the following conditions:
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What Questions Should I Ask My Doctor
Discuss your perimenopause symptoms with your healthcare provider. It might help to keep a journal of your menstrual cycles including when they start and stop and the amount of bleeding.
Some questions you should ask are:
- Are these symptoms of perimenopause?
- What can I do to relieve my symptoms?
- How long do you think I will have these symptoms?
- Would hormone therapy be an option for me?
- Do I need to start taking medication or vitamins?
- Are there any tests that should be done?
- Can I still become pregnant?
How Can I Treat The Symptoms
There are a bunch of ways.
Lifestyle changes. A healthy diet and regular exercise program will help manage your symptoms and boost your health. This is a great time to finally kick any old, unhealthy habits like smoking or drinking too much alcohol. To help with hot flashes, dress lightly and in layers. Avoid triggers like caffeine and spicy foods. And if you stay sexually active, that may help preserve your vaginal lining.
Prescription medication for hot flashes. If you still have your uterus, your doctor might prescribe treatment with estrogen and progesterone. This is called combination hormone therapy or hormone replacement therapy . It helps with hot flashes and night sweats, and it may help prevent osteoporosis. If you donât have a uterus, you might get estrogen alone.
Hormone therapy isnât for everyone. Donât take it if you’ve ever had breast cancer, uterine or “endometrial” cancer, blood clots, liver disease, or a stroke. Also don’t take it if you might be pregnant or you have undiagnosed vaginal bleeding.
If you can’t or don’t want to take hormones, other medications can ease symptoms. They include antidepressants, antiseizure drugs, or blood pressure medications to help with hot flashes and mood swings.
Prescription and OTC medication for vaginal dryness and sleep problems. You can try topical estrogen, lubricants, and non-estrogen prescriptions for dryness and painful sex. OTC or prescription sleep aids can help if you have trouble falling asleep.
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