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Symptoms

article summary

  • Vasomotor symptoms (aka, hot flashes and night sweats) are the top medical complaint during the menopause transition, followed genitourinary symptoms such as vaginal dryness and decreased libido.
  • Common psychological symptoms include difficulty concentrating, memory lapses, mood changes and irritability.
  • Also common: poor sleep, bone loss, skin and body changes
  • All these symptoms have one thing in common: estrogen decline!
  • Symptoms can absolutely be treated and improved with options including lifestyle changes, supplements and herbal remedies, and hormone replacement therapy (HRT). Midi supports all of these, and works with you to make sure you feel confident about the choices you make. While HRT is the gold standard for improving and reducing the severity of most symptoms, it’s not right for every woman, so find a collaborative specialist or Midi clinician to individualize your treatment.

Menopause is just another chapter of change we navigate in life—natural, normal, and not without benefits. Freedom from monthly periods can feel fantastic, along with perks like relaxing about pregnancy and enjoying the perspective you’ve gained through lots of experience. But for most women, perimenopause and menopause come with symptoms related to the hormone transition going on in our bodies. Those symptoms can range from vaguely bothersome to truly devastating. They’re mostly the result of changes in estrogen levels, which become erratic and slowly decline, usually starting in your mid forties.

While you might think that estrogen and other female sex hormones, like progesterone, only influence your reproductive system, that couldn’t be further from the truth. These hormones, particularly estrogen, interact with nearly every system and organ in your body. So it’s no surprise that hormonal chaos impacts everything from your sleep, to your mood, to your brain function.

In this article, we discuss the 12 most common symptoms. You may have heard about them from your mom, friends, or doctor—or they could be news to you, and unlock an “aha” moment about your health. Read on, not just to recognise what you and other women you know might be going through, but to learn about treatments that help. Because every symptom we explore below can be improved with well-chosen interventions. You’ve earned the right to feel good, so get after your symptoms, and know that Midi is always here to help.

1. Irregular periods

A change in your period is often the first sign of perimenopause, and women experience markedly irregular menstrual cycles as time goes on. Period variability usually lasts one to three years, until eventually, it stops entirely.

As ovulation becomes more unpredictable, period patterns also change. Yours may be less frequent, lighter, or much heavier. Your cycle could also become longer or shorter than usual, and premenstrual syndrome (PMS) symptoms can shift along with everything else. The stretches of time between periods may also vary greatly. In late perimenopause, periods in some women get much less frequent, with 60 days or more between.

What helps:

  • Keeping track of your periods, particularly noting the start date, length, heaviness, or any in-between spotting. The more data you have, the easier it is for a clinician to help you decide on treatment.
  • Low dose birth control pills are a good option for many women who want to prevent pregnancy and manage their period flow and timing.
2. Hot flashes

It’s hard to mistake a hot flash—that sudden feeling of intense heat that might come with a flushed face, sweating, rapid heart rate, and wrap up with a cold chill.

About 75% of women experience hot flash symptoms and they may persist for around seven years, with a single episode lasting anywhere from one to ten minutes. The frequency and severity of hot flashes varies widely among women, depending on factors like race, weight, and whether you smoke (which, yes, makes them worse).

What helps:

  • Making lifestyle changes to keep cool and avoid environmental and dietary triggers
  • Sticking to a healthy eating and exercise routine
  • Wellness therapies including cognitive behavior therapy, hypnosis and acupuncture
  • Supplements such as black cohosh
  • Hormone replacement therapy
  • Low-doses of antidepressant, anti-seizure or other medications
3. Night sweats

Night sweats are simply hot flashes that happen at night. They can wake you from a sound sleep, drenched in sweat and kicking off covers for relief. Just like hot flashes, 75% of menopausal women experience night sweats and symptoms last five to seven years, or  longer.

Aside from the obvious annoyance of hot flashes, long-term sleep disruption lowers your overall quality of life and raises your risk for multiple diseases.

What helps:

  • Choosing breathable bedding and pajamas and keeping your bedroom extra cool
  • Incorporating deep breathing and relaxation in your daily routine
  • Wellness therapies including cognitive behavior therapy, hypnosis and acupuncture
  • Hormone replacement therapy
  • Low-dose antidepressant, anti-seizure or other medications
4. Sleep disturbance

Difficulty sleeping affects 61% of menopausal women, and for those who experience hot flashes, nearly 44% suffer from chronic insomnia (anxiety and night sweats are one culprit there).

Missing out on the rest your body needs isn’t just a matter of dragging a little the next day. Ongoing sleep problems contribute to a wide range of health problems including cardiovascular diseases, obesity and mental health disorders. The most important thing to remember is that you don’t have to settle for subpar sleep—and you shouldn’t, because effective solutions exist.

What helps:

  • Establishing an exercise routine and keeping active through the day
  • Avoiding caffeine in late afternoon
  • cognitive behavior therapy
  • Hormone replacement therapy
  • Some non-hormonal prescription meds, given in low doses (eg, Gabapentin)
  • Sedative-hypnotic agents such as sleeping pills for short term use
5. Mood changes and Irritability

Life throws a lot at us, so there’s often good reason to feel testy. As many as 70% of women deal with emotional fluctuations through the menopause transition.  That can include overwhelming reactions to everyday events, ranging from tiredness to tears to full-blown rage. Another 25% of women notice increased mood swings that can range from mild to severe.

