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It is entirely natural for the production of our hormones, namely progesterone, estrogen, and testosterone, to decrease with age. For example, testosterone decreases by 50% between the ages of 20 and 50. During the menopause transition (MT), these changing hormone levels can affect everything from your menstrual cycle and quality of sleep to your mood and weight. Many varying symptoms are likely to develop as a woman moves closer to menopause, and the onset of these often uncomfortable changes can be overwhelming.
Fortunately, you can improve your menopause symptoms via lifestyle adjustments, as well as by introducing menopause medication. This article will define and discuss some of the most prominent symptoms of menopause, identify ways to find relief, and introduce you to a highly effective treatment: Hormone Replacement Therapy (HRT).
Common menopause symptoms
The MT comprises the phases of perimenopause and menopause. Menopause is the point at which a woman has gone 12 months without a period, but the stage before menopause - when many symptoms begin - is called perimenopause; a woman can be perimenopausal for between 7-10 years.
On average, women reach menopause at the age of 51, but the MT can begin in the late 30s and early 40s. Most women experience their own unique set of symptoms and the severity of those symptoms varies widely.(1,2)
The most common symptoms include the following:
Anxiety, mood changes, and depression
Vaginal dryness and irritation
Urinary incontinence (UI)
Urinary tract infections (UTIs)
Discomfort or pain during sex
Sleep problems, including sleep apnea
Hair and skin changes (dryness)
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1. Weight Gain
Through their reproductive years, it is common for women to notice weight gain around their hips and thighs. However, during the MT, women tend to gain weight around their abdomen and upper back. This shift in a fat deposit is due to hormone imbalances that result from decreasing hormone production. Excess weight around the midsection is called “visceral fat,” and it can be exacerbated by depression, stress, poor sleep, smoking, and excess intake of beverages sweetened with fructose.
Hormonal weight gain of this kind can have serious health implications. Visceral fat creates inflammation and increases insulin resistance, and it can put a woman at higher risk for the following:
High blood pressure
Cancers, specifically colon, breast, uterine, esophageal, kidney, and pancreatic.4
Type 2 diabetes
While there are many factors that can affect weight gain, for women going through their MT, the shift in hormones is the most influential factor.
2. Brain fog, anxiety, mood changes, fatigue, and depression
The hormone fluctuations in perimenopause and menopause can create a feeling of being out of control. Women often feel more irritable and may experience heightened anxiety, fatigue, and brain fog.
Exercise and good nutrition go a long way in improving some of these mood changes. Incorporating relaxation and stress-reduction techniques into your daily routine may also be beneficial in balancing your system. That being said, mood issues should not be taken lightly. Because depression can increase with perimenopause and menopause, it is important to talk to your healthcare provider to identify the cause and severity of your depression. They can help you to decide on the most appropriate intervention. Prescription antidepressant medications may be appropriate to correct a chemical imbalance.
3. Urinary Incontinence and UTIs
When estrogen, progesterone, and testosterone levels start to decline sharply during perimenopause, the urinary tract and bladder are both impacted. Specifically, as estrogen levels decrease, the bladder begins to lose both its volume and elasticity; this necessitates more frequent trips to the bathroom and increases the possibility of urinary incontinence (UI) (leaks). The urethra is also susceptible to losing volume, and with thinner urethral walls, it is easier for bacteria to access the bladder and increase the likelihood of urinary tract infections (UTIs). In turn, UTIs can also contribute to UI.
The following are suggested changes you can make to your routine that help decrease the risk of UI:
Avoid alcohol and carbonated or caffeinated drinks like coffee, tea, and soda, which may irritate the bladder. These beverages fill your bladder quickly and may induce the urge to use the bathroom more often.2
Avoid foods with a high acid content, including grapefruit, oranges, and tomatoes.
Drink more water to keep urine diluted (pale yellow).
Limit your beverages before bed to avoid leaking and the need for frequent trips to the bathroom during the night.
Eat a high-fiber diet to avoid constipation.
