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8 Changes That Come With Menopause

Are you having sleeping problems? Hot flashes? Mood swings? Here’s what you need to know.

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You know those ambitious, entrepreneur types who like to dabble in just about everything? Well, your hormones are kind of like them. Sure, they're known for their reproductive prowess, but that's not their only role. They influence everything from your brain to your bones, even your heart. So, when estrogen levels start to fall during menopause, your entire body is affected.

Whether your midlife change is smooth sailing or a wild, rollicking ride, menopause can have a wide-ranging effect on both your mental and physical health. Here are eight common signs that signal you're probably going through "the change."

Medically reviewed in December 2020.

Hot flashes and night sweats

2 / 10 Hot flashes and night sweats

For about three in four women, menopause can really heat things up. The exact cause of hot flashes is unknown, but some experts think low estrogen triggers a malfunction in the area of the brain that controls body temperature. So, the brain thinks the body is overheating and tells the nervous system to release body heat ASAP. The result is intense hot spells that can turn you red and drench you in sweat. The quicker you go through menopause, the more intense symptoms may be.

Smoking and stress can raise your risk of hot flashes and night sweats. About 20 percent of women will have hot flashes that impair their quality of life, says JoAnn Manson, DrPH, MD, chief of preventive medicine at Brigham and Women's Hospital in Boston.

Insomnia

3 / 10 Insomnia

Getting a good night's sleep can be a major challenge for menopausal people, for multiple reasons:

  • During the menopause transition, production of estrogen and progesterone (a sleep-promoting hormone) decline, which can make falling and staying asleep tougher.
  • Hot flashes can jolt you awake. Then, the physical discomfort and sheet-drenching that often accompany night sweats can keep you from getting back to sleep.
  • Urinary symptoms are common to women going through menopause, so you may get up during the night to pee.
  • People going through menopause have a higher risk of sleep apnea, or interrupted breathing during sleep.

Add the usual midlife stresses, such as work and family, and you can see why sleep may so often evade menopausal people.

Mood swings

4 / 10 Mood swings

Just as PMS can trigger cravings and crankiness, fluctuating hormone levels can cause emotional symptoms, too. Sadness, irritability, fatigue, anxiety and aggressiveness are some of the feelings that can crop up along your journey.

“Women may cry at the drop of a hat over something that on a different day wouldn’t bother them,” says Judith Volkar, MD, of the Center for Specialized Women’s Health at Cleveland Clinic.

While most people go through menopause without serious emotional health issues, many will experience depression. Depression differs from mood swings, and is often characterized by prolonged sadness, fatigue and loss of interest in things you formerly enjoyed. If you have a personal history of mood disorders or other psychiatric conditions, you may be more prone to depression during menopause.

Sexual Changes

5 / 10 Sexual Changes

Menopause does not mean your sex life is over. Still, midlife changes can pose new challenges. Lower levels of estrogen can cause your vulva and vaginal walls to become dry, thin and fragile, and sex may feel less comfortable. Called genitourinary syndrome of menopause (GSM), the condition affects between 27 and 84 percent of women, according to the North American Menopause Society.

Prescription vaginal estrogen may ease symptoms, including discomfort during intercourse. Lubes and moisturizers may help, as well. Speak with a healthcare provider about treatments that could work for you.

Remember that as you age, other people’s bodies change, too. The ways in which you express intimacy and affection may not be the same as when you were 21, but they can still be satisfying.

Urinary trouble

6 / 10 Urinary trouble

Feel like you're taking more trips to the bathroom than you used to? GSM affects your ability to urinate, too.

Pelvic floor muscles, which are responsible for bladder control, may weaken as you get older. In addition, the ovaries begin to stop manufacturing estrogen, which helps protect the lining of the bladder and urethra (the tube that empties your urine). When the body’s production of estrogen slows down, some women may become more prone to urinary tract infections or incontinence. That means you may have a tough time holding your bladder long enough to get to the bathroom (urinary urge incontinence), or you might experience a trickle when you cough, laugh or sneeze (urinary stress incontinence).

Cardiovascular Changes

7 / 10 Cardiovascular Changes

Total cholesterol, LDL (bad) cholesterol and triglycerides often increase during menopause, while HDL (good) cholesterol decreases. That said, although a woman's risk for heart disease rises after age 50, it may have less to do with her midlife change and more to do with getting older, explains Margery Gass, MD, former executive director of The North American Menopause Society. "It's really a product of age and lifestyle," she says. Still, hormonal changes during menopause can lead to weight gain and may contribute to increased blood pressure—both of which are risk factors for heart disease.

Bone loss

8 / 10 Bone loss

Bone density doesn’t change much between age 30 and menopause. (It may decline slightly.) After that, lower levels of hormones such as estrogen tend to weaken bones, which is why from the onset of menopause to about 10 years later, women lose an average of 25 percent of their bone mass. As your bones become weaker and more porous, your risk of fractures and osteoporosis goes up.

