Symptoms of Menopause

Menopause is an individualized experience. Some women notice little difference in their bodies or moods, while others find the change extremely bothersome and disruptive. Estrogen and progesterone affect virtually all tissues in the body, but everyone is influenced by them differently.

Hot Flashes

Hot flashes, or flushes, are the most common symptom of menopause, affecting more than 60 percent of menopausal women in the United States. A hot flash is a sudden sensation of intense heat in the upper part or all of the body. The face and neck may become flushed, with red blotches appearing on the chest, back, and arms. This is often followed by profuse sweating and then cold shivering as body temperature readjusts. A hot flash can last a few moments or 30 minutes or longer.

Hot flashes occur sporadically and often start several years before other signs of menopause. They gradually decline in frequency and intensity as you age. Eighty percent of all women with hot flashes have them for 2 years or less, while a small percentage have them for more than 5 years. Hot flashes can happen at any time. They can be as mild as a light blush, or severe enough to wake you from a deep sleep. Some women even develop insomnia. Others have experienced that caffeine, alcohol, hot drinks, spicy foods, and stressful or frightening events can sometimes trigger a hot flash. However, avoiding these triggers will not necessarily prevent all episodes.

Hot flashes appear to be a direct result of decreasing estrogen levels. In response to falling estrogen levels, your glands release higher amounts of other hormones that affect the brain's thermostat, causing body temperatures to fluctuate. Hormone therapy relieves the discomfort of hot flashes in most cases.

Some women claim that vitamin E offers minor relief, although there has never been a study to confirm it. Aside from hormone therapy, which is not for everyone, here are some suggestions for coping with hot flashes:

• Dress in layers so you can remove them at the first sign of a flash.
• Drink a glass of cold water or juice at the onset of a flash.
• At night keep a thermos of ice water or an ice pack by your bed.
• Use cotton sheets, lingerie and clothing to let your skin "breathe."

Vaginal/Urinary Tract Changes

With advancing age, the walls of the vagina become thinner, dryer, less elastic and more vulnerable to infection. These changes can make sexual intercourse uncomfortable or painful. Most women find it helpful to lubricate the vagina. Water-soluble lubricants are preferable, as they help reduce the chance of infection. Try to avoid petroleum jelly; many women are allergic, and it damages condoms. Be sure to see your gynecologist if problems persist.

Tissues in the urinary tract also change with age, sometimes leaving women more susceptible to involuntary loss of urine (incontinence), particularly if certain chronic illnesses or urinary infections are also present. Exercise, coughing, laughing, lifting heavy objects or similar movements that put pressure on the bladder may cause small amounts of urine to leak. Lack of regular physical exercise may contribute to this condition. It's important to know, however, that incontinence is not a normal part of aging, to be masked by using adult diapers. Rather, it is usually a treatable condition that warrants medical evaluation. Recent research has shown that bladder training is a simple and effective treatment for most cases of incontinence and is less expensive and safer than medication or surgery.

Within 4 or 5 years after the final menstrual period, there is an increased chance of vaginal and urinary tract infections. If symptoms such as painful or overly frequent urination occur, consult your doctor. Infections are easily treated with antibiotics, but often tend to recur. To help prevent these infections, urinate before and after intercourse, be sure your bladder is not full for long periods, drink plenty of fluids, and keep your genital area clean. Douching is not thought to be effective in preventing infection.

Menopause and Mental Health

A popular myth pictures the menopausal woman shifting from raging, angry moods into depressive, doleful slumps with no apparent reason or warning. However, a study by psychologists at the University of Pittsburgh suggests that menopause does not cause unpredictable mood swings, depression, or even stress in most women.

In fact, it may even improve mental health for some. This gives further support to the idea that menopause is not necessarily a negative experience. The Pittsburgh study looked at three different groups of women: menstruating, menopausal with no treatment, and menopausal on hormone therapy. The study showed that the menopausal women suffered no more anxiety, depression, anger, nervousness or feelings of stress than the group of menstruating women in the same age range. In addition, although more hot flashes were reported by the menopausal women not taking hormones, surprisingly they had better overall mental health than the other two groups. The women taking hormones worried more about their bodies and were somewhat more depressed.

However, this could be caused by the hormones themselves. It's also possible that women who voluntarily take hormones tend to be more conscious of their bodies in the first place. The researchers caution that their study includes only healthy women, so results may apply only to them. Other studies show that women already taking hormones who are experiencing mood or behavioral problems sometimes respond well to a change in dosage or type of estrogen.

Studies indicate that women of childbearing age, particularly those with young children at home, tend to report more emotional problems than women of other ages.

The Pittsburgh findings are supported by a New England Research Institute study which found that menopausal women were no more depressed than the general population: about 10 percent are occasionally depressed and 5 percent are persistently depressed. The exception is women who undergo surgical menopause. Their depression rate is reportedly double that of women who have a natural menopause.

Studies also have indicated that many cases of depression relate more to life stresses or "mid-life crises" than to menopause. Such stresses include an alteration in family roles, as when your children are grown and move out of the house, no longer "needing" mom; a changing social support network, which may happen after a divorce if you no longer socialize with friends you met through your husband; interpersonal losses, as when a parent, spouse or other close relative dies; and your own aging and the beginning of physical illness. People have very different responses to stress and crisis. Your best friend's response may be negative, leaving her open to emotional distress and depression, while yours is positive, resulting in achievement of your goals. For many women, this stage of life can actually be a period of enormous freedom.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.