Signs and SymptomsMenopause Signs and Symptoms

Elevated Heart Rate+-

Some women experience a racing heart or heart palpitations (a temporary increase in the heart rate) during menopause. Your heart rate can increase during a hot flash by as much as 8 to 16 beats per minute. Any change in the heart can be a sign of another underlying condition, such as a heart condition, so report any of these symptoms to your doctor. Manage irregular heartbeats and palpitations with these tips:

  • Reduce stress and anxiety: Both can ramp up your heart rate. Some stress in life is unavoidable, but too much can cause health problems.
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  • Limit salt in your diet: Sodium (salt) stimulates the heart and can raise blood pressure.
  • Limit caffeine and nicotine: If you drink coffee, tea, soft drinks, or other beverages that contain caffeine, keep them to a minimum and do not drink them close to bedtime. It will be helpful to also avoid foods that contain caffeine.
  • Limit your intake of alcohol.
  • Avoid stimulants in cough and cold medication or in herbal or nutritional supplements.
  • Hydration: It is important to maintain an adequate fluid intake, which is typically in the range of 2-2.5 L for a woman.

Hair Changes+-

Many women experience changes to their hair as they reach midlife, most commonly hair loss. Either stress and-or the body's decline in estrogen and progesterone hormones triggers an increase in the production of androgens. Androgens, a group of chemically related sex steroid hormones, that can shrink hair follicles, resulting in hair loss on the head. Some medications have side effects that include hair loss as well. There are many ways to counter hair loss. These can include:

  • Estrogen: Hormone therapy, when used for other menopausal symptoms like hot flashes and night sweats, can also improve hair loss, but it should not be used primarily for this purpose.
  • Healthy diet: What you eat (or don't eat) can affect the health of your hair. Make sure you're getting enough iron, protein, vitamin C, and vitamin B in your diet.
  • Herbal supplements: Many women have reported success in managing hair issues with specific herbal supplements and preparations.
  • Medications: Treatment depends on the type of hair loss, which could be due to hormonal changes, stress, nutritional deficiencies, or styling practices. If you are experiencing significant hair loss or if you think your medications may be the cause, talk to your healthcare provider. Don’t stop taking your medications until you’ve spoken with your doctor, as this could be dangerous for your health.

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Hot Flashes and Night Sweats +-

If you have hot flashes or night sweats, you are not alone—they are the most common symptoms of menopause and experienced by nearly three-fourths of women. These are also often the most bothersome symptoms, causing mood changes, sleep disruption, and a negative impact on a woman’s quality of life.

Thankfully, treatment is available. Options include:

  • Estrogen: Hormone therapy can treat many menopause symptoms, including hot flashes. Benefits and risks should be considered and evaluated with your doctor. See the section on Estrogen and Hormone Therapy.
  • Gabapentin: This medication works well at relieving hot flashes, especially those that occur during nighttime. Side effects can include dizziness and sleepiness.
  • SSRI and SNRI drugs: Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) like citalopram, paroxetine, venlafaxine, and escitalopram are mostly used as antidepressants, but also have proved to be effective in treating hot flashes and night sweats. They are prescribed at lower doses for menopause symptoms, making them easier to tolerate.

Curb hot flashes and night sweats by avoiding triggers like spicy food, alcohol, and smoking. Other options for managing hot flashes, including herbal supplements, deep breathing, hypnosis, and acupuncture, have not consistently demonstrated effectiveness.

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Irregular Menstrual Cycles+-

Perimenopause is the time during which you transition to menopause. It is normal to experience menstrual irregularities during this time. These may include missed periods, heavy periods, or shorter cycles. While some degree of irregularity and heavier bleeding is expected during perimenopause, if you have heavy vaginal bleeding, you should seek medical advice. You may need tests like pelvic ultrasonography to look for other causes of vaginal bleeding, such as fibroids. Even if the heavy bleeding is simply due to the hormonal fluctuations of perimenopause, you may need treatment such as low-dose birth control pills or a hormone-secreting Intrauterine Device or IUD.

Memory and Concentration Problems+-

You may have issues with memory loss and problems concentrating, particularly in perimenopause and during the first few years after menopause. Potential reasons for these problems include sleep disturbance, mood problems, and an independent effect of lack of estrogen on memory. Fortunately, these problems improve over time for most women. Treatments include:

  • Hormone therapy: Estrogen, when used for other menopausal symptoms like hot flashes and night sweats, can also improve memory and concentration problems, but it should not be used primarily for this purpose.
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  • Mental Activities: Doing things to challenge your brain is a great, healthy way to improve memory and concentration.

Mood Changes, Including Depression, Irritability, and Anxiety+-

Your treatment options for mood problems, including anxiety and depression, are much wider than they were in the past and include:

  • SSRI and SNRI drugs: Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) are primarily used as antidepressants, but they have proved to be effective in treating hot flashes as well.
  • Counseling: Talking with a professional therapist can be a very effective way of treating symptoms of mood disorders.
  • Estrogen: Hormone therapy can treat many menopause symptoms, including mood problems. However, the benefits and risks should be considered carefully. Hormone therapy is not recommended for treatment of mood disturbances alone but can be considered if you also have hot flashes and night sweats. Also, perimenopausal women who have persistent mood problems despite use of antidepressants can have a trial of hormone therapy to assess its benefit.
  • Exercise: Physical activity can improve your mood and reduce the stress that can trigger anxiety.

