Symptoms and signs of menopause

symptoms signs menopauseMenopause symptoms and the associated signs of menopause are part of a woman’s natural reproductive cycle. Most women will have at least one of a variety of menopause symptoms at some time before, during or after the menopause.
During the early teens, your ovaries will start releasing an egg every month. If the egg is fertilized, pregnancy occurs. If there is no fertilization the egg dies. The uterine lining (endometrium) which was built up in preparation for pregnancy, breaks down and is shed – menstruation. There are 4 main hormones involved in the menstrual cycle:

  1. estrogen
  2. progesterone
  3. follicle stimulating hormone (FSH)
  4. luteinizing hormone (LH)

The two that concern you most with regard to signs of menopause and symptoms of menopause are estrogen and progesterone. The menstrual cycle can be divided into 3 parts:

  1. pre-ovulation
  2. post-ovulation
  3. menstruation

In the pre-ovulatory phase, the developing egg releases a lot of estrogen. This makes the endometrium grow and thicken. In the post ovulatory phase, progesterone is secreted in increasing amounts from the corpus luteum which is left in the ovary after ovulation.
It acts to increase the blood supply to the endometrium making it water-logged and rich in nutrients. If pregnancy does not occur, the corpus luteum dies through lack of stimulation from a growing fetus. Following this, the secretion of estrogen and progesterone declines.

The endometrium does not have enough hormonal stimulation to thrive and starts to break down shedding the top 2 layers and leaving the basal layer intact. This is referred to as menstruation. In the absence of pregnancy, this cycle occurs roughly every month (22-35 days).

There is a limited number of eggs in the ovaries and as you get older, more and more of them die off. By the time you’re in your 40s, most of the eggs have been released during ovulation or died and the few that are left are usually of poor quality. Ovulation may not occur every month and the length of the menstrual cycle gradually increases. Menstruation becomes irregular until eventually periods stop altogether.

During this time of irregular ovulation/menstruation, there is a lot of variation in estrogen and progesterone levels. Estrogen levels tend to be higher than those of progesterone, leading to the use of the term ‘estrogen dominance’ to describe this imbalance. Without a corpus luteum there is very little secretion of progesterone.

However, estrogen is still produced (in the fat cell for example) from conversion of androgens (male sex hormones) produced by the ovaries and adrenal glands. Menopause symptoms and menopause signs are thus caused by several factors:

  1. imbalance between estrogen and progesterone
  2. progesterone deficiency
  3. estrogen deficiency

The following list of menopause symptoms and menopause signs is very long and far from exhaustive. Fortunately, no woman will have all the menopause symptoms and signs and some women are fortunate enough to have relatively mild menopause symptoms.

Hot flashes / hot flushes

Hot flashes (or flushes) are the most common menopause symptom. They affect up to 85% of perimenopausal and menopausal women. They may be more severe in women who stop producing estrogen suddenly and in women who have surgical menopause through removal of their ovaries. Even if the uterus is removed without removing the ovaries, changes in blood supply to the ovaries may mean that they don’t function properly.

Night sweats

This is also known as nocturnal hyperhydrosis and involves waking up at night to find yourself drenched in sweat.

Irregular menstruation

Normal periods may change during menopause. the time between each period may become much shorter or longer. The period may be absent for a couple of months. The flow of the period may also become heavier or lighter.

Vaginal dryness

The lining of the vagina becomes very thin and fragile making it irritated and sore. It also loses its elastic nature and can’t stretch the way it used to. Estrogen and progesterone help to keep the vagina healthy. Without them, the vagina eventually shrinks, a process called vaginal atrophy. It also makes intercourse uncomfortable and even painful.

Other menopause symptoms include

  • chest pain
  • palpitations
  • sore breasts
  • itchy vulva
  • loss of sex drive
  • slower sexual arousal
  • constipation
  • abdominal bloating
  • increased facial hair
  • thinning hair
  • itchy skin
  • brittle nails
  • pins and needles
  • sore muscles
  • stiff/swollen joints
  • osteoporosis
  • back pain

These menopause symptoms occur at various times. Early symptoms of menopause include irregular or heavy vaginal bleeding while menopause symptoms like thinning of the hair and brittle nails may not occur for several years after the menopause.

black cohoshThe herb black cohosh is used by many menopausal women to relieve symptoms of menopause especially hot flashes and night sweats as an alternative to estrogen/progesterone hormone replacement therapy.

However, the results of a study published recently found that it was no more effective than placebo (usually an inactive sugar pill) for treating menopause symptoms.
Should this worry you? Probably not! There’s been some criticism of this study. Only one brand of black cohosh was used. Effectiveness of the herb can vary depending on how it is extracted. The two best studied black cohosh extracts are those found in Remifemin and Klimadynon and these have been found to consistently improve menopause symptoms. Also, black cohosh wasn’t found to be harmful to the women that took it.

Black cohosh may not work as fast as HRT but it does not have estrogenic effects which is great for women who want to avoid estrogen. So if you’re using black cohosh and it’s working for you, keep doing what you’re doing – well, until another study tells you otherwise!