Maintain a healthy weight - extra weight, especially around your abdomen, increases pressure on your bladder.
Try Kegel exercises to strengthen your pelvic floor muscles.
Be aware that certain medications like steroids and diuretics can cause UI.
4. Vaginal Dryness and Irritation
The MT can be accompanied by a series of very uncomfortable vaginal changes. If you notice changes in your vagina, including dryness, tenderness, and painful intercourse, you are not alone.
Vaginal and Vulvar Atrophy (VVA), also known as genitourinary syndrome of menopause (GSM), is likely what you are experiencing. VVA and/or GSM is the thinning, drying, and inflammation of the vaginal wall brought about by decreasing estrogen levels, and it makes vaginal tissue less elastic and more fragile.
VVA/GSM is a prevalent, chronic, progressive, and painful condition. Unlike hot flashes that tend to get better as you move through the MT, vaginal atrophy only gets worse. It affects more than half of all menopausal women in the US, yet the majority are unaware that it is a treatable condition.
Estrogen not only plays a critical role in vaginal health but also in a woman's sexual health. As a result of VVA/GSM, one-third of women will experience vaginal itch, dryness, irritation, and even pain during sex (dyspareunia).8
Vaginal dryness, while uncomfortable, is rarely serious, and there are some simple ways you can improve your experience:
Vitamins A, B, and E may help promote natural lubrication and can be found in vegetables, nuts, seeds, and healthy fats.
Hyaluronic acid is a molecule found naturally in your skin that helps retain moisture. It can relieve vaginal dryness when used as a topical gel.
Exercise, a balanced diet, and sufficient sleep will all help improve vaginal irritation and dryness.
If a yeast infection is the cause of vaginal irritations, OTC treatments should help relieve symptoms quickly.
Refrain from douching.
Avoid vaginal products that contain perfumes, herbal extracts, or artificial colors, which can cause irritation and contact dermatitis.
Be aware that while sexually transmitted infections don't always cause vaginal itching or dryness, those symptoms may be an indication that one is active.
Over-the-counter lubricants can be applied to the vaginal area to reduce dryness and discomfort and change the vagina's pH, decreasing the likelihood of getting a UTI. However, some store-bought lubricants can dry out the vagina, even more, so be sure to look for lubes that promote vaginal hydration.
5. Hot Flashes and Night Sweats
Another undesired effect of decreasing hormone production is the dysregulation of your body’s thermostat. Your body temperature may be normal, but your thermostat needs recalibration. The result is a hot flash: your body sends a burst of cooling to regulate your temperature. Hot flashes, or vasomotor symptoms, are the most commonly reported symptom of perimenopause. A hot flash typically comes on rapidly and lasts from 1-10 minutes. Women can experience hot flashes a few times a week or up to ten times a day.
Hot flashes while sleeping are referred to as night sweats; they may soak your nightclothes or bedding and are a significant obstacle to getting a good night's sleep. Regular night sweats can create an endless fatigue cycle. Getting enough sleep (7 to 8.5 hours every night) is critical to reducing stress, which in turn helps to reduce perimenopausal and menopausal symptoms.
The following is guidance that may help control your hot flashes:
Caffeine can trigger hot flashes, so try to limit the amount of coffee and caffeinated soda that you consume. If giving them up altogether is too hard, try not to intake caffeine past noon.
The serotonin and caffeine in chocolate can affect the brain's temperature control center. But rather than giving it up, extra dark chocolate is a better choice.
The spices in some of our favorite foods raise body temperature and can induce hot flashes, so try ordering “mild” instead.
Hot Foods and liquids trigger hot flashes, so limit them when you can.
Drinking alcohol regularly, especially red wine, can increase the number and intensity of hot flashes, and drinking alcohol too close to bedtime can bring about night sweats. Try limiting the amount of alcohol you consume and when you do so.
Drinking water at the onset of a hot flash can lessen the discomfort for some women.