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Skin Changes+-

You may notice changes in your skin due to menopause. Dry, itchy, or slack skin is common, and some women report skin bumps or rashes as well. The decrease in estrogen production that comes with menopause plays a role in this. Estrogen stimulates the production of skin oils and skin collagen, while also affecting the body's ability to retain moisture. A decline in estrogen production reduces these benefits to the skin.

Other factors can also contribute to discomfort of the skin, including the thinning of skin tissues that occurs with age. Fortunately, dry skin is relatively easy to treat in most cases.

Sleep Disturbances or Insomnia+-

Sleep disturbances are common during perimenopause and after menopause and can significantly disrupt your life. Fortunately, there are some effective ways of handling these problems, including:

  • Change your bedtime habits: These changes can include wearing loose-fitting cotton bedclothes and keeping your bedroom cool and well-ventilated at night. Also, try to go to bed at the same time every night, and limit or avoid naps during the day.
  • Exercise regularly: Exercise helps encourage good sleep patterns. But avoid exercising too close to bedtime.
  • Limit spicy food and caffeine: This is especially important in the hours before bedtime.
  • Estrogen: Hormone therapy can treat many menopause symptoms, including sleep problems. However, the benefits and risks should be considered carefully. Hormone therapy is not recommended for treatment of sleep disturbances alone but can be considered if you are also having hot flashes and night sweats.
  • Prescription medications: If nothing else is helping you get the sleep you need, talk with your doctor about prescription medication options and their side effects.
  • Herbal supplements: Many women have reported success in managing sleep issues with specific herbal supplements and preparations.
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Urinary Tract Problems+-

Problems in the urinary tract can affect you in any stage of menopause. As estrogen levels decrease, the health of your urethra and bladder may also decline.

Stress incontinence is leakage due to pressure on the bladder in the setting of weakened pelvic floor muscles, which fail to prevent the urine from flowing. This happens at the time of increased pressure in the abdomen, for example, when laughing, coughing, straining, or running. Urge incontinence occurs when you have a sudden urge to urinate. The bladder muscles "squeeze" randomly and at the wrong times, leading to leakage. Working with a pelvic floor physical therapist, who specializes in pelvic floor retraining and relaxation exercises, can be beneficial in such situations.

Treatments include:

  • Kegel exercises: Kegel exercises strengthen the pelvic floor muscles and help you hold urine longer and urinate at prescribed times.
  • Limit caffeine and alcohol: Beverages and foods that contain caffeine and alcohol can contribute to urinary problems, including urinary urgency and incontinence.
  • Estrogen: Vaginal estrogen therapy can help improve urinary urgency and urge incontinence in postmenopausal women. However, it is not helpful for stress urinary incontinence.
  • Medications: Several medications, such as Tolterodine, Solifenacin, Fesoterodine, Oxybutynin, Mirabegron, or Oxybutynin can alleviate urinary issues. Their use should be considered if the above measures do not improve the urinary symptoms.

Vaginal Dryness and Painful Sexual Intercourse+-

A drop in estrogen levels from menopause can cause the vagina to become dryer and more fragile. The vaginal dryness usually becomes worse with a lack of sexual activity. Sex stimulates blood flow in the vagina and aids in the production of vaginal fluids. So, sex actually keeps the vagina lubricated and healthy. If you have these symptoms, the following treatment options are available:

  • Short-acting vaginal lubricants and moisturizers: These are over-the-counter products that are effective for the initial treatment of vaginal dryness. They are applied to vagina and vulva right before and during sexual activity. They serve to reduce friction and increase lubrication and comfort. They can be water-, silicone-, or oil-based. However, they are not as effective as vaginal estrogen, which thickens the vaginal lining. If you experience more severe vaginal dryness, you may require vaginal estrogen in addition to lubricants and moisturizers.
  • Long-acting vaginal lubricants: The longer acting than lubricants and are not timed with sexual activity. Rather, you can apply them to the vagina and vulva on a regular basis, typically every 1 to 3 days, depending on the severity of dryness and symptoms. Vaginal moisturizers stick to the lining of the vagina, allowing the tissues to retain moisture.
  • Low-dose vaginal estrogen: This is available in tablet, ring, gel capsule, or cream form. You might consider this treatment if you continue to experience vaginal dryness and pain with sexual intercourse despite the use of lubricants and moisturizers. Low-dose vaginal estrogen is not only effective for treatment of vaginal dryness but is safe for long-term use. It does not have the risks typically associated with systemic estrogen, including the risk of blood clots and breast cancer. Vaginal estrogen helps keep vaginal and urethral tissue from thinning. A small amount of vaginal estrogen gets absorbed into the body, but this should only be a concern if you have a history of breast cancer.
  • Vaginal DHEA suppositories: These are an effective treatment for vaginal dryness. Some experts argue that this may be an even safer option than vaginal estrogen in certain patient populations, for example, breast cancer survivors.
  • Estrogen: Hormone therapy can treat many menopause symptoms, including vaginal dryness.
  • Ospemefene: This medication is taken orally and reduces vaginal pain associated with intercourse. Side effects can include an increased risk of hot flashes, blood clots, stroke, and the growth of the lining of the uterus.

Weight Gain+-

Gaining weight is a problem for all people as they age. There are a variety of factors affecting how our weight changes as we get older. After menopause, women have a greater tendency to carry excess body fat in the midsection or around the belly area, particularly visceral fat, which is fat surrounding the abdominal organs. An increase in visceral fat is known to be a risk factor for multiple health conditions including hypertension, diabetes, and cardiovascular disease.