Increased heart risks with severe menopause symptoms

Women who have severe menopause symptoms are more likely to develop heart disease according to a recent study. Those who had the most hot flushes and night sweats had higher cholesterol levels, higher blood pressure, higher BMI and a higher risk of developing heart disease over the next 10 years. It is possible that the deficiency in estrogen that leads to the hot flashes may also have a negative effect on the cardiovascular system.
Seeing as research has shown that taking hormones to reduce the risks of heart disease has shown that it does the opposite over time, taking HRT to prevent heart disease is not a good idea.
The only other option is a healthier lifestyle – a balanced high-fiber diet and 20-30 minutes of exercise at least 3 times a week even before menopause.

Breast cancer survivors, yoga and menopause symptoms

yoga, breast cancerBreast cancer survivors often have problems when it comes to managing menopause symptoms. Use of hormonal therapy may lead to a relapse of the cancer. In addition, some of the medication used to treat breast cancer can themselves worsen menopause symptoms.
According to a recent US study, breast cancer survivors can find relief from menopause symptoms like hot flashes, through yoga.
The “Yoga of Awareness” program included stretching, breathing exercises, meditation and group discussions.

“Yoga of Awareness” is based on traditional yoga techniques that go beyond the teaching of specific postures to incorporate practices aimed at reducing stress and creating a heightened sense of awareness and acceptance about one’s physical and mental state.

The beneficial effects included:

  • reduction in frequency and severity of hot flashes,
  • fewer sleep disturbances
  • less joint pain
  • more energy

This isn’t the usual run of the mill yoga course. Get in touch with an experienced yoga instructor if you want similar results.

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  1. Conception has never been a problem for me (pregnant three times on the very first try) and according to the ovulation scope I use each month to, ironically, make sure I don’t get pregnant, I ovulate regularly (and even since all this started, FSH has always been normal) although now that I’m approaching 40, I expect that will start to change.

    To be honest, I don’t think I have POV. The only other possibility that was mentioned was PCOS although other than a couple of weird, wiry chin hairs, I have absolutely no symptoms or signs and believe me, I’ve had enough bloodwork for three lifetimes…lol

    Thanks for your help 🙂

  2. Hi Izzy. I know how frustrating this kind of thing can be. It’s difficult to give you a definite answer because your doctor and Ob/midwife who have been attending to you will have a more accurate idea about what’s going on.
    There are a couple of things I can tell you though.

    1. You can divide ovarian failure into 4 stages with grade 1 being the mildest. This is also known as occult (hidden) ovarian failure where you may have regular menstruation and still experience hot flashes and other menoause symptoms.
    2. Ovarian failure sometimes becomes apparent after pregnancy or coming off oral contraceptives.
    3. Women with ovarian failure may still ovulate once in a while and so pregnancy is not impossible but they do tend to have infertility.
    4. If you ovulate, you will have progesterone in your circulation

    Like I said, I’m assuming you actually do have ovarian failure because your doctor is in the best position to know what’s going on.
    You managed to conceive? You’re really blessed!
    Take care.

  3. Since the birth of my first child, when i was 34, I have had many symptoms of menopause.

    I was put on an estrogen patch and birth control pills, which have helped tremendously but the few times Ihave tried to go off my pills or been late putting on my patch, the symptoms come right back. The main ones are sore muscles/muscle tension, stiff, achy joints, vaginal dryness, heart palpitations and extreme irritability.

    My ob/midwife says that it’s not widely talked about but that it’s not uncommon for your hormones to be permanently altered after childbirth and that she sees a number of women in the same boat as me.

    I’ve never heard of this and have only met one other woman who was having the same exact problems. Have you heard of this happening after childbirth?

    Incidentally, by going off birth control but staying on my patch, I was able to conceive and have another child but I still have the same menopausal symptoms if I’m not vigilant with the patch.

    The doctor who originally prescribed the patch/pill combo for me said I had premature ovarian failure but my progesterone levels were always very normal. If my ovaries were failing, wouldn’t all ovarian hormones be low, not just estrogen?

    Sorry for this long comment and all the questions. it’s just that after seven years, I’m still confused about all of this and wish i knew what was wrong with me.

  4. Hi Kelly. I know it must be a little difficult waiting to see if your period is going to turn up each month, don’t lose hope.
    Out of curiosity, I just wanted to ask how you know that you ovulated 2 days ago.
    As for the sore nipples, there is the tendency for them to be sore in the second half of the menstrual cycle because of increased levels of progesterone. Progesterone causes water retention which can lead to sensitivity and soreness. That said, 2 days after ovulation is too early to know if you’re pregnant. Difficult as it may be, just give it a little time. If it happens, there’s no way you won’t find out eventually.
    Take care.

  5. I actually have a question. I’m 44 and ttc. My nipples are sore and I ovulated 2 days ago. Is this a post-ovulation symptom? I really need to know so I don’t get my hopes up. Thank you for your reply.

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