Menopause Overview

Some Menopausal Symptoms Explained:

A combination of altered hormone levels due to various factors can lead to short term symptoms and long term health problems. These symptoms are explained in more detail below:

• Vaso-motor symptoms (adrenaline surges): These are commonly known as hot flushes and night sweats as the blood vessels dilate. The heart rate increases (palpitations), and body temperature control becomes erratic. Palpitations may be associated with panic feelings due to the increased adrenaline drive. If these occur whilst asleep, then deep sleep will be interrupted. The individual will sleep lightly or badly all night, waking to feel unrefreshed and exhausted and may report vivid dreams due to remaining in a state of semi-wakeful, restless dreaming sleep or REM sleep (rapid eye movement sleep REM) rather than going through the normal cycle of light (REM) sleep and deep (non-REM) non-dreaming sleep.

• Psychological symptoms (mood): These include persistent tiredness, often worst in the morning due to the absence of normal cyclical sleep, especially due to reduced non-dreaming sleep. A tell-tale sign is an increased difficulty in ‘getting going’, feeling depressed or low first thing in the morning. This then re-occurs mid to late afternoon as cortisol levels gradually and naturally decline. Profound lack of energy, motivation and drive is also associated with this.  Previous tasks that seemed straightforward now become monumentally difficult. Short term memory and especially ‘word-blindness’ occur with an increasing inability to concentrate.

• Negative feelings: These occur with loss of self-worth and self-esteem and occasionally agoraphobia and claustrophobia. Sudden mood changes can occur as tolerance levels are deficient. This ‘flying off the handle’ may be out of character or exacerbate previously existing characteristics, with minimal control of the situation.

• Clumsiness: This is caused to do reduced reaction time, and the lack of ability to judge distance can occur with a woolly ‘out of body’ feeling. Many of these so-called psychological symptoms have been attributed to the known reduction of blood flow to the brain during oestrogen deprivation as the blood vessels constrict. However, there is increasing evidence that chronic sleep disturbance may be responsible even if it is not obvious that sleep quality is impaired.

• Bladder symptoms: The bladder’s base, where the nerve endings arise, is sensitive to hormone changes, becoming more irritable and less able to hold large volumes of urine than previously. The symptoms include urgency, frequency and getting up at night to pass urine, so-called Urethral syndrome. Stress incontinence has also been observed to worsen at low sex hormone production in men and women. In women especially, the symptoms worsen pre-menstrually, and as connective tissue becomes weak at that time, prolapse worsens due to the weakening of the pelvic floor muscles. In women, local oestrogen treatment (creams, pessaries, rings) can be used to improve the area’s strength and health even if hormone replacement therapy is already being taken.

• Bowel-related symptoms:  The muscular layer of the bowel wall is sensitive to sex hormones, and lack of oestrogen in females stops the gut’s muscular contractions so preventing the bowel from moving matter forward. Therefore, the bowel distends and becomes bloated and full of gas, which can be excruciatingly painful. Eventually, the bowel will contract in reaction to the increased diameter, and this will cause spasm and further pain. As the faecal matter is not moving forward, it remains in the bowel and water is absorbed from it so that it becomes harder and therefore even more difficult to move forward. Early morning or, indeed, constant nausea may occur along with a metallic taste in the mouth and constipation and occasional diarrhoea (IBS – Irritable Bowel Syndrome). Many individuals experience a marked increase in bowel-related symptoms after carbohydrate or sugar load, which may be perceived as being due to allergy to a particular food product. Instigating changes such as reducing some carbohydrates, especially wheat, can affect the hormone profile leading to improved bowel symptoms.

• Connective tissues: Oestrogen and testosterone both impact connective tissue, and when their levels decline, symptoms may occur, including joint pains after resting, dry mucous membranes (eyes, mouth, nose, ears, vagina), and this may also have an impact on connective tissue throughout the body (loss of hair, dry skin, itchy skin, brittle nails). Reduced connective tissue (collagen) in the pelvic floor also increases the risk of prolapse, even in young women. In women who have undergone vaginal repair, recurrence of prolapse will occur if the strength of the vaginal skin and muscle is not maintained. While many of these symptoms can be improved with hormone replacement, dietary changes are as important.

• Blood vessel effects: The blood vessel muscular wall is also susceptible to hormone levels which, if reduced, can lead to spasm of the vessel, and this, in turn, can result in deprivation of oxygen and nutrients to the tissue normally supplied by that blood vessel. Headaches and migraines will, therefore, often worsen at times of relative low hormone production. In females, this is most common pre-menstrually. During the menstrual cycle, it often occurs more commonly during reduced ovulation, such as PCOS and during perimenopause and after menopause. Cramp-like chest pains may occur (males and females) even when the blood vessels are otherwise healthy due to constriction of the vessel supplying the heart muscle, and leg cramps or restless legs can also occur for the same reason and often at the same time. Often a hot flush or panic feeling will be accompanied by a profound headache indicating hormonal dysfunction at the time.