Menopause - Indications and Signs

Indications and Signs

During the menopause transition years, as the body responds to the rapidly fluctuating and dropping levels of natural hormones, a number of effects may appear. Not every woman experiences bothersome levels of these effects; the range of effects and the degree to which they appear is very variable from person to person.

Effects that are due to low estrogen levels (for example vaginal atrophy and skin drying) will continue after the menopause transition years are over; however, many effects that are caused by the extreme fluctuations in hormone levels (for example hot flashes and mood changes) usually disappear or improve significantly once the perimenopause transition is completely over. All the various possible perimenopause effects are caused by an overall drop, as well as dramatic but erratic fluctuations, in the absolute levels and relative levels of estrogens and progesterone. Effects such as formication (crawling, itching, or tingling skin sensations), may be associated directly with hormone withdrawal.

Both users and non-users of hormone replacement therapy identify lack of energy as the most frequent and distressing effect. Other effects can include vasomotor symptoms such as hot flashes and palpitations, psychological effects such as depression, anxiety, irritability, mood swings, memory problems and lack of concentration, and atrophic effects such as vaginal dryness and urgency of urination.

The average woman also has increasingly erratic menstrual periods, due to skipped ovulations. Typically, the timing of the flow becomes unpredictable. In addition the duration of the flow may be considerably shorter or longer than normal, and the flow itself may be significantly heavier or lighter than was previously the case, including sometimes long episodes of spotting. Early in the process it is not uncommon to have some 2-week cycles. Further into the process it is common to skip periods for months at a time, and these skipped periods may be followed by a heavier period. The number of skipped periods in a row often increases as the time of last period approaches. At the point when a woman of menopausal age has had no periods or spotting for 12 months, she is considered to be one year into post-menopause.

One way of assessing the impact on women of some of these menopause effects is the Greene Climacteric Scale questionnaire.

Vascular instability

• Hot flashes or hot flushes, including night sweats and, in a few people, cold flashes
• Possible but contentious increased risk of atherosclerosis
• Migraine
• Rapid heartbeat

Urogenital atrophy, also known as vaginal atrophy

• Thinning of the membranes of the vulva, the vagina, the cervix, and also the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas.
• Itching
• Dryness
• Bleeding
• Watery discharge
• Urinary frequency
• Urinary incontinence
• Urinary urgency
• Increased susceptibility to inflammation and infection, for example vaginal candidiasis, and urinary tract infections

Skeletal

• Back pain
• Joint pain, Muscle pain
• Osteopenia and the risk of osteoporosis gradually developing over time

Skin, soft tissue

• Breast atrophy
• breast tenderness ± swelling
• Decreased elasticity of the skin
• Formication (itching, tingling, burning, pins and needles, or sensation of ants crawling on or under the skin)
• Skin thinning and becoming drier

Psychological

• Depression and/or anxiety
• Fatigue
• Irritability
• Memory loss, and problems with concentration
• Mood disturbance
• Sleep disturbances, poor quality sleep, light sleep, insomnia and sleepiness

Sexual

• Dyspareunia or painful intercourse
• Decreased libido
• Problems reaching orgasm
• Vaginal dryness and vaginal atrophy

Cohort studies have reached mixed conclusions about medical conditions associated with the menopause. For example, a 2007 study found that menopause was associated with hot flashes; joint pain and muscle pain; and depressed mood. In the same study, it appeared that menopause was not associated with poor sleep, decreased libido, and vaginal dryness. However, in contrast to this, a 2008 study did find an association with poor sleep quality.