Many factors contribute to headaches; however, women often notice a relationship between headaches and hormonal changes, especially during perimenopause and menopause. The decrease in estrogen and progesterone during the MT can affect headache-related chemicals in the brain and lead to sometimes quite severe headaches. 7. Trouble Sleeping
Menopause and sleep problems often go hand-in-hand. You're not alone if you are going through menopause and are experiencing night sweats, insomnia, or sleep apnea.
Only about 12% of women in their 20s and early 30s will report sleep problems, but these increase with age. Approximately 40% of women in their late 40s and early 50s will struggle with serious sleep problems. Women report the most sleep problems during perimenopause, menopause, and postmenopause - a 20-year timespan on average.
The hormonal decreases involved in the MT often contribute to sleep issues that can continue for decades. Fans, cooling pillows, and white noise machines are all great options to improve sleep, and it can be helpful to establish a regular sleep schedule and routine:(1,2)
Wake up and go to bed at consistent times, even on weekends.
Before sleep, relax and wind down by reading a book, listening to music, or taking a leisurely bath.
Consume tryptophan by way of milk or peanuts or drink a cup of tea to help the body relax.
Keep bedroom light, noise, and temperature at a comfortable level; dark, quiet, and cool are conditions that support sleep.
Use the bedroom only for sleep and sex.
Avoid caffeine and alcohol late in the day.
8. Hair and Skin Changes
The decrease in hormones in estrogen, progesterone, and testosterone from your MT likely begins long before you even think about menopause, and the deficit can accelerate aging-related changes in the skin. The imbalances can also result in hair loss as women age and progress through the MT and into postmenopause.
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Hormone Replacement Therapy
While implementing lifestyle changes can absolutely improve your experience with perimenopausal and menopausal symptoms, the fact remains that your body has ceased to produce the levels of hormones it once did, and this is the underlying reason for those myriad undesired symptoms. Hormone Replacement Therapy (HRT) is a treatment that directly addresses the hormone deficits that accompany the MT. HRT uses bioidentical hormones to make up for what your body is not producing, and it is actually effective at preventing, treating, and reversing the symptoms discussed above.(3,5)
Here are some of the ways HRT can help the symptoms we’ve explored:
HRT regulates hormone-induced weight gain, and menopausal women taking HRT tend to have less body fat (particularly less abdominal fat).5 A thorough review of hormones and how HRT can help normalize hormone levels is presented HERE.
HRT works to treat mood changes and depression brought about by hormone imbalance.
Using HRT to increase estrogen to its desired level can reduce the impact that hormone decreases have on your urinary tract and vagina.
Estrogen replacement - by way of pills, skin patches, or creams, can return the vaginal lining to a state of youthful thickness, elasticity, and natural lubrication.
HRT reduces night sweats more effectively than any other treatment, allowing for restful sleep, decreased anxiety, and weight loss.3
Normalizing hormone levels through HRT can improve hormone-induced headaches.
Restoring hormone levels with HRT can improve unwanted changes to hair and skin.
Perimenopausal and menopausal women can take the experience of their MT into their own hands by implementing changes to their lifestyle and routine. However, the root cause of their symptoms is biological, and failing to address it will likely adversely impact their quality of life. Using menopause medication like HRT can provide lasting relief as it begins to correct the hormone deficits that are associated with this time of life. Balanced hormones mean fewer and less severe symptoms and the opportunity to regain control of your life.
Menopause itself cannot be reverse, Winona is here to provide you with alternatives to help address the resulting, often-chronic symptoms. Your symptoms can be improved with the help of professionals focused on providing proven treatments for you at this stage of life.
“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”
Wysocki S, Kingsberg S, Krychman M. Management of vaginal atrophy: implications from the REVIVE survey. Clin Med Insights Reprod Health. 2014;8:23-30.
Chen L, Ng M, van der Vlugt TH, Price PH, Orencia A. Statistical considerations for the efficacy assessment of clinical studies of vulvar and vaginal atrophy. Ther Innov Regul Sci. 2010;44(5):581-5881. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87-94.