What’s going on, from a hormonal perspective? It comes back to estrogen, which affects the production of serotonin, the hormone responsible for mood stabilization, feelings of well being and happiness (it’s also known as the “happy hormone,” for good reason). When estrogen fluctuates and declines, serotonin follows a similar path, and your emotions roller coaster with it. And don’t forget lack of sleep and fatigue due to other symptoms, which can also make you emotionally volatile.

What helps:

  • Incorporating stress management techniques and finding healthy outlets for emotions, including meditation and therapy
  • Making time for hobbies, friend-time, and basic self-care in your daily routine
  • Healthy lifestyle habits and changes: exercising regularly, eating a nutritious diet, and incorporating stress management techniques
  • Wellness therapies including cognitive behavior therapy (studies even support the use of hypnosis and acupuncture)
  • SSRI and SNRI (selective serotonin reuptake inhibitors & serotonin and norepinephrine reuptake inhibitors, respectively)
6. Vaginal dryness

Estrogen helps to keep the skin all over your body, but especially in the vaginal area, strong and well moisturized. So a decrease in estrogen means less vaginal lubrication, which may lead to dryness, thinning of the vaginal walls and less elasticity. Vaginal atrophy might also affect the urinary system leading to urinary tract infections (UTIs) and stress incontinence. All of this helps explain why fully half of menopausal women struggle with pain during intercourse.

What helps:

  • Water-soluble lubricants
  • Plant based lubricants like coconut oil suppositories
  • Prescription estrogen applied directly to the vagina in the form of creams, pills, or vaginal rings
7. Decreased libido

Estrogen is directly connected to sex drive, so it’s no surprise that as the hormone dwindles during perimenopause and menopause, libido may drop along with it.  And the mood changes, sleep disturbances and painful sex we’ve discussed take a toll on your desire for sex as well. The decline is more pronounced for women whose ovaries have been removed before menopause, but overall, around 77% of postmenopausal women report low sex drive.

What helps:

  • Sex therapy and counselling
  • Medication such as bupropion
  • Hormone replacement therapy
8. Difficulty concentrating

If you’re in the menopause transition and struggle to stay focused, or notice other issues with cognition, you’re in good company: 60% of women report difficulty concentrating, and many say it complicates their work and home lives.

The root cause relates to dropping estrogen levels, which affects brain function. Estrogen supports activity in the hippocampus, which plays a vital role in processing information. With less of it, concentration and learning may suffer, along with memory (keep reading for more on that).

What helps:

  • Finding healthy ways to cope with stress
  • Limiting alcohol and caffeine
  • Exploring ways to improve mental function through diet or a new hobby
  • Hormone replacement therapy  
9. Memory lapses

Losing your keys or phone happens to all of us (pretty much daily), but memory glitches can become even more frequent during perimenopause. About 60% of menopausal women report brain fog, described as difficulty remembering details—from names to appointments to common words. And yes, the same brain/estrogen connection that undermines concentration  is at work here, too.

Brain fog is frightening, and drives plenty of women to google early Alzheimer’s, but remember that it tends to go away after menopause once hormone levels stabilize.

What helps:

  • Eating a healthy diet, prioritizing sleep, and exercising
  • Activities and games that keep the mind active have been shown to strengthen memory and cognition, and bolster for your overall health
  • Hormone replacement therapy
10. Bone loss

Estrogen plays an important role in maintaining bone strength and density, by promoting the activity of osteoblasts—the cells responsible for new bone formation. Estrogen decrease during the menopause transition, along with the wear and tear of aging, may cause osteoporosis, or, essentially, weakened bones. On average, women lose up to 10% of their bone mass in the first five years after menopause. As a result, 1 in 10 post-menopausal women are affected by osteoporosis worldwide. The loss of bone mass and strength usually occurs without symptoms, but in time causes muscle pain and spasm, increased risk of fractures, and decreased mobility and function.

What helps:

11. Skin changes

Remember acne and other skin issues you left behind in your teen years? Well, they might be back now that your hormones are all over the place. As estrogen levels plummet, your skin loses collagen and elastin, the building blocks of your skin that keep it structured and resilient. Estrogen also plays a role in sebum production and oil gland maintenance which keeps the skin lubricated. As this study points out, “estrogen insufficiency decreases defense against oxidative stress; skin becomes thinner with less collagen, decreased elasticity, increased wrinkling.” Moreover, as estrogen declines, it no longer balances out other hormones, called androgens, which leads to teenage-like acne for some women.

What helps:

  • Apply sunscreen every day
  • Moisturize, moisturize, moisturize
  • Use skin care products that contain peptides or retinol (these stimulate collagen production)
  • Use a cleanser with salicylic acid if you are having breakouts
  • Eat a diet rich in plant based foods that are high in antioxidants (brightly colored vegetables and fruits are good sources) as they help clear skin and reduce inflammation.
  • See your dermatologist regularly
  • Hormone Therapy
12. Weight gain

Waning estrogen, rising FSH (follicle stimulating hormone, another female hormone involved with the reproductive system), as well as increased age, and other menopausal symptoms such as poor sleep all contribute to metabolism slowing down about 5-10% each decade. As a result, women gain about 1.5 pounds per year during their post-menopausal years. Hormonal changes also affect fat distribution and body composition, so weight gain concentrates in the upper body, particularly the abdomen.

What helps:

  • Stepped-up exercise: at least 150 minutes of aerobic activity weekly, plus muscle-building activity at least two days a week
  • Eating a diet focused on whole foods, limiting carbs, and cutting way back on sugar

These are the most common symptoms of hormone transition, but there are many more, ranging from breast soreness to headaches to hair loss. Get familiar with those, too, so you can report them to your doctor or Midi clinician and collaborate to feel better, no matter what you’re experiencing.

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