Symptoms Before, During and After: The Menopause

Are you familiar with the symptoms of the Menopause?

Your body is unique, with its own hormone levels and interactions – the journey of the menopause is in 3 acts but the same players are centre stage in each; these are the female sex hormones oestrogen and progesterone. Each has multiple critical roles to play in keeping you healthy through your life journey, so it follows that a number of symptoms emerge as your body begins to naturally ‘withdraw’ from them around the age of 45-50.

Speaking strictly about the reproductive roles, oestrogen helps eggs in the ovary to prepare for ovulation (release into the uterus) and progesterone helps maintain the lining of the uterus ready to receive and nourish a fertilised egg. When an egg is released but not fertilised, signals are sent to stop the production of progesterone and allow the lining of the uterus to be shed from the body as a monthly period. This cycle is disrupted in menopause as hormone levels fluctuate out of sync.

These powerful hormones work in concert with many others to regulate far more than just your menstrual cycle. Let’s look at some common symptoms of menopause at each stage and how oestrogen and progesterone contribute to them:

Symptoms of perimenopause – Ages 45-55

Most women transition into menopause in their 40s but some may start later. You will usually start menopause at the same or similar age as your mother.

All women will experience a change in their periods and a drop in oestrogen and progesterone levels, to different degrees at different points in their transition. This is why the experience of

menopause is so unique to you.

1. A change in periods: As your progesterone levels fall, periods may become lighter, or you may have irregular heavy and light bleeding until they stop altogether. Periods may also become irregular with bleeding happening two or three weeks apart and then nothing for some months. This is normal, but you should seek medical advice should you find you develop very heavy and prolonged bleeding (>2 weeks) which is affecting your daily living.

2. Hot flashes and night sweats: The most common symptom is hot flashes, or night sweats when it happens during sleep. This happens because oestrogen, which usually lowers body temperature, is at much lower levels than before. Other hormones begin to act on the brain to help return body temperature to more consistent levels, but this can take up to 2 years to settle. Progesterone is also responsible for raising internal temperatures, so when this level is high it can also cause hot flashes.

3. Sweating and heart-related symptoms: With hot flashes can also come increased heart rate and perspiration. This is your body’s response to higher internal temperatures. It works to increase blood flow to the skin's surface so the heat can be lost in sweat. Some women can experience dizziness and palpitations (awareness of their heart beating suddenly) because of these changes in blood flow.

4. Brain fog, mood swings and irritability: Oestrogen is a neuroprotective (brain protecting) hormone which helps prevent inflammatory brain conditions such as Alzheimer’s by acting as an antioxidant in the brain. It also helps stimulate and maintain brain nerve connections. As the levels of oestrogen fall, you may experience some memory issues like forgetting where you left your keys, important dates, and that word that’s just on the tip of your tongue!

It can also cause anxiety, irritability and mood swings which can be worsened by the other symptoms of menopause we’ve mentioned above. For some women, there may be a knock-on effect of loss of oestrogen on other hormones, like serotonin, which can lead to anxiety and even depression. At times, the oestrogen levels can be much higher than progesterone leading to a condition called ‘oestrogen dominance’. In perimenopause, this can come about intermittently and unpredictably causing mood swings.

Androgens (male sex hormones like Testosterone) increase in the body, also leading to increased aggression and irritability. For some women, this can range from mild PMS-like (Pre-menstrual Syndrome) mood symptoms like irritability and anxiety to very severe PMDD-like mood symptoms (Pre-menstrual Dysphoric Syndrome) like anger and aggression.

These most common symptoms can be managed with HRT (Hormone Replacement Therapy).

Symptoms of menopause – Ages 50-55

For most women, symptoms of perimenopause settle within 3-5 years. After this, oestrogen and progesterone levels are consistently low and other hormones take over some of their functions. Periods have stopped completely by this point and a woman is said to have reached menopause when she has not had a period for 12 consecutive months.

Some additional symptoms may be experienced.

1. Skin and intimate dryness: This is most common in the post-menopause period (ages 55+) but some women may begin to notice this during the later stage of perimenopause or early menopause. Oestrogen helps produce collagen, hyaluronic acid and elastin in the skin while progesterone keeps the skin surface well-hydrated with oil and sebum production. Skin loses its elasticity and plumpness during the menopause. The loss of sex hormones can lead to dryness in the vulva as the glands responsible for keeping the area hydrated no longer work as they used to.

2. Changes to the vulva and vagina: Both hormones are responsible for keeping the vulva full, hydrated and healthy just as they do the skin. As the levels fall, the vulva begins to atrophy (shrink and change in size and shape) and you may experience itchiness, discomfort and loss of libido. It can also affect emptying your bladder as the urethra (channel connecting the bladder to the outside world) can change in shape and size leading to incontinence (leaking of urine). Some women may have constant dribbling while others may only lose bladder control when coughing or laughing.

Learn how you can manage and treat symptoms 1 and 2 here!

3. Changes to the uterus: Women who have had pregnancies, whether they deliver vaginally or by c-section, have an increased risk of uterine prolapse (dropping of the uterus into the vaginal canal). This is because the ligaments holding up the uterus become lax over time and this is accelerated as you go through menopause.

4. Hair thinning/loss: Hair growth is slowed and follicles are thinner as progesterone and oestrogen drop. Androgen levels (male sex hormones) rise which shrink the hair follicles leading to hair loss globally but most noticeably on the scalp. Hair loss and thinning can knock your confidence and seem very hard to treat, but there are options available. Click here to learn 4 ways to minimise or restore your hair loss (some you can even start right now).

5. Body-wide effects: At this point, we lose the heart, bone and brain-protecting functions of these hormones and we see a rise in risk of heart and blood vessel conditions, osteoporosis (bone density loss) and inflammatory brain conditions like Alzheimer’s. Some women may begin taking prescribed medication to mitigate these risks.

Interest in sex can also be heavily affected as the intimate area changes and mood and libido are impacted.

Symptoms of post-menopause (Ages 55+)

In the post-menopause period, things will have settled down in the body as hormones become more consistent. The above issues in the menopause period will continue and may need management to reduce their impact on your daily life.

Menopause means ‘menstrual pause’ – it doesn’t need to pause your life! There are many treatment and management options, both medical and non-medical, to help make the big ‘C’ Change into a gentler journey with smaller steps. Click the button below and fill out the form to learn about the treatment options available to relieve your symptoms with Dr Hala.

How Can I Manage My Menopause Symptoms?