The more bone you have at the time of peak bone mass, the better protected you'll be once bone loss begins. Eating foods rich in bone-building nutrients can help—especially protein, calcium, potassium and vitamin D.

Brain fog

9 / 10 Brain fog

Feeling a little hazy lately? The so-called brain fog of menopause is real for some women, Dr. Gass says. During the change, between one- and two-thirds of women report forgetfulness and other mental hiccups. Starting during perimenopause, women may have a tougher time staying focused, solving difficult tasks or retaining new information. But don't despair. According to Gass, some studies suggest that these memory lapses last only as long as menopause. Think of it as pregnancy brain for the menopause set.

Going forward

10 / 10 Going forward

While menopause can be a challenging rite of passage, if you are like many women, you may find there is an upside to this time of life. It’s often marked by a greater sense of confidence, control and personal direction. There are many things you can do to make navigating menopause easier. Adopting healthy habits and taking care of your physical and mental health—including paying attention to and getting help for symptoms—can make all the difference in how smoothly you pass through this time of change.

Sources:

The North American Menopause Society. “Menopause FAQS: Hot Flashes.” 2020. Accessed December 18, 2020.
Mayo Clinic. “Hot flashes.” April 24, 2020.
WomensHealth.gov. “Menopause symptoms and relief.” May 22, 2018. Accessed December 18, 2020.
P Proserpio, S Marra, et al. “Insomnia and menopause: a narrative review on mechanisms and treatments.” Climacteric. 2020. Volume 23, Issue 6.
RL Smith, JA Flaws, MM Mahoney. “Factors associated with poor sleep during menopause: results from the Midlife Women's Health Study.” Sleep Medicine. May 2018, Volume 45, pages 98-105.
Johns Hopkins Medicine. “How Does Menopause Affect My Sleep?” 2020. Accessed December 18, 2020.
E Perger, P Mattaliano, C Lombardi. “Menopause and Sleep Apnea.” Maturitas. June 2019. Volume 124, pages 35-38.
AG Mirer, T Young, et al. “Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study.” Menopause. February 2017. 24(2), 157–162.
M Azizi, E Fooladi, et al. “Biopsychosocial Risk Factors of Depression in the Menopausal Transition: A Narrative Review.” Iranian Journal of Psychiatry and Behavioral Sciences. July 22, 2018. 12 (4); e12928.
CN Soares. “Can depression be a menopause-associated risk?” BMC Medicine. December 2010. 8(1):79.
The North American Menopause Society. “Changes in the Vagina and Vulva.” 2020. Accessed December 18, 2020.
SS Faubion, SA Kingsberg, et al. “The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.” Menopause: The Journal of The North American Menopause Society. 2020. Vol. 27, No. 9, pp. 976-992.
E Moral, JL Delgado, et al. “Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study.” Climacteric. 2018 Apr;21(2):167-173.
J Gandhi, A Chen, et al. “Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management.” American Journal of Obstetrics & Gynecology. 2016 Dec;215(6):704-711.
G Kołodyńska, M Zalewski, & K Rożek-Piechura. “Urinary incontinence in postmenopausal women - causes, symptoms, treatment.” Przegladmenopauzalny = Menopause review. April 2019. 18(1), 46–50.
American Heart Association. “Menopause and Heart Disease.” July 31, 2015. Accessed December 18, 2020.
S Reddy Kilim, & SR Chandala. “A comparative study of lipid profile and oestradiol in pre- and post-menopausal women.” Journal of clinical and diagnostic research: JCDR. August 2013. 7(8), 1596–1598.
Memorial Hermann. “Heart Disease and Age.” 2020. Accessed December 18, 2020.
BL Abramson, K Srivaratharajah, et al. “Women and Hypertension: Beyond the 2017 Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.” American College of Cardiology. July 17, 2018.
American Academy of Orthopaedic Surgeons. “Healthy Bones at Every Age.” 2020. Accessed December 18, 2020.
NIH Osteoporosis and Related Bone Diseases National Resource Center. “Osteoporosis: Peak Bone Mass in Women.” October 2018. Accessed December 18, 2020.
WomensHealth.gov. “Osteoporosis.” August 30, 2017. Accessed December 18, 2020.
S Marshall & M Rees. “Managing menopause and post-reproductive health with nutrition and lifestyle.” Nutrition & Dietetics: Journal of Dietitians Australia. August 26, 2020. Volume 77, Issue S1.
UpToDate. “Patient education: Osteoporosis prevention and treatment (Beyond the Basics).” November 2020. Accessed December 18, 2020.
J Ha, SA Kim, et al. “The association of potassium intake with bone mineral density and the prevalence of osteoporosis among older Korean adults.” Nutrition research and practice. February 14, 2020. 14(1), 55–61.
JR Sliwinski, AK Johnson, & GR Elkins, G. R. “Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind-Body Medicine to Improve Cognitive Performance.” Integrative medicine insights. 2014. 9, 17–23.
R Thurston. “Cognition and the menopausal transition: is perception reality?” Menopause. December 2013. Volume 20, Issue 12, p1231-1